Caffeine for Apnea of Prematurity-Sleep (CAP-S) Study
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Purpose
Apnea of prematurity is a common condition that is usually treated with methylxanthines. Methylxanthines are adenosine receptor blockers that have powerful influences on the central nervous system. However, little is known about the long-term effects of methylxanthines on the developing brain.
The Caffeine for Apnea of Prematurity-Sleep (CAP-S) Study is a sub-study of the main Caffeine for Apnea of Prematurity (CAP) trial, an international placebo-controlled randomized trial of methylxanthine therapy for apnea of prematurity. This sub-study is designed to take advantage of this cohort of ex-premature, 5-7 year old children who were randomized at birth to receive either caffeine or placebo, and are currently receiving detailed neurocognitive and behavioral assessments in the CAP trial.
| Condition | Intervention | Phase |
|---|---|---|
|
Apnea of Prematurity |
Drug: Caffeine citrate injection Drug: placebo |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment |
| Official Title: | Long-Term Effects On Sleep Of Methylxanthine Therapy For Apnea Of Prematurity |
- Aim 1: The primary outcome is the mean actual sleep time as measured by actigraphy, between subjects who received caffeine vs placebo. [ Time Frame: 5-7 years ] [ Designated as safety issue: No ]
- Aim 2: The primary outcome is the apnea hypopnea index (AHI) between subjects who received caffeine vs placebo. [ Time Frame: 5-7 years ] [ Designated as safety issue: No ]
- Aim 3: The primary outcome is the correlation between full-scale IQ from the Wechsler Preschool and Primary Scale of Intelligence (measured in the CAP trial rather than directly from this protocol), sleep time and AHI. [ Time Frame: 5-7 years ] [ Designated as safety issue: No ]
- Questionnaire data: National Sleep Foundation (NSF) and Pediatric Sleep Questionnaire (PSQ) scores [ Time Frame: 5-7 years ] [ Designated as safety issue: No ]
- Polysomnography data: Sleep architecture, arousal index, central apnea index, SpO2 and periodic limb movement index. [ Time Frame: 5-7 years ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 200 |
| Study Start Date: | November 2009 |
| Estimated Study Completion Date: | July 2013 |
| Estimated Primary Completion Date: | July 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Active Comparator: caffeine |
Drug: Caffeine citrate injection
Loading dose: 20 mg/kg administered over at least 30 minutes via IV infusion or over at least 10 minutes via slow IV injection. Daily maintenance dose (to commence at least 24 hours after loading dose): 5 mg/kg, administered over at least 10 minutes via IV infusion, or over at least 5 minutes via slow IV injection. Maintenance dose to be adjusted for body weight every 7 days. If indicated, maintenance dose may be increased to a maximum of 10 mg/kg. May be given orally once full enteral feeds are established. Duration of treatment: discontinue after infant has tolerated at least 5 consecutive days without positive pressure support AND when the infant is judged by the attending clinician to be no longer a candidate for methylxanthine therapy. Other Name: CafCit
|
| Placebo Comparator: placebo |
Drug: placebo
normal saline
|
Detailed Description:
The use of methylxanthines as therapy for apnea of prematurity may be a double-edged sword. Although widely-used, and efficacious for treatment of apnea of prematurity, long-term drug effects have not been rigorously studied. Neonatal methylxanthine therapy may have long-term impacts on sleep organization and ventilatory control. The CAP trial, funded by the Canadian Institutes of Health Research, was initiated due to the paucity of well-controlled data on the long-term effects of methylxanthines in preterm infants. The initial CAP trial was a multicenter, randomized, placebo-controlled trial of caffeine vs placebo as treatment for apnea of prematurity with follow-up to a corrected age of 18 months. 2,006 infants were enrolled. The CAP trial found that methylxanthines reduced the rates of bronchopulmonary dysplasia (BPD) and cerebral palsy (CP), and did not affect mortality. However, concerns remain regarding long-term sequelae of methylxanthine use. The Canadian Institutes of Health Research have therefore funded further follow-up of the entire CAP trial cohort to age 5 years, corrected for prematurity. The key objectives of this study are to examine the impact of methylxanthines on neurocognition and behavior. This ongoing parent study provides an opportunity to determine potential long-term effects of methylxanthines on sleep disorders, and to correlate these findings with daytime functioning. Our overall hypothesis is that methylxanthine use in preterm infants, while beneficial in the short term, results in longstanding abnormalities in the regulation of sleep, and breathing during sleep.
Eligibility| Ages Eligible for Study: | 5 Years to 7 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Males or females aged 5-7 years who are enrolled in the CAP trial.
- Parental/guardian permission (informed consent) and if appropriate, child assent.
Contacts and Locations| Contact: Carole L Marcus, MBBCh | 267-426-5842 | marcus@email.chop.edu |
| Contact: Barbara K Schmidt, MD,MSc | 215-662-3228 | barbara.schmidt@uphs.upenn.edu/schmidt@mcmaster.ca |
| Australia | |
| Royal Women's Hospital | Recruiting |
| Melbourne, Australia | |
| Contact: Lex Doyle, MD lwd@unimelb.edu.au | |
| Principal Investigator: Lex Doyle, MD | |
| Mercy Hospital for Women | Recruiting |
| Melbourne, Australia | |
| Contact: Gillian Opie, MD gopie@mercy.com.au | |
| Principal Investigator: Gillian Opie, MD | |
| Canada, Ontario | |
| McMaster University Medical Centre | Recruiting |
| Hamilton, Ontario, Canada, L8S 4J9 | |
| Contact: Joanne Dix dix@hhsc.ca | |
| Principal Investigator: Joanne Dix | |
| Sunnybrook Health Sciences Centre | Recruiting |
| Toronto, Ontario, Canada, M5S 1B2 | |
| Contact: Elizabeth Asztalos, MD elizabeth.asztalos@sunnybrook.ca | |
| Principal Investigator: Elizabeth Asztalos, MD | |
| Principal Investigator: | Carole Marcus, M.B.B.Ch. | University of Pennsