Sleep Apnea, Obstructive Clinical Trial
Official title:
Sleep-Disordered Breathing and CPAP After Adenotonsillectomy in Children
Obstructive sleep-disordered breathing (SDB) affects 2-3% of children and may lead to problems with nighttime sleep and daytime behavior, learning, sleepiness, and mood. Adenotonsillectomy (AT) is the second most common surgical procedure in children. It is now performed more often for suspected SDB than for any other indication. However, recent studies indicate that many if not most children still have SDB after AT, and many still have learning or behavioral problems associated with SDB. The goals of this study are: (1) to assess the extent that behavior, cognition, and sleepiness in children can improve with Continuous positive airway pressure (CPAP) treatment after AT, and (2) to identify which patients stand to gain most from post-operative assessment and treatment.
Obstructive sleep-disordered breathing (SDB) affects at least 2-3% of children and may have
substantial adverse impact on behavior and cognition. Adenotonsillectomy (AT), the second
most common surgical procedure in children, is now performed more often for suspected SDB
than for any other indication. However, recent studies among an increasingly obese population
now show something alarming: many if not most children still have SDB after AT, and many
still suffer from residual neurobehavioral morbidity. Furthermore, the investigators'
ongoing, 12-year, NIH-funded research has shown that standard preoperative polysomnographic
measures of SDB do not consistently predict post-AT improvement in behavior and cognition.
This may arise in part because many children after AT still have SDB, and because linear
relationships between standard SDB measures and neurobehavioral morbidity may not exist. Even
at subtle levels, SDB may promote significant neurobehavioral morbidity. Some have suggested
that polysomnography may be more important after AT than before AT. However, in practice few
children receive polysomnography before AT, and even fewer after AT, when continuous positive
airway pressure (CPAP) could still provide definitive relief from SDB. Preliminary data from
our group suggest that CPAP after AT is well-tolerated by most children and may provide
significant benefit. However, virtually no published evidence exists to address critical
clinical questions: which children benefit most from CPAP after AT; what role can clinical
symptoms or polysomnography play in that determination; and what neurobehavioral gains are
achieved by CPAP after AT?
The investigators therefore will undertake a highly practical, clinical study with two main
goals: (1) to assess the extent that behavior, cognition, and sleepiness in children can
improve with CPAP after AT, and (2) to identify which patients stand to gain most from
post-operative assessment and treatment. This research will use reversible SDB-related
neurobehavioral morbidity as the criteria by which to judge the utility of clinical symptoms
and polysomnography in identification of candidates for CPAP after AT.
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