Obstructive sleep apnea syndrome (OSAS) is a common and serious cause of morbidity during childhood OSAS is characterized by recurrent episodes of partial or complete airway obstruction resulting in hypoxemia hypercapnea, and/or respiratory arousal. The sleep fragmentation and gas exchange abnormalities observed with OSAS may produce serious cardiovascular and neurobehavioral impairment. Habitual snoring is reported in 3-12% of the general pediatric population, although only 1-3% will have OSAS. The anatomical and/ol neuromuscular basis of the primary snoring (PS) and OSAS phenotype has not been elucidated. Upper airway patency is maintained by an intricate balance between the static pharyngeal mechanics, neuromuscular activity, and luminal pressure. A prominent role for upper airway neuromuscular control mechanisms in the pathophysiology of OSAS is hypothesized to explain the observation that obstruction does not occur while awake and is infrequently seen during NREM sleep. Using a validated intra-oral surface electrode to record genioglossus activity (EMGgg) and a nasal mask technique for measuring airway collapsibility (Pcrit), we will assess children with OSAS, PS and normal controls, awake and asleep, for the following; 1) Basal tonic and phasic EMGgg activity as a percentage of maximal; 2) Muscle and airway mechanical responses to hypercapnea (chemoresponsiveness); 3) Muscle and airway mechanical responses to continuous positive airway pressure (CPAP) and pulses of negative airway luminal pressure (mechanoresponsiveness); 4) Muscle and airway mechanical responses to inspiratory resistance loading. These studies address the role of neuromuscular compensatory mechanisms in the maintenance of airway patency during wakefulness and sleep in children. This proposal for a Mentored Patient-Oriented Research Career Development Award will permit the applicant to pursue his goal to become a clinical scientist. This training is set in the rich intellectual environment provided by the airway physiology laboratory of Dr. David P. White at Brigham and Women's Hospital, the Division of Respiratory Diseases at Children's Hospital Boston and the Harvard School of Public Health.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL073238-04
Application #
7113734
Study Section
Special Emphasis Panel (ZHL1-CSR-J (F1))
Program Officer
Rothgeb, Ann E
Project Start
2003-07-01
Project End
2007-01-15
Budget Start
2006-07-01
Budget End
2007-01-15
Support Year
4
Fiscal Year
2006
Total Cost
$125,820
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Canapari, Craig A; Hoppin, Alison G; Kinane, T Bernard et al. (2011) Relationship between sleep apnea, fat distribution, and insulin resistance in obese children. J Clin Sleep Med 7:268-73
Katz, Eliot S; D'Ambrosio, Carolyn M (2010) Pediatric obstructive sleep apnea syndrome. Clin Chest Med 31:221-34
Katz, Eliot S; D'Ambrosio, Carolyn M (2008) Pathophysiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 5:253-62
Brietzke, Scott E; Katz, Eliot S; Roberson, David W (2007) Pulse transit time as a screening test for pediatric sleep-related breathing disorders. Arch Otolaryngol Head Neck Surg 133:980-4
Katz, Eliot S; Marcus, Carole L; White, David P (2006) Influence of airway pressure on genioglossus activity during sleep in normal children. Am J Respir Crit Care Med 173:902-9
Brietzke, Scott E; Katz, Eliot S; Roberson, David W (2004) Can history and physical examination reliably diagnose pediatric obstructive sleep apnea/hypopnea syndrome? A systematic review of the literature. Otolaryngol Head Neck Surg 131:827-32
Katz, Eliot S; White, David P (2004) Genioglossus activity during sleep in normal control subjects and children with obstructive sleep apnea. Am J Respir Crit Care Med 170:553-60