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

儿童睡眠呼吸障碍与生长：一项纵向队列研究

基本信息

批准号：
7530644
负责人：
KAREN A. BONUCK
金额：
$ 23.06万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-01 至 2010-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7530644
关键词：
Accounting Adenoidectomy Age Age-Months Age-Years Apnea Behavioral Binding Proteins Biological Markers Biomarker of Dietary Intake Biometry Birth Breathing Case Series Child Childhood Clinical Cognitive Cohort Studies Consensus Data Data Analyses Data Sources Development Dietary intake Differential Diagnosis Endocrinology Energy Intake Epidemiology Etiology Failure Family Feeding Patterns Genetic Gestational Age Growth Habits Health Height Hypertrophy Infant Insulin-Like Growth Factor Binding Protein 3 Insulin-Like Growth Factor I International Intervention Knowledge Left Leptin Link Longitudinal Studies Measures Mediating Mediator of activation protein Medicine Modeling Morbidity - disease rate Mouth Breathing Obesity Operative Surgical Procedures Oral cavity Otolaryngology Parents Pathway interactions Pattern Pediatrics Plasma Population Prevalence Primary Health Care Provider Puberty Public Health Pulmonology Questionnaires Recording of previous events Reporting Research Research Design Risk Sampling Score Screening procedure Severities Sleep Sleep Apnea Syndromes Snoring Socioeconomic Status Somatomedins Specialist Surveys Symptoms Text Time Tonsillectomy Weight Work airway obstruction base cohort day demographics early childhood experience feeding health record improved infancy multidisciplinary nutrition prospective size trend

项目摘要

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.

描述（由申请人提供）：我们将评估儿童生长障碍（GF）与以打鼾、呼吸暂停和张口呼吸为特征的睡眠呼吸障碍（SDB）之间的关联。腺样体扁桃体肥大是导致儿童SDB的首要因素。扁桃体切除术和腺样体切除术 (T&A) 可以治愈 80% 的病例。作为专门针对 SDB 的干预措施，接受 T&As 的儿童的必然好处是追赶性成长。来自转诊儿童的小规模病例系列数据表明，SDB 可能会增加 GF 的风险，但这从未在纵向、基于人群的研究中得到评估。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，这是一项在英国开展的前瞻性、基于人群的队列研究。ALSPAC 是世界上规模最大、描述最清楚的儿童队列之一。 ALSPAC 初步数据发现，6 个月时打鼾的儿童在 6-42 个月期间身高增长幅度较小 (p<.05)； 30-42 个月大的儿童在 18 个月大时通过口呼吸 (p<.03)，以及那些在 18 个月大时报告呼吸暂停的儿童 (p<.02)。据我们所知，我们的研究是第一项旨在研究 SDB 对长期增长不良的影响的研究。主要目标：（整个队列） 1) 描述儿童期睡眠呼吸障碍 (SDB) 症状的特征我们将： a) 测量 SDB 症状的患病率、严重程度和持续性，以及； b) 描绘从婴儿期到青春期前的 SDB 自然史和治疗史的趋势。 2) 确定 SDB 症状与生长之间的关联我们将评估： a) SDB 症状的患病率、严重程度和持续性是否与 GF 相关； b) 这种关联是否由以下因素介导或独立于以下因素：早期生长模式、饮食习惯、能量摄入、T&A 手术；家庭人口统计。次要目标：（队列的子样本）3）确定 SDB 症状、膳食摄入量、生长生物标志物和生长之间的关联我们将分析：a）血浆胰岛素样生长因子、瘦素水平、膳食摄入量和生长之间的关联深发展局，以及； b) 这些生物标志物和 SDB 的影响及其对生长的相互作用。公共健康相关性：ALSPAC 提供了前所未有的机会来检查睡眠呼吸障碍 (SDB) 和整个儿童期的生长，并评估因果关系的证据。自 1992 年以来，ALSPAC 跟踪了 13,000 多名儿童的初始队列。经过验证的测量和多个数据源（例如检查、调查和健康记录）将得出合理有效的结论。该项目的国际多学科团队包括以下领域的专业知识：生物统计学、内分泌学、流行病学、营养学、耳鼻喉科、儿科和肺病学/睡眠医学。很少有儿科初级保健提供者对 SDB 进行筛查，并且 50% 的人不知道其与生长障碍 (GF) 的潜在联系。他们和儿科 GF 的亚专家都没有在 GF 的鉴别诊断中常规地包括上气道阻塞。如果在我们的纵向多变量分析中，SDB 与 GF 具有显着的时间相关性，那么对于 GF 儿童的筛查、转诊和治疗具有很强的临床实践意义。