Prevalence and Correlates of Childhood Sleep Apnea

To determine if there are anatomic and physical characteristics that distinguish pre-adolescent children with sleep disordered breathing and if the sleep disordered breathing is associated with adverse effects on school and neurocognitive performance.

BACKGROUND: The study is part of an initiative, Obstructive Sleep Apnea in Children, which was released in December, 1997 with co-sponsorship from the National Institute of Dental and Craniofacial Research and the National Institute of Child Health and Human Development. The goal of the initiative is to define abnormalities in airway structure and function responsible for obstructive sleep apnea in children, ages 3 to 12, and to identify physiological and clinical measures associated with increased morbidity. DESIGN NARRATIVE: A 3 stage stratified sampling procedure is conducted on pre-adolescent Tucson school children between the ages of 6 and 12 years of age. Stratification is performed on the following factors:age, ethnicity, gender and snoring status. In the initial phase, 2500 (625 each year) pre-adolescent Tucson school children between the ages of 6 and 12 years of age are surveyed using a questionnaire designed to elicit symptoms of sleep disordered breathing (SDB) including obstructive sleep apnea (OSA). From these data, a subset of 90 snoring and 30 non-snoring children (500 total) will be recruited each year to have home polysomnography, basic anthropometric measurements and a battery of neurocognitive tests performed in order to identify a group of children with SDB including OSA and a group without this condition. In the third phase of the study, 20 children with SDB and 20 without will be recruited each year (80 total) to undergo more intensive anatomic and physiologic testing including cephalometry, measurement of upper airway geometry and resistance using acoustic reflection and oscillation techniques and control of ventilation studies. The intent of the study is to: 1) determine the prevalence of symptoms of SDB in pre-adolescent Caucasian and Hispanic children; 2) compare the prevalence of objectively measured SDB in pre-adolescent Caucasian and Hispanic children; 3) determine whether there are physiologic and anatomic differences among pre-adolescent children who have SDB including obstructive sleep apnea and upper airway resistance syndrome (UARS) and those who do not during quiet wakefulness; and 4) determine the association between SDB and school performance, neuro-cognitive ability and daytime symptoms. The study has been extended through November 2008 to to follow a large cohort of pre-adolescent children to determine whether untreated sleep apnea is associated with identifiable decrements in neurocognitive performance and school performance, as well as perturbations of blood pressure and growth, at approximately four years after initial enrollment and identification of sleep apnea. The study also aims to identify pre-adolescent anthropometric and ethnic variables associated with future development and/or regression of sleep apnea .The study secondarily aims to determine whether abnormalities in ventilatory drive found in pre-adolescence in children with sleep apnea persist after approximately four years of untreated sleep apnea.

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Goodwin JL, Kaemingk KL, Fregosi RF, Rosen GM, Morgan WJ, Sherrill DL, Quan SF. Clinical outcomes associated with sleep-disordered breathing in Caucasian and Hispanic children--the Tucson Children's Assessment of Sleep Apnea study (TuCASA). Sleep. 2003 Aug 1;26(5):587-91. doi: 10.1093/sleep/26.5.587.

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Fregosi RF, Quan SF, Jackson AC, Kaemingk KL, Morgan WJ, Goodwin JL, Reeder JC, Cabrera RK, Antonio E. Ventilatory drive and the apnea-hypopnea index in six-to-twelve year old children. BMC Pulm Med. 2004 Apr 29;4:4. doi: 10.1186/1471-2466-4-4.

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