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

项目摘要/摘要 最近的证据表明，高达30%的接受腺扁桃体切除术(AT)的儿童 儿童阻塞性睡眠呼吸暂停综合征(OSAS)会有明显的残留病。尽管大多数 患者将从AT中获得一些好处，即能够可靠地预测任何个人的AT结果 患者尚未得到证实。 候选人的长期目标是成为开发和批判性评估治疗方面的领先专家 适用于儿童阻塞性睡眠呼吸暂停综合征。为了帮助实现这一目标，应聘者对这一职业的具体培训目标 发展奖包括1)获得高级生物统计和成果研究培训，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 在诊断和治疗儿童阻塞性睡眠呼吸暂停综合征方面的临床经验。这些培训目标将会实现 通过俄勒冈州临床和翻译学院进行高级生物统计学课程和培训 研究机构(OCTRI)学者计划以及与OHSU的临床和研究合作 睡眠障碍计划。 这项建议的总体研究目标是开发一个全面的预测模型 包含由睡眠决定的解剖学和动态功能危险因素的阻塞性睡眠呼吸暂停综合征的预后 内窥镜检查。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 这些发现将准确地预测AT的结果，并允许估计手术成功的可能性。 这项研究的具体目的是1)确定有效的睡眠内窥镜检查与 评价量表和AT后结果，以及2)开发和验证结果的复合预测模型 包括睡眠内窥镜评分和其他基线因素的AT。这些目标将通过一个 对2-18岁因诊断为OSAS而接受AT的儿童进行前瞻性队列研究。其他 纳入标准将包括AT术后易患残余OSAS的危险因素：肥胖、严重的术前 OSAS，非裔美国人，年龄超过7岁。患者将在接受睡眠内窥镜检查之前 在…。结果测量包括呼吸暂停低通气指数、一般生活质量和特定于睡眠呼吸暂停综合征的生活质量，以及 确认护理者对执行功能的评级。一种考虑后AT影响的复合预测模型 将制定和验证OSAS作为主要结果变量。这样的模型将允许更准确的 和可靠的预测AT的结果，并将有助于告知需要术后随访和 可能会提出进一步干预的策略。

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.