Metabolic Complications Of Obstructive Sleep Apnea During Early Development
Funder
National Health and Medical Research Council
Funding Amount
$320,375.00
Summary
Adults with OSA are known to have increased risk for heart disease. We will study children with OSA, and an animal model of the disease during early development, to help clarify how this disease of adulthood actually has its origins in childhood. We have already shown that obese children with obstructive sleep apnea (OSA) are more prone to diabetes (metabolic problems) than those without OSA. More recently, we found that this is also true for children who are not overweight. This early diabetes ....Adults with OSA are known to have increased risk for heart disease. We will study children with OSA, and an animal model of the disease during early development, to help clarify how this disease of adulthood actually has its origins in childhood. We have already shown that obese children with obstructive sleep apnea (OSA) are more prone to diabetes (metabolic problems) than those without OSA. More recently, we found that this is also true for children who are not overweight. This early diabetes is known to be to show a future risk for heart disease. This study will examine why OSA in children is linked to metabolic problems. First, we will continue our study in children who are not overweight. We need to study more children to be sure that OSA is truly linked to metabolic problems - whether or not a child is overweight, because this means that children with OSA are at risk for metabolic and future cardiac problems, whether they are overweight or not. Since weight does not usually change after treatment of OSA, we will also study children again, after they have been treated for OSA. We expect to show that treatment of OSA resolves the metabolic problems. Since hypoxia (low oxygen) occurs in OSA we believe that this is the fundamental cause of the metabolic problems. To test whether this is true, we will look for metabolic problems in piglets exposed to similar, low levels of oxygen as those seen in children with OSA, comparing them to piglets that have not been so exposed. We believe that the tendency to develop OSA and diabetes is inherited. To test this, we will study the genes of a very large family whose members have OSA and-or diabetes, and try to find which genes are associated with OSA and with diabetes. This will help determine if the two genes are linked in some way.Read moreRead less
The Effect Of Adenotonsillectomy On Neurocognitive Functioning In Children With Upper Airway Obstruction
Funder
National Health and Medical Research Council
Funding Amount
$185,850.00
Summary
Upper airway obstruction during sleep affects up to 3% of all children and is very frequently unrecognised. If severe it causes growth failure, developmental delay and heart failure. However, there is little information on the effects of less severe degrees of upper airway obstruction in children but recent work suggests that reduced academic performance may also be present in children with relatively mild degrees of upper airway obstruction. In particular, the areas most affected appear to be i ....Upper airway obstruction during sleep affects up to 3% of all children and is very frequently unrecognised. If severe it causes growth failure, developmental delay and heart failure. However, there is little information on the effects of less severe degrees of upper airway obstruction in children but recent work suggests that reduced academic performance may also be present in children with relatively mild degrees of upper airway obstruction. In particular, the areas most affected appear to be intelligence, memory, behaviour and attentional capacity . Currently it is unclear whether these deficits are due to sleep disruption or reduced nocturnal oxygen levels. The treatment of upper airway obstruction is the removal of adenoids and tonsils, however, it is unknown whether or not this improves the child's intellectual capacity. This study aims to be one of the first to critically evaluate the impact of upper airway obstruction during sleep on children's intelligence, memory, behaviour and attentional capacity, and the improvements wrought by the removal of the child's tonsils and adenoids.Read moreRead less
Previous research has shown that SIDS victims have a number of subtle abnormalities that set them apart from the normal population. These include the occurrence of upper airway obstruction in sleep, a reduced ability to awaken from sleep and abnormalities of the automatic control of heart rate and blood pressure in sleep. These body functions are controlled by a component of the brain called the autonomic nervous system which controls the heart and other internal functions by means of nerves cal ....Previous research has shown that SIDS victims have a number of subtle abnormalities that set them apart from the normal population. These include the occurrence of upper airway obstruction in sleep, a reduced ability to awaken from sleep and abnormalities of the automatic control of heart rate and blood pressure in sleep. These body functions are controlled by a component of the brain called the autonomic nervous system which controls the heart and other internal functions by means of nerves called the parasymmpathetic and sympathetic systems. The purpose of this project is to undertake studies of the autonomic system in normal infants and in those infants who are considered to be at risk for SIDS. As SIDS occurs almost exclusively in sleep it is important to study the infant?s heart rate and blood pressure responses