The pediatric syndrome of sleep disordered breathing (SDB) encompasses children with simple snoring, obstructive hypoventilation (OH), and varying degrees of obstructive sleep apnea (OSA). The syndrome occurs in more than 12% of all children, with most falling within the mild to moderate range of the severity spectrum. Although the long-term cardiovascular sequelae of severe SDB are well recognized, those that develop secondary to milder forms of SDB remain undefined. The lack of knowledge regarding the long-term cardiovascular morbidity of less severe forms of SDB precludes adequate management of children with the disorder and prevention of cardiovascular disease during adulthood. We build on intriguing preliminary data demonstrating for the first time that compared to controls, lean and obese children with SDB have structural and functional changes of the carotid artery, higher systolic blood pressure and wider pulse pressure. All are important indicators of blood vessel stiffness and determinants of left ventricular load and mass. The goals of this study are threefold: 1) to compare inflammatory cardiovascular disease mechanisms in 5- to 13-year-old children with varying degrees of SDB to those in normal controls;2) to determine how cytokine levels in plasma relate to those in tonsils;3) to examine the relationship between inflammatory markers and prognostically important cardiovascular measures such as carotid intima thickness, carotid compliance, pulse pressure, aortic stiffness and left ventricular mass and function before and after adenotonsillectomy. As an important segment of this K 24 application, this research will serve as a platform for the mentees in the program.
The candidate fully recognizes that there is very limited number of pediatric pulmonologists and pediatric sleep specialists who have been able to develop successful academic careers and make novel discoveries in both fields. Recently, the American Board of Pediatrics released the results of the national survey "The Future of Pediatric Education II: Pulmonology " The report showed that on average, the percent effort dedicated to research by pediatric pulmonologist is 14.7%. At all levels of academic careers, such limited effort dedicated to research cannot lead to novel discoveries. Limited training opportunities in patient oriented research compel pediatric pulmonologist and sleep specialists into choosing academic careers with low research expectations. The candidate immediate and long-term goals are to create the mentoring environment for trainees and young faculty members that fosters research that has potential to improve patient health outcomes.