Sleep and Neurobehavioral Performance After Cleft Palate Repair

腭裂修复后的睡眠和神经行为表现

• 批准号: 7530706
• 负责人: LOUISE M O'BRIEN
• 金额: $ 19.31万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7530706
• 关键词: 10 year old; Accounting; Affect; Age; Air; Apnea; Attention; Behavior; Behavioral; Case Study; Child; Childhood; Classification; Cleaved cell; Cleft Lip; Cleft Palate; Clinical; Cognitive; Congenital Abnormality; Controlled Study; Data; Development; Diagnosis; Dose; Evaluation; Excision; Goals; Hyperactive behavior; Infant; Learning; Legal patent; Measurement; Measures; Medical; Michigan; Morbidity - disease rate; Mucocele; Neuropsychological Tests; Newborn Infant; Nose; Obstruction; Obstructive Sleep Apnea; Operative Surgical Procedures; Oral cavity; Outcome; Parents; Performance; Polysomnography; Problem behavior; Recruitment Activity; Reporting; Research; Research Design; Research Personnel; Resistance; Risk; Robin bird; Schools; Severities; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Soft Palate; Speech; Symptoms; Testing; Time; Uncontrolled Study; United States; Universities; behavior rating scale; craniofacial; esophagus pressure; high risk; impression; improved; inattention; innovation; instrument; malformation; multidisciplinary; neurobehavioral; neuropsychological; orofacial; palate repair; programs; prospective; public health relevance; repaired; response

DESCRIPTION (provided by applicant): Cleft palate is a highly prevalent craniofacial malformation that affects approximately one in 700 newborns in the U.S. Studies on small numbers of children have raised the concern that repair of the cleft palate increases later risk for obstructive sleep apnea (OSA). However, the extent to which children who have had cleft palate repair have an increased risk for OSA has not been well defined. The issue is important because OSA is associated with significant morbidity, including behavioral problems, learning difficulties, and poor school performance, all of which may improve when the sleep disorder is treated. Furthermore, anecdotal reports and clinical impressions suggest that children with cleft palate repairs, in the absence of other medical conditions, are at high risk for neuropsychological problems. The possibility that OSA could be the underlying cause has never been studied. The main goal of the proposed research, therefore, is to examine the relationships between cleft palate repair, OSA, and neuropsychological problems in children. The investigators will recruit 40 children with previous cleft palate repair who are attending the multidisciplinary Craniofacial Anomalies Program at the University of Michigan. In addition, 40 children of similar ages with previous repair of cleft lip only, excision of a mucocele, or a frenulectomy will be recruited to serve as controls. All children will undergo nocturnal polysomnography followed by neuropsychological testing. Specific Aim 1 will determine whether OSA is more prominent among children with past repair of cleft palate rather than controls. Aim 2 will assess whether children with cleft palate repairs have more prominent neuropsychological problems, especially in attention and activity levels, two domains most sensitive to effects of OSA. Aim 3 will test whether measures of OSA may explain some neuropsychological measures in children with cleft palate repair, to demonstrate for the first time that undiagnosed OSA could underlie adverse neuropsychological morbidity. Results will highlight the importance of attention to the upper airway years after repair of cleft palate, suggest a mechanism to explain ongoing neuropsychological morbidity in these children, and provide data necessary to justify larger and more definitive studies of the potential unintended impact of cleft palate repair. PUBLIC HEALTH RELEVANCE: Cleft palate is a common birth defect affecting about 1 in 700 children in the US. We believe that the behavioral problems reported in these children may be due to undiagnosed sleep apnea, a condition common in children with other medical problems. Results from this study could help to focus the attention of clinicians on a common sleep disorder that may be ignored in these children but which may improve their behavioral problems if diagnosed and treated.

描述（由申请人提供）：腭裂是一种非常普遍的颅面畸形，在美国大约有七百个新生儿中就有一个受到影响。对少数儿童的研究引起了人们的关注，即腭裂修复会增加以后患阻塞性睡眠呼吸暂停 (OSA) 的风险。然而，接受过腭裂修复的儿童患 OSA 的风险增加的程度尚未明确。这个问题很重要，因为 OSA 与严重的发病率相关，包括行为问题、学习困难和学习成绩差，所有这些在睡眠障碍得到治疗后都可能得到改善。此外，轶事报告和临床印象表明，在没有其他医疗条件的情况下，进行腭裂修复的儿童出现神经心理问题的风险很高。 OSA 可能是根本原因的可能性从未被研究过。因此，本研究的主要目标是检查腭裂修复、OSA 和儿童神经心理问题之间的关系。研究人员将招募 40 名曾接受过腭裂修复的儿童，他们正在参加密歇根大学的多学科颅面异常项目。此外，还将招募 40 名年龄相近且曾接受过唇裂修复、粘液囊肿切除或系带切除术的儿童作为对照。所有儿童都将接受夜间多导睡眠图检查，然后进行神经心理学测试。具体目标 1 将确定 OSA 在过去修复过腭裂的儿童中是否比对照组更突出。目标 2 将评估接受腭裂修复的儿童是否存在更突出的神经心理问题，特别是在注意力和活动水平方面，这两个领域对 OSA 的影响最敏感。目标 3 将测试 OSA 测量是否可以解释腭裂修复儿童的一些神经心理学测量，以首次证明未诊断的 OSA 可能是不良神经心理学发病率的基础。结果将强调腭裂修复后数年关注上呼吸道的重要性，提出一种解释这些儿童持续神经心理学发病率的机制，并提供必要的数据来证明对腭裂修复潜在的意外影响进行更大规模、更明确的研究。公众健康相关性：腭裂是一种常见的出生缺陷，在美国大约每 700 名儿童中就有 1 人患有腭裂。我们认为，这些儿童报告的行为问题可能是由于未确诊的睡眠呼吸暂停造成的，这是患有其他健康问题的儿童中常见的一种情况。这项研究的结果可以帮助临床医生将注意力集中在这些儿童中可能被忽视的常见睡眠障碍上，但如果诊断和治疗，可能会改善他们的行为问题。