Identification of Sleep-Disordered Breathing in Children

描述(申请人提供)：睡眠障碍呼吸(SDB)影响至少1%至3%的儿童。相关的发病率可能包括注意力不集中和多动行为、破坏性行为障碍、认知缺陷和白天过度嗜睡。睡眠专家建议儿童接受多导睡眠监测以确认SDB，特别是在腺扁桃体切除术之前，这是最常见的治疗方法。然而，耳鼻喉科医生很少在手术前或手术后进行这样的测试。已发表的报告表明，SDB的临床诊断并不能可靠地预测多导睡眠监测结果，但睡眠监测措施本身预测发病率，特别是可治疗的发病率的程度尚不为人所知。来自研究人员的初步数据表明，标准的SDB指标，如呼吸暂停和低呼吸发生率、睡眠唤醒比率和氧气减饱和程度，不能可靠地预测神经行为发病率或其改善。相比之下，两种较新的技术，很少在临床实践中使用，确实显示出独特的预测价值。第一个是由研究人员开发和验证的创新信号处理算法，以评估SDB儿童皮层EEC活动与非窒息呼吸周期同步变化的程度。第二项是食道压力监测，这是衡量SDB特征的呼吸努力增加的黄金标准。 因此，修订后的竞争性更新申请的主要目标是研究和改进识别携带可逆性发病率的儿童SDB的方法。研究人员将对100名计划接受临床扁桃体切除术的儿童和50名匹配的对照组受试者进行夜间多导睡眠监测和对行为、精神状态、认知和困倦的有效评估。所有评估将在6个月后重复进行，以完成这项受控的非随机随访试验。具体目的1是确定术前呼吸周期相关脑电变化(RCREC)而不是标准的多导睡眠图唤醒是否可以预测神经行为发病率及其术后改善。目标2是评估食道压力，而不是标准的SDB测量，是否可以预测同样的结果。目的3是评估新的和标准的措施在识别临床相关的残留SDB方面的术后实用性。这项关于SDB两个基本特征的研究--呼吸努力增加及其与儿童SDB的皮质识别和神经行为影响活动风险的相关性--很可能导致儿童SDB识别和神经行为影响风险的根本改善。

DESCRIPTION (provided by applicant): Sleep-disordered breathing (SDB) affects at least 1 to 3% of children. Associated morbidity can include inattentive and hyperactive behavior, disruptive behavior disorders, cognitive deficits, and excessive daytime sleepiness. Sleep specialists recommend that children undergo polysomnography to confirm SDB, especially before adenotonsillectomy, which is the most common treatment. However, otolaryngologists rarely obtain such testing either before or after surgery. Published reports show that a clinical diagnosis of SDB does not predict polysomnographic results reliably, but the extent to which bolysomnographic measures themselves predict morbidity, and especially treatable morbidity, is not well known. Preliminary data from the investigators suggest that standard SDB measures, such as rates of apneas and hypopneas, rates of arousals from sleep, and the extent of oxygen desaturation, do not reliably predict neurobehavioral morbidity or its improvement. In contrast, two newer techniques, rarely used in clinical practice, do show unique predictive value. The first is an innovative signal processing algorithm developed and validated by thfe investigators to assess the extent to which cortical EEC activity changes in synchrony with non-apneic respiratory cycles in children with SDB. The second, esophageal pressure monitoring, is a gold-standard measure of the increased respiratory effort that characterizes SDB. The main goal of this revised competitive renewal application, therefore, is to study and improve methods for identification of childhood SDB that carries reversible morbidity. The investigators will administer nocturnal polysomnography and well-validated assessments of behavior, psychiatric status, cognition, and sleepiness to 100 children scheduled for clinically-indipated adenotonsillectomy, and to 50 matched control subjects. All evaluations will be repeated 6 months later to complete this controlled, non-randomized follow-up trial. Specific Aim 1 is to determine whether pre-operative respiratory cycle-related EEC changes (RCREC), rather than standard polysomnographic arousals, can predict neurobehavioral morbidity and its improvement after surgery. Aim 2 is to assess whether esophageal pressure', rather than standard SDB measures, can predict the same outcomes. Aim 3 is to evaluate the post-operative utility of the newer and standard measures in identification of clinically-relevant residual SDB. This investigation of two fundamental SDB characteristics -increased respiratory effort arid its correlation with cortical identification of childhood SDB and risk for neurobehavioral impact activity - may well lead to fundamental improvement in identification of childhood SDB and risk for neurobehavioral impact.