Developing a Predictive Model of the Outcomes of Adenotonsillectomy for Pediatric Obstructive Sleep Apnea Syndrome

开发小儿阻塞性睡眠呼吸暂停综合征腺样体扁桃体切除术结果的预测模型

• 批准号: 10438448
• 负责人: Derek J Lam
• 金额: $ 4.63万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2022-01-09
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10438448
• 关键词: Adenoidal structure; African American; Age; Anatomy; Apnea; Biometry; Breathing; Caregivers; Child; Childhood; Clinical; Clinical Research; Collaborations; Diagnosis; Endoscopy; Excision; Goals; Intervention; K-Series Research Career Programs; Modeling; NCI Scholars Program; Obesity; Obstructive Sleep Apnea; Operative Surgical Procedures; Oregon; Outcome; Outcome Measure; Outcomes Research; Patients; Postoperative Period; Predisposing Factor; Prospective cohort study; Quality of life; Race; Research; Research Institute; Research Training; Residual Tumors; Residual state; Risk Factors; Sleep; Sleep Disorders; Snoring; Tonsil; Training; Translational Research; aged; executive function; experience; follow-up; inclusion criteria; indexing; individual patient; outcome prediction; predictive modeling; primary outcome; prognostic; programs; success; surgery outcome; Adenoidal structure; African American; Age; Anatomy; Apnea; Biometry; Breathing; Caregivers; Child; Childhood; Clinical; Clinical Research; Collaborations; Diagnosis; Endoscopy; Excision; Goals; Intervention; K-Series Research Career Programs; Modeling; NCI Scholars Program; Obesity; Obstructive Sleep Apnea; Operative Surgical Procedures; Oregon; Outcome; Outcome Measure; Outcomes Research; Patients; Postoperative Period; Predisposing Factor; Prospective cohort study; Quality of life; Race; Research; Research Institute; Research Training; Residual Tumors; Residual state; Risk Factors; Sleep; Sleep Disorders; Snoring; Tonsil; Training; Translational Research; aged; executive function; experience; follow-up; inclusion criteria; indexing; individual patient; outcome prediction; predictive modeling; primary outcome; prognostic; programs; success; surgery outcome

Project Summary/Abstract Recent evidence has demonstrated that up to 30% of children undergoing adenotonsillectomy (AT) for pediatric obstructive sleep apnea syndrome (OSAS) will have significant residual disease. Although most patients will experience some benefit from AT, the ability to reliably predict the outcome of AT for any individual patient has not been demonstrated. The candidate's long-term goal is to become a leading expert in developing and critically evaluating treatments for pediatric OSAS. To help achieve this goal, the candidate's specific training objectives for this career development award include 1) obtaining advanced biostatistics and outcomes research training, 2) gaining experience in developing and validating a predictive model of surgical outcomes, and 3) developing further clinical expertise in the diagnosis and treatment of pediatric OSAS. These training objectives will be achieved by pursuing advanced biostatistical coursework and training through the Oregon Clinical and Translational Research Institute (OCTRI) Scholars Program as well as clinical and research collaboration with the OHSU Sleep Disorders Program. The overall research objective of this proposal is to develop a comprehensive predictive model for the outcomes of AT for OSAS that includes anatomic and dynamic functional risk factors determined by sleep endoscopy. It is our central hypothesis that a composite predictive model that includes sleep endoscopy findings will accurately predict the outcome of AT and allow estimation of the likelihood of surgical success. The specific aims of this study are to 1) determine the associations between a validated sleep endoscopy rating scale and post AT outcomes, and 2) develop and validate a composite predictive model of the outcomes of AT incorporating sleep endoscopy ratings and other baseline factors. These aims will be achieved through a prospective cohort study of children aged 2-18 years who are undergoing AT for a diagnosis OSAS. Other inclusion criteria will include risk factors predisposing to residual OSAS after AT: obesity, severe preoperative OSAS, African American race, and age greater than 7 years. Patients will undergo sleep endoscopy prior to AT. Outcome measures include apnea-hypopnea index, generic and OSAS-specific quality of life, and validated caregiver ratings of executive function. A composite predictive model using presence of post-AT OSAS as the primary outcome variable will be developed and validated. Such a model will allow more accurate and reliable prognostication of AT outcomes and will help to inform the need for postoperative follow-up and possibly suggest strategies for further intervention. 6

项目摘要/摘要 最近的证据表明，多达30％的儿童接受腺孔切除术（AT） 小儿阻塞性睡眠呼吸暂停综合征（OSA）将有明显的残留疾病。虽然大多数 患者将从AT中获得一些好处，可靠地预测任何个人的AT结果 尚未证明患者。 候选人的长期目标是成为发展和批判性评估治疗方面的领先专家 用于小儿osas。为了帮助实现这一目标，候选人在此职业中的具体培训目标 开发奖包括1）获得先进的生物统计学和成果研究培训，2）获得 在开发和验证手术结果的预测模型和3）进一步发展的经验 小儿OSA诊断和治疗方面的临床专业知识。这些培训目标将实现 通过俄勒冈州的临床和翻译进行高级生物统计课程和培训 研究学院（OCTRI）学者计划以及与OHSU的临床和研究合作 睡眠障碍计划。 该提案的总体研究目标是为 OSA的AT结果，包括由睡眠确定的解剖和动态功能风险因素 内窥镜检查。我们的中心假设是，包括睡眠内窥镜的复合预测模型 发现将准确预测AT的结果并允许估计手术成功的可能性。 这项研究的具体目的是1）确定经过验证的睡眠内窥镜检查之间的关联 评分量表和以结果的张贴，2）开发和验证结果的综合预测模型 纳入睡眠内窥镜评级和其他基线因子。这些目标将通过 对诊断OSA的2-18岁儿童的前瞻性队列研究。其他 纳入标准将包括易感因素的危险因素：肥胖症，严重术前的危险因素 OSA，非裔美国人种族，年龄大于7岁。患者将在接受睡眠内窥镜检查之前 在。结果指标包括呼吸暂停指数，通用和特定于OSA的生活质量以及 验证的执行功能的护理人员评级。使用后AT的存在的复合预测模型 OSA作为主要结果变量将被开发和验证。这样的模型将允许更准确 以及可靠的结果预测，并将有助于告知术后随访的需求和 可能提出进一步干预的策略。 6