Sleep Disordered Breathing and Growth in Children: A Longitudinal Cohort Study

描述(由申请人提供)：我们将评估儿童生长障碍(GF)与睡眠障碍呼吸(SDB)之间的联系，SDB以鼾声、呼吸暂停和口呼吸为特征。扁桃体肥大是导致儿童SDB的主要因素。扁桃体和腺样体切除(T&A)在80%的病例中是治愈的。作为一种专门针对SDB的干预措施，接受T&A治疗的儿童表现出追赶增长的必然好处。来自转诊儿童的小型病例系列的数据表明，SDB可能会增加GF的风险，但这从未在以人群为基础的纵向研究中进行评估。我们将在雅芳父母和儿童纵向研究(ALSPAC)中分析SDB和GF的数据，ALSPAC是英国一项基于人群的前瞻性队列研究。ALSPAC是世界上规模最大、描述最清楚的儿童队列研究之一。ALSPAC的初步数据发现，在6个月打鼾者(P&lt；.05)中，6-42个月大的儿童身高增长较小；在18个月大时通过嘴呼吸的儿童(P&lt；.03)和18个月大时报告患有呼吸暂停的儿童(P&lt；.02)，身高从30-42个月开始增长较小(p&lt；.02)。据我们所知，我们的研究是第一个旨在考察SDB随着时间的推移对增长乏力的影响的研究。主要目标：(整个队列)1)表征儿童时期的睡眠障碍呼吸(SDB)症状我们将：a)测量SDB症状的患病率、严重性和持续性，以及b)描述SDB从婴儿期到青春期前的自然和治疗历史的趋势。2)为了确定SDB症状和生长之间的联系，我们将评估：a)SDB症状的患病率、严重程度和持续性是否与GF有关；以及b)这种联系是否由以下因素调节或独立于因素：早期生长模式、摄食习惯、能量摄入、T&A手术和家庭人口统计。次要目的：(队列次样本)3)确定SDB症状、饮食摄入量、生长生物标记物和生长之间的关系我们将分析：a)血浆胰岛素样生长因子、瘦素水平、饮食摄入量和SDB之间的关系；b)这些生物标记物和SDB的影响及其对生长的交互作用。公共卫生相关性：ALSPAC提供了一个前所未有的机会来检查睡眠呼吸紊乱(SDB)和整个童年的发育，并评估因果关系的证据。自1992年以来，ALSPAC最初的队列中有13,000多名儿童。经过验证的措施和多个数据来源(例如，检查、调查和健康记录)将允许得出合理有效的结论。该项目的国际多学科团队包括：生物统计学、内分泌学、流行病学、营养学、耳鼻喉科、儿科学和肺病学/睡眠医学的专业知识。很少有儿科初级保健提供者筛查SDB，50%的人不知道它与生长障碍(GF)的潜在联系。无论是他们，还是儿科GF的专科专家，在他们的GF鉴别诊断中，通常都不包括上呼吸道阻塞。在我们的纵向多变量分析中，如果SDB与GF有显著的时间相关性，那么对于GF儿童的筛查、转诊和治疗有很强的临床实践意义。

DESCRIPTION (provided by applicant): We will evaluate the association between growth failures (GF) in children, and sleep disordered breathing (SDB) characterized by snoring, apnea, and mouth-breathing. Adenotonsillar hypertrophy is the primary factor leading to SDB in children. Tonsillectomy and adenoidectomy (T&A) is curative in 80% of cases. As an intervention specifically for SDB, children undergoing T&As show, as a corollary benefit, catch-up growth. Data from small, case series of referred children suggest that SDB may increase the risk of GF, but this has never been evaluated in a longitudinal, population-based study. We will analyze data on SDB and GF in the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, population-based cohort study in the U.K. ALSPAC is amongst the largest, most well-delineated child cohorts in the world. Preliminary ALSPAC data find smaller height increases from 6- 42 months of age in children who snored at 6 months (p<.05), and; from 30-42 months of age in children who breathed through their mouth at 18 months (p<.03), and those with reported apnea at 18 months of age (p<.02). To our knowledge, ours is the first study designed to examine the impact of SDB upon poor growth over time. Primary Aims: (entire cohort) 1) To Characterize Sleep Disordered Breathing (SDB) Symptoms in Childhood We will: a) measure the prevalence, severity, and persistence of SDB symptoms, and; b) delineate trends in the natural and treatment history of SDB from infancy through pre-puberty. 2) To Determine the Association Between SDB Symptoms & Growth We will assess: a) whether the prevalence, severity, and persistence of SDB symptoms is associated with GF, and; b) whether such associations are mediated by or are independent of factors such as: early growth patterns, feeding habits, energy intake, T&A surgery, and; family demographics. Secondary Aim: (sub-sample of cohort) 3) To Determine Associations Between SDB Symptoms, Dietary Intake, Growth Biomarkers, & Growth We will analyze: a) the association between plasma insulin-like growth factors, leptin levels, dietary intake, and SDB, and; b) the effects of these biomarkers and SDB, and their interactions on growth. PUBLIC HEALTH RELEVANCE: ALSPAC provides an unprecedented opportunity to examine sleep disordered breathing (SDB) and growth throughout childhood, and evaluate evidence of causality. ALSPAC follows an inception cohort of 13,000+ children since 1992. Validated measures and multiple data sources (e.g., exams, surveys, and health records) will permit reasonably valid conclusions. The project's international multidisciplinary team includes expertise in: biostatistics, endocrinology, epidemiology, nutrition, otolaryngology, pediatrics, and pulmonology/sleep medicine. Few pediatric primary care providers screen for SDB, and 50% are unaware of its potential link to growth failure (GF). Neither they, nor sub-specialists in pediatric GF routinely include upper airway obstruction in their differential diagnosis of GF. If SDB has a significant temporal association with GF in our longitudinal, multivariable analysis, there are strong clinical practice implications for the screening, referral, and treatment of children with GF.