Sleep and Neurobehavioral Performance After Cleft Palate Repair

描述（由申请人提供）：腭裂是一种非常普遍的颅面畸形，在美国，大约每700名新生儿中就有1人患有腭裂，对少数儿童的研究引起了人们的关注，即腭裂的修复会增加以后患阻塞性睡眠呼吸暂停（OSA）的风险。然而，接受腭裂修复的儿童患阻塞性睡眠呼吸暂停的风险增加的程度还没有明确的定义。这个问题很重要，因为睡眠呼吸暂停与显著的发病率相关，包括行为问题、学习困难和学习成绩差，所有这些都可能在治疗睡眠障碍后得到改善。此外，传闻报告和临床印象表明，在没有其他医疗条件的情况下，腭裂修复的儿童患神经心理问题的风险很高。阻塞性睡眠呼吸暂停是潜在原因的可能性从未被研究过。因此，这项研究的主要目的是研究腭裂修复、呼吸暂停和儿童神经心理问题之间的关系。研究人员将招募40名曾经接受过腭裂修复的儿童，他们正在密歇根大学参加多学科颅面畸形项目。此外，40名年龄相近的儿童，既往仅做过唇裂修复、粘液囊肿切除或系带切除术，将被招募作为对照。所有儿童都将接受夜间多导睡眠描记仪检查，然后进行神经心理测试。特异性目的1将确定OSA是否在腭裂修复过的儿童中比在对照组中更为突出。目的2将评估腭裂修复儿童是否有更突出的神经心理问题，特别是在注意力和活动水平方面，这两个领域对OSA的影响最敏感。目的3将测试OSA的测量是否可以解释腭裂修复儿童的一些神经心理测量，首次证明未确诊的OSA可能是不良神经心理发病率的基础。结果将强调关注腭裂修复后数年上呼吸道的重要性，提出解释这些儿童持续神经心理发病率的机制，并提供必要的数据来证明腭裂修复的潜在意外影响的更大规模和更明确的研究。公共卫生相关性：腭裂是一种常见的出生缺陷，在美国，每700名儿童中就有1名患有腭裂。我们认为，这些儿童报告的行为问题可能是由于未确诊的睡眠呼吸暂停，这种情况在患有其他疾病的儿童中很常见。这项研究的结果可能有助于将临床医生的注意力集中在一种常见的睡眠障碍上，这种障碍可能在这些儿童中被忽视，但如果得到诊断和治疗，可能会改善他们的行为问题。

DESCRIPTION (provided by applicant): Cleft palate is a highly prevalent craniofacial malformation that affects approximately one in 700 newborns in the U.S. Studies on small numbers of children have raised the concern that repair of the cleft palate increases later risk for obstructive sleep apnea (OSA). However, the extent to which children who have had cleft palate repair have an increased risk for OSA has not been well defined. The issue is important because OSA is associated with significant morbidity, including behavioral problems, learning difficulties, and poor school performance, all of which may improve when the sleep disorder is treated. Furthermore, anecdotal reports and clinical impressions suggest that children with cleft palate repairs, in the absence of other medical conditions, are at high risk for neuropsychological problems. The possibility that OSA could be the underlying cause has never been studied. The main goal of the proposed research, therefore, is to examine the relationships between cleft palate repair, OSA, and neuropsychological problems in children. The investigators will recruit 40 children with previous cleft palate repair who are attending the multidisciplinary Craniofacial Anomalies Program at the University of Michigan. In addition, 40 children of similar ages with previous repair of cleft lip only, excision of a mucocele, or a frenulectomy will be recruited to serve as controls. All children will undergo nocturnal polysomnography followed by neuropsychological testing. Specific Aim 1 will determine whether OSA is more prominent among children with past repair of cleft palate rather than controls. Aim 2 will assess whether children with cleft palate repairs have more prominent neuropsychological problems, especially in attention and activity levels, two domains most sensitive to effects of OSA. Aim 3 will test whether measures of OSA may explain some neuropsychological measures in children with cleft palate repair, to demonstrate for the first time that undiagnosed OSA could underlie adverse neuropsychological morbidity. Results will highlight the importance of attention to the upper airway years after repair of cleft palate, suggest a mechanism to explain ongoing neuropsychological morbidity in these children, and provide data necessary to justify larger and more definitive studies of the potential unintended impact of cleft palate repair. PUBLIC HEALTH RELEVANCE: Cleft palate is a common birth defect affecting about 1 in 700 children in the US. We believe that the behavioral problems reported in these children may be due to undiagnosed sleep apnea, a condition common in children with other medical problems. Results from this study could help to focus the attention of clinicians on a common sleep disorder that may be ignored in these children but which may improve their behavioral problems if diagnosed and treated.