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.
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.
| Bonuck, Karen; Chervin, Ronald D; Howe, Laura D (2015) Sleep-disordered breathing, sleep duration, and childhood overweight: a longitudinal cohort study. J Pediatr 166:632-9 |
| Bonuck, Karen; Rao, Trupti; Xu, Linzhi (2012) Pediatric sleep disorders and special educational need at 8 years: a population-based cohort study. Pediatrics 130:634-42 |
| Bonuck, Karen; Freeman, Katherine; Chervin, Ronald D et al. (2012) Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years. Pediatrics 129:e857-65 |
| Freeman, Katherine; Bonuck, Karen (2012) Snoring, mouth-breathing, and apnea trajectories in a population-based cohort followed from infancy to 81 months: a cluster analysis. Int J Pediatr Otorhinolaryngol 76:122-30 |
| Bonuck, Karen A; Chervin, Ronald D; Cole, Timothy J et al. (2011) Prevalence and persistence of sleep disordered breathing symptoms in young children: a 6-year population-based cohort study. Sleep 34:875-84 |