to various challenges whilst asleep. All infants (both controls and subjects) enrolled in the protocol will therefore undergo overnight sleep studies during which their automatic responses to a variety of stimuli will be measured. Once we have established the normal response to these stimuli we can then compare them to the results of the at risk group. If, as we anticipate, there is a difference between our at risk group and the normal controls in automatic function then we will measure some of the stress hormones in the body which reflect the function of the autonomic nervous system. If there is a difference in the levels of these hormones between the normal and the at risk groups which correlates with the expected subtle abnormalities in function we may be able to devise an accessible and quantifiable measure for those infants at risk of SIDSRead moreRead less
A Multi-centre, Double-blind, Randomised Controlled Trial To Evaluate The Efficacy Of 10 Valent-pneumococcal-Protein D Conjugate Vaccine In Reducing Respiratory Exacerbations In Children Aged ? 18 Months With Suppurative Lung Disease
Funder
National Health and Medical Research Council
Funding Amount
$1,160,660.00
Summary
Chronic suppurative (ie infected) lung diseases in children are major causes of poor health and deaths worldwide. Repeated childhood infections contribute to poor lung health in adults. The most common organism causing infection is non-typeable Haemophilus influenzae (NTHi). This study aims to determine whether a vaccine against NTHi can reduce repeated respiratory infections in children. If so, vaccination may lead to substantial improvements in current/ future lung health, and considerable dir ....Chronic suppurative (ie infected) lung diseases in children are major causes of poor health and deaths worldwide. Repeated childhood infections contribute to poor lung health in adults. The most common organism causing infection is non-typeable Haemophilus influenzae (NTHi). This study aims to determine whether a vaccine against NTHi can reduce repeated respiratory infections in children. If so, vaccination may lead to substantial improvements in current/ future lung health, and considerable direct and indirect cost of disease savings.Read moreRead less
Postnatal Dexamethasone In Tiny Babies: Does It Do More Good Than Harm?
Funder
National Health and Medical Research Council
Funding Amount
$394,688.00
Summary
The survival rate for tiny or very premature babies has improved dramatically in recent times, from below 10% in the 1960s to greater than 70% in the 1990s. However, some of these babies require prolonged periods of help with breathing and oxygen treatment to survive, and many develop a form of chronic lung disease in the newborn period. A powerful group of drugs, known as corticosteroids, have been used to treat or prevent this chronic lung disease in newborn babies, with some success in shorte ....The survival rate for tiny or very premature babies has improved dramatically in recent times, from below 10% in the 1960s to greater than 70% in the 1990s. However, some of these babies require prolonged periods of help with breathing and oxygen treatment to survive, and many develop a form of chronic lung disease in the newborn period. A powerful group of drugs, known as corticosteroids, have been used to treat or prevent this chronic lung disease in newborn babies, with some success in shortening the time that the babies need help with breathing. However, corticosteroids have the potential to cause long-term harm to the developing baby's brain, and may cause lifelong problems with thinking, walking, talking, seeing or hearing. We want to test in a clinical trial if corticosteroids, specifically dexamethasone, can reduce the need for help with breathing and the rate of chronic lung disease without causing long-term problems to the developing baby's brain. Babies who are very tiny (born weighing less than 1000 g), or born very early (born before 28 weeks of pregnancy, or more than 12 weeks premature) will be eligible for this study if they still need help with their breathing after one week of age from a machine called a respirator, and their doctor considers that corticosteroids might be helpful to the baby's breathing. Some babies will receive dexamethasone and other babies will be treated with a harmless placebo - chance will decide which treatment the baby receives. All other aspects of the babies' care will continue as normally. Children who survive to 2 years of age will be assessed fully to determine if they have any problems with their health, including problems with their thinking, walking, talking, seeing or hearing. We will determine if dexamethasone is helpful or not for very tiny or very premature babies who have breathing problems after the first week of life. We will also measure the economic impact of dexamethasone treatment in these babies.Read moreRead less
Impact Of Sleep Disordered Breathing On Cardiovascular, Behavioural And Neurocognitive Function In Preschool Children
Funder
National Health and Medical Research Council
Funding Amount
$425,703.00
Summary
Studies in school age children have shown that disruption to normal sleep patterns resulting from sleep disordered breathing (SDB) has severe consequences for both the cardiovascular system and neurocognition. To date there have been limited investigations of the effects of SDB in pre-school children despite the knowledge that disruptions to breathing during sleep are maximal at this age and the central nervous system which is immature and developing at this time, is most vulnerable to injury.
