Identification of Sleep-Disordered Breathing in Children
Condition: Sleep; Sleep Apnea Syndromes; Sleep Disordered Breathing
MeSH terms: Sleep Apnea Syndromes; Respiratory Aspiration
Study type: Observational

Summary: 
      The purpose of this research is to study and improve the methods used to detect childhood
      breathing problems during sleep that can affect daytime behavior at home and school. Early
      diagnosis of these sleep disorders may allow doctors to treat children at a time when the
      consequences can still be reversed.
    

Detailed description: 
      BACKGROUND:

      Sleep-disordered breathing (SDB) affects at least 1 to 3 percent 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 undergoing treatment,
      which often involves an adenotonsillectomy. Unfortunately, such testing is rarely performed
      either before or after surgery. Available data suggest that a clinical diagnosis of SDB does
      not predict polysomnographic results reliably. However, the extent to which polysomnographic
      results predict morbidity, and especially treatable morbidity, is not well known. The main
      goal of the proposed research, therefore, is to study and improve methods for identification
      of childhood SDB that carries reversible morbidity.

      DESIGN NARRATIVE:

      Researchers will examine the utility of polysomnography in a group of children scheduled to
      undergo adenotonsillectomy for clinical indications, and a group of matched control subjects.
      Initial evaluations, before surgery in the first group, will be compared to results of
      identical evaluations 6 months later in this controlled nonrandomized trial. Outcomes will be
      provided by well-validated assessments of behavior, psychiatric status, cognition, and
      sleepiness. Explanatory variables will include standard clinical and polysomnographic
      information, and data from two newer techniques. The first, nasal pressure monitoring, shows
      increased sensitivity for events that characterize SDB, but few results and no outcome data
      have been reported from use of this method in children. The second is an innovative signal
      processing algorithm developed by the investigators to show that cortical
      electroencephalogram (EEG) activity changes in synchrony with non-apneic respiratory cycles
      in children with SDB. Preliminary data suggest that the magnitude of respiratory
      cycle-related EEG changes (RCREC) varies with SDB severity, diminishes after SDB treatment,
      and improves prediction of neurobehavioral outcomes. The specific aims of the proposed
      research are to show that 1) nasal pressure monitoring, in comparison to standard measures of
      airflow, improves prediction of neurobehavioral response to adenotonsillectomy; 2) RCREC, in
      comparison to standard visually-scored EEG-based arousals, do likewise; 3) polysomnographic
      SDB measures, including nasal pressure monitoring and RCREC, add useful information to that
      derived from office-based assessments; and 4) polysomnography after adenotonsillectomy can
      identify clinically relevant residual SDB in some children.
    

Intervention name(s): Observational follow-up study of adenotonsillectomy
Intervention type(s): Procedure
Intervention description(s): Studies of sleep, behavior, cognition, and daytime sleepiness
Other intervention name(s): Adenotonsillectomy vs. non-surgical subjects
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Children who are scheduled to undergo adenotonsillectomy for clinical indications, as well
        as a group of control subjects will be enrolled.