Sleep and Neurobehavioral Performance After Cleft Palate Repair

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，大约每700名新生儿中就有一名受到影响。对少数儿童的研究引起了人们的担忧，即腭裂修复术会增加阻塞性睡眠呼吸暂停（OSA）的风险。然而，在何种程度上有腭裂修复的儿童有OSA的风险增加还没有得到很好的界定。这个问题很重要，因为OSA与显著的发病率有关，包括行为问题，学习困难和学习成绩差，所有这些都可以在治疗睡眠障碍时得到改善。此外，轶事报告和临床印象表明，腭裂修复的儿童，在没有其他医疗条件下，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，本研究的主要目的是探讨腭裂修复、阻塞性睡眠呼吸暂停综合征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术的儿童，他们正在参加密歇根大学的多学科颅面异常项目。此外，将招募40名年龄相似的儿童作为对照组，这些儿童以前仅接受过唇裂修复术、粘液囊肿切除术或系带切除术。所有儿童都将接受夜间多导睡眠描记术，然后进行神经心理学测试。具体目标1将确定是否OSA是更突出的儿童与过去修复腭裂，而不是控制。目的2将评估腭裂修复儿童是否有更突出的神经心理问题，特别是在注意力和活动水平，这两个领域对OSA的影响最敏感。目的3将测试OSA的措施是否可以解释腭裂修复儿童的一些神经心理学指标，首次证明未确诊的OSA可能是不良神经心理学发病率的基础。结果将突出重视腭裂修复后的上呼吸道年的重要性，提出一种机制来解释这些儿童正在进行的神经心理学发病率，并提供必要的数据，以证明更大和更明确的研究腭裂修复的潜在意外影响。公共卫生相关性：腭裂是一种常见的出生缺陷，在美国约有1/700的儿童受到影响。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，这是一种常见于有其他医疗问题的儿童的疾病。这项研究的结果可能有助于将临床医生的注意力集中在一种常见的睡眠障碍上，这种睡眠障碍在这些儿童中可能被忽视，但如果诊断和治疗，可能会改善他们的行为问题。

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.