Developing a Predictive Model of the Outcomes of Adenotonsillectomy for Pediatric Obstructive Sleep Apnea Syndrome

开发小儿阻塞性睡眠呼吸暂停综合征腺样体扁桃体切除术结果的预测模型

• 批准号: 10078958
• 负责人: Derek J Lam
• 金额: $ 17.92万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2022-11-09
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10078958
• 关键词: Address; Adenoidal structure; African American; Age; Algorithms; Anatomy; Apnea; Attention deficit hyperactivity disorder; Autonomic Dysfunction; Biometry; Breathing; Caregivers; Child; Childhood; Clinical; Clinical Research; Collaborations; Diagnosis; Disease; Endoscopy; Evaluation; Excision; Failure; Foundations; Functional disorder; Future; Goals; Guidelines; Hypertension; Intervention; K-Series Research Career Programs; Knowledge; Lead; Logistic Regressions; Modeling; NCI Scholars Program; Obesity; Obstruction; Obstructive Sleep Apnea; Operative Surgical Procedures; Oregon; Outcome; Outcome Measure; Outcomes Research; Patient-Focused Outcomes; Patients; Pattern; Polysomnography; Population; Postoperative Period; Predisposing Factor; Prevalence; Prospective cohort; Prospective cohort study; Quality of life; Race; Reporting; Research; Research Institute; Research Personnel; Research Training; Residual Tumors; Residual state; Risk; Risk Factors; Severity of illness; Sleep; Sleep Disorders; Snoring; Standardization; Testing; Tonsil; Training; Translational Research; Treatment Failure; Variant; aged; airway obstruction; cohort; comorbidity; executive function; experience; follow-up; health care service utilization; high risk; inclusion criteria; indexing; individual patient; individualized medicine; insight; obese patients; outcome prediction; predictive modeling; primary outcome; prognostic; programs; randomized trial; skills; success; surgery outcome; therapy development; trial comparing

Project Summary/Abstract Recent evidence has demonstrated that up to 30% of children undergoing adenotonsillectomy (AT) for pediatric obstructive sleep apnea syndrome (OSAS) will have significant residual disease. Although most patients will experience some benefit from AT, the ability to reliably predict the outcome of AT for any individual patient has not been demonstrated. The candidate's long-term goal is to become a leading expert in developing and critically evaluating treatments for pediatric OSAS. To help achieve this goal, the candidate's specific training objectives for this career development award include 1) obtaining advanced biostatistics and outcomes research training, 2) gaining experience in developing and validating a predictive model of surgical outcomes, and 3) developing further clinical expertise in the diagnosis and treatment of pediatric OSAS. These training objectives will be achieved by pursuing advanced biostatistical coursework and training through the Oregon Clinical and Translational Research Institute (OCTRI) Scholars Program as well as clinical and research collaboration with the OHSU Sleep Disorders Program. The overall research objective of this proposal is to develop a comprehensive predictive model for the outcomes of AT for OSAS that includes anatomic and dynamic functional risk factors determined by sleep endoscopy. It is our central hypothesis that a composite predictive model that includes sleep endoscopy findings will accurately predict the outcome of AT and allow estimation of the likelihood of surgical success. The specific aims of this study are to 1) determine the associations between a validated sleep endoscopy rating scale and post AT outcomes, and 2) develop and validate a composite predictive model of the outcomes of AT incorporating sleep endoscopy ratings and other baseline factors. These aims will be achieved through a prospective cohort study of children aged 2-18 years who are undergoing AT for a diagnosis OSAS. Other inclusion criteria will include risk factors predisposing to residual OSAS after AT: obesity, severe preoperative OSAS, African American race, and age greater than 7 years. Patients will undergo sleep endoscopy prior to AT. Outcome measures include apnea-hypopnea index, generic and OSAS-specific quality of life, and validated caregiver ratings of executive function. A composite predictive model using presence of post-AT OSAS as the primary outcome variable will be developed and validated. Such a model will allow more accurate and reliable prognostication of AT outcomes and will help to inform the need for postoperative follow-up and possibly suggest strategies for further intervention.

项目总结/摘要 最近的证据表明，高达30%的儿童接受腺样体切除术（AT）， 小儿阻塞性睡眠呼吸暂停综合征（OSAS）将有明显的残留疾病。虽然大多数 患者将从AT中获益，能够可靠地预测任何个体的AT结局 病人没有得到证实。 候选人的长期目标是成为开发和批判性评估治疗方法的领先专家 小儿阻塞性睡眠呼吸暂停综合征为了帮助实现这一目标，候选人对这一职业的具体培训目标 发展奖包括1）获得先进的生物统计学和成果研究培训，2）获得 开发和验证手术结果预测模型的经验，以及3）进一步开发 儿童阻塞性睡眠呼吸暂停综合征的诊断和治疗。这些培训目标将实现 通过追求先进的生物统计课程和培训，通过俄勒冈州临床和翻译 研究所（OCTRI）学者计划以及与OHSU的临床和研究合作 睡眠障碍项目。 本提案的总体研究目标是开发一个全面的预测模型， AT治疗OSAS的结局，包括由睡眠决定的解剖学和动态功能风险因素 内镜我们的中心假设是，包括睡眠内窥镜检查在内的复合预测模型 这些发现将准确预测AT的结果，并允许估计手术成功的可能性。 本研究的具体目的是：1）确定经验证的睡眠内窥镜检查与 评定量表和AT后结局，以及2）开发并验证结局的复合预测模型 AT合并睡眠内窥镜评分和其他基线因素。这些目标将通过一个 对2-18岁因诊断为OSAS而接受AT的儿童进行的前瞻性队列研究。其他 纳入标准包括AT后易发生残余OSAS的危险因素：肥胖、严重术前 OSAS，非裔美国人，年龄大于7岁。患者将接受睡眠内窥镜检查， 原子结果指标包括呼吸暂停低通气指数、一般和OSA特异性生活质量， 执行功能的有效护理者评级。一种使用后AT存在的复合预测模型 OSAS作为主要结局变量将被开发和验证。这样的模型可以更准确地 和AT结局的可靠说明，并将有助于告知术后随访的需要， 可能会提出进一步干预的策略。