Multimodal Approaches to Understanding Attentional Deficits in Pediatric Sleep Disordered Breathing

PROGRAM DESCRIPTION: Sleep disordered breathing (SDB) affects up to 10% of children, with profound impacts on attention and behavior that can persist after surgical intervention. This session examines the neurobiological basis of attention deficits in pediatric SDB through a multimodal lens, integrating functional near-infrared spectroscopy (fNIRS), structural/functional MRI, standardized cognitive testing, and parent-reported outcomes. We present findings from a unique NIH-funded research program that combines these complementary neuroimaging techniques with deep learning analysis of upper airway anatomy to understand brain-behavior relationships in SDB. We identify robust biomarkers that generalize across diverse patient populations by analyzing relationships between anatomical features and neural activation patterns. We reveal mechanistic insights that inform clinical assessment and therapeutic approaches by linking sleep architecture to brain structure, function, and behavioral manifestations. This integrated understanding of neurobehavioral outcomes provides new insights for otolaryngologists managing pediatric SDB, enabling more precise patient selection and outcome prediction for surgical intervention.

OUTCOME OBJECTIVE 1: Evaluate functional near-infrared spectroscopy (fNIRS) as a clinical neuroimaging tool for assessing real-time brain activation and attention in children with sleep disordered breathing, leveraging its high temporal resolution and child-friendly design.

OUTCOME OBJECTIVE 2: Analyze relationships between upper airway anatomy and brain outcomes using deep learning and MRI to identify robust population-based biomarkers that predict neurobehavioral outcomes in pediatric sleep disordered breathing.

OUTCOME OBJECTIVE 3: Analyze clinical, anatomical, and neurobiological features using data-driven feature selection methods to identify key predictive markers for surgical success in pediatric sleep disordered breathing.

BACKGROUND STATEMENT: Despite interventions, children with SDB continue to show attention deficits. Current approaches lack objective markers to predict neurobehavioral outcomes. We address this gap using novel imaging-based multimodal approaches to enhance surgical decision-making and outcome prediction.

Comprehensive Otolaryngology Track Statement : While not submitted under the comprehensive track, this session addresses a significant component of comprehensive otolaryngology practice. SDB and associated attention deficits represent a considerable portion of our practice, from initial evaluation to post-surgical follow-up.