BEHAVIORAL EFFECT OF OBSTRUCTIVE SLEEP APNEA IN CHILDREN

腺扁桃体切除术（AT）仍然是儿童最常见的外科手术之一，但近年来AT的适应症发生了变化。现在，外科医生在许多疑似阻塞性睡眠呼吸障碍（SDB）的病例中都实施了AT，有时也会对可能由SDB引起的日间行为，尤其是注意力不集中和多动进行AT治疗。然而，SDB是否会导致这些和其他破坏性行为，这些行为的确切性质，以及SDB可能关注的类型或水平尚不清楚。如果没有这些知识，儿科医生和耳鼻喉科医生通常不会使用客观的术前检查来帮助评估SDB或异常行为。本研究的主要目的是：(1)更好地界定AT儿童的注意力不集中和多动是否频繁发生；(2)确定指示这些行为的SDB的测量和水平；(3)检验AT后SDB的改善是否与行为的改善有关；(4)探讨SDB是某些儿童注意力不集中、多动及相关行为的原因的假设。受试者为5至12岁的儿童，由医生安排进行AT （n = 200）或疝修补（n = 75对照）后招募。在手术前，一系列经过良好验证的行为评估工具、认知测试和有组织的精神病学访谈将被用于确定哪些行为在计划进行AT而不是疝气修复的儿童中更为突出。所有儿童术前都将进行多导睡眠描记术，其中将首次包括可以检测儿童中特别普遍的SDB的细微形式的设备。结果将允许确定哪些多导睡眠图结果与明确的不良行为结果相关。最后，对这些受试者进行术前和术后测试，将为AT治疗SDB提供一项对照非随机试验，证明AT后SDB相关异常行为是否有所改善，并为SDB是否是这些行为的原因提供有力证据。

Adenotonsillectomy (AT) remains one of the most common surgical procedures performed in children, but indications for AT have changed in recent years. Surgeons now perform AT in many instances for suspected obstructive sleep-disordered breathing (SDB), and sometimes for daytime behaviors that may be a consequence of SDB, especially inattention and hyperactivity. However, whether SDB causes these and other disruptive behaviors, the precise nature of these behaviors, and what types or levels of SDB may be of concern are not well known. Without such knowledge, pediatricians and otolaryngologists do not often make use of objective preoperative testing that could help to assess for SDB or abnormal behavior. The main goals of the research described in this proposal are to (1) better define whether inattention and hyperactivity are frequent among children who undergo AT, (2) identify measures and levels of SDB that are indicative of these behaviors, (3) test whether improvement in SDB after AT is associated with improvement in behavior, and (4) investigate the hypothesis that SDB is a cause of inattention, hyperactivity, and related behaviors in some children. Subjects will be 5 through 12 year-old children recruited after they have been scheduled by their physicians for AT (n = 200) or hernia repair (n = 75 controls). A battery of well-validated behavioral assessment tools, cognitive tests, and structured psychiatric interviews will be used before surgery to define what behaviors are more prominent in the children scheduled for AT rather than hernia repair. All children will undergo preoperative polysomnography which will include, for the first time in such a series, equipment that can detect subtle forms of SDB which may be particularly prevalent in children. Results will allow determination of what polysomnographic findings are associated with well-defined adverse behavioral outcomes. Finally, preoperative and postoperative testing in these subjects will provide a controlled non-randomized trial of AT for SDB, demonstrate whether SDB-associated abnormal behaviors improve after AT, and provide strong evidence for whether SDB is a cause of these behaviors.