TRANS NASAL INSUFFLATION FOR SLEEP APNEA IN CHILDREN

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 阻塞性睡眠呼吸暂停综合征(OSA)在儿童中很常见，但其病理生理学仍知之甚少。观察到的成人患病率为2-4%(1)，儿童为1-3%(2-4)。儿童轻度至中度阻塞性睡眠呼吸暂停的并发症包括发育不良、肺心病、神经认知异常(8)和高血压。虽然理论上CPAP治疗仍然是阻塞性SDB最简单和最有效的治疗方法，但患者对CPAP的依从性很低(文献中报告的依从性不到50%)。因此，该方案将检验鼻腔注入新鲜空气(TnI)对睡眠期间上呼吸道塌陷的影响及其对儿童睡眠障碍呼吸(SDB)的治疗效果。在成人中的初步结果(JHMI-IRB方案#：04-05-18-02)表明，在睡眠中以20 L/m的高流速给予TnI可以消除轻度的上呼吸道阻塞(低呼吸)，并稳定所有研究对象的呼吸模式。在这项研究中，我们将确定TnI对睡眠期间和上呼吸道塌陷时儿童的呼吸机能和呼吸模式的影响。气流的定量测量将使我们能够评估儿童睡眠期间的呼吸模式，特别是评估最大吸气气流和潮气量。虽然这些测量是在成人研究方案中常规进行的，但在儿童中几乎没有数据。空气流量的定量测量将使用连接在小型鼻罩上的轻型气动记录仪进行。这允许评估在上呼吸道阻塞期间的通气性，以及与睡眠期间无阻塞的呼吸相比较的TNI。因此，我们的研究将为深入了解睡眠障碍呼吸的病因和TnI缓解儿童上呼吸道塌陷的机制提供依据。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Obstructive sleep apnea syndrome (OSA) is common in children, yet the pathophysiology remains poorly understood. The observed prevalence in adults is 2-4%(1), and in children is 1-3%(2-4). Complications of mild to moderate OSA in children include failure to thrive, cor pulmonale, neurocognitive abnormalities (8), and hypertension. While CPAP therapy, in theory, remains the simplest and most effective treatment for obstructive SDB, patient compliance to CPAP is low (less than 50% reported in the literature). Therefore, this protocol will examine the effect of nasal insufflation of fresh air (TNI) on upper airway collapse during sleep and its therapeutic effect on sleep disordered breathing (SDB) in children. Preliminary results in adults (JHMI-IRB protocol#: 04-05-18-02) demonstrates that the administration of TNI at high flow rates of 20 L/m during sleep abolishes mild degrees of upper airway obstruction (hypopneas) and stabilizes the breathing pattern in all subjects studied. In this study we will determine the effect of TNI on ventilation and respiratory pattern in children during sleep both during upper airway collapse. Quantitative measurements of airflow will allow us to evaluate respiratory patterns in children during sleep specifically to assess maximum inspiratory airflow, and tidal volume. While these measurements are performed routinely in adult research protocols, little data exists in children. Quantitative airflow measurements will be made with a lightweight pneumotachograph attached to a small nasal mask. This allows for the assessment of ventilation during periods of upper airway obstruction and TNI compared to nonobstructed breathing during sleep. Thus, our study will provide insight into the etiology of sleep-disordered breathing and the mechanisms responsible for alleviation of upper airway collapse with TNI in children.