Cardiovascular, Neurophysiological And Neurocognitive Assessments To Define Sleep Disordered Breathing In Children
Funder
National Health and Medical Research Council
Funding Amount
$324,008.00
Summary
Disruptions to breathing during sleep (snoring), known as sleep disordered breathing occurs in up to 27% of children and forms a continuum of symptoms ranging from mild to severe. It has previously been thought that only severe disruptions to breathing, as occurs in obstructive sleep apnoea (OSA), were of clinical significance requiring intervention, however recent studies have shown that even snoring with no currently used signs of altered blood oxygenation levels or sleep disruption can have a ....Disruptions to breathing during sleep (snoring), known as sleep disordered breathing occurs in up to 27% of children and forms a continuum of symptoms ranging from mild to severe. It has previously been thought that only severe disruptions to breathing, as occurs in obstructive sleep apnoea (OSA), were of clinical significance requiring intervention, however recent studies have shown that even snoring with no currently used signs of altered blood oxygenation levels or sleep disruption can have a significant impact on daytime functioning and school performance. It is also known that cardiovascular disease is a long-term consequence of untreated sleep disordered breathing in adults, however the long-term effects on the cardiovascular system in children are unknown. This study will examine both the neurocognitive and cardiovascular effects of a range of severities of sleep disordered breathing in children and will identify new more sensitive markers of sleep disruption in order to predict neurocognitive dysfunction. In order to address this most important issue, this project will combine the expertise of scientists and clinicians in the fields of paediatric sleep, cardiovascular control and neuropsychological assessment from Monash and Melbourne Universities, and the Monash Medical Centre and Royal Children's Hospital.Read moreRead less
SCHOOL-AGE OUTCOME FOR VERY TINY/PRETERM CHILDREN BORN IN VICTORIA IN 1991-92
Funder
National Health and Medical Research Council
Funding Amount
$252,956.00
Summary
The survival rate for tiny or very premature babies has improved dramatically in recent times, from below 10% in the 1960s to greater than 70% in the 1990s. Several new treatments have helped to improve their survival rate, but some have the potential to cause long-term harm to the developing baby's brain or lung, and may cause lifelong problems with thinking, walking, talking, seeing, hearing, growth or breathing. Babies who are very tiny (born weighing less than 1000 g), or born very early (bo ....The survival rate for tiny or very premature babies has improved dramatically in recent times, from below 10% in the 1960s to greater than 70% in the 1990s. Several new treatments have helped to improve their survival rate, but some have the potential to cause long-term harm to the developing baby's brain or lung, and may cause lifelong problems with thinking, walking, talking, seeing, hearing, growth or breathing. Babies who are very tiny (born weighing less than 1000 g), or born very early (born before 28 weeks of pregnancy, or more than 12 weeks premature) will be assessed long term (to 8-9 years of age), as broadly as possible, and in comparison with normal birthweight (NBW, birthweight >2499 g) children. Outcomes will encompass academic progress and behaviour, brain function, general health, growth, and respiratory health. We will compare the outcomes for very tiny-preterm children who were treated with several of these new therapies with those who were not so treated. We will assess whether alternative measures of long term outcome that assess the quality of life are applicable to very tiny-preterm children. If so, these measures could be used much more widely, since they are cheaper and less time-consuming.Read moreRead less
Respiratory failure at birth is a major cause of death and disease in newborn infants. At birth the airways must be cleared of liquid to allow the inhalation of air, but, little is known about the process of lung aeration, because it has not been possible to observe or measure it. We have developed imaging and analytical techniques to observed and measure lung aeration. We will determine ventilation procedures that promote uniform lung aeration and minimise lung injury in ventilated infants.