Sleep and Neurobehavioral Performance After Cleft Palate Repair

描述(申请人提供)：腭裂是一种非常普遍的头面部畸形，在美国大约每700名新生儿中就有一名受到影响。对少数儿童的研究提出了这样的担忧，即修复腭裂会增加日后患阻塞性睡眠呼吸暂停(OSA)的风险。然而，接受过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很好的定义。这个问题很重要，因为阻塞性睡眠呼吸暂停综合症与严重的发病率有关，包括行为问题、学习困难和学习成绩不佳，所有这些都可能在睡眠障碍得到治疗后得到改善。此外，坊间报道和临床印象表明，在没有其他医疗条件的情况下，进行腭裂修复的儿童患神经心理问题的风险很高。OSA可能是根本原因的可能性从未被研究过。因此，这项拟议研究的主要目标是检查腭裂修复、阻塞性睡眠呼吸暂停和儿童神经心理问题之间的关系。调查人员将招募40名曾接受过腭裂修复的儿童，他们正在参加密歇根大学的多学科颅面畸形项目。此外，40名年龄相近的儿童将被招募为对照组，这些儿童以前只修复过唇裂，切除过粘液囊肿，或做过系带切除术。所有儿童都将接受夜间多导睡眠监测，然后进行神经心理测试。具体目标1将确定OSA在既往修复过腭裂的儿童中是否比对照组更突出。目的2将评估腭裂修复的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，这两个领域最敏感的OSA的影响。目的3将测试OSA的测量是否可以解释儿童腭裂修复中的一些神经心理指标，以首次证明未诊断的OSA可能是不利的神经心理疾病的基础。研究结果将强调在腭裂修复后数年关注上呼吸道的重要性，提出一种机制来解释这些儿童持续的神经心理疾病，并提供必要的数据，以证明对腭裂修复潜在意外影响的更大和更明确的研究是合理的。与公共卫生相关：腭裂是一种常见的出生缺陷，在美国大约每700名儿童中就有1名受到影响。我们认为，这些儿童报告的行为问题可能是由于未诊断的睡眠呼吸暂停，这是一种在有其他医疗问题的儿童中常见的情况。这项研究的结果可能有助于临床医生将注意力集中在一种常见的睡眠障碍上，这种睡眠障碍在这些儿童中可能被忽视，但如果诊断和治疗，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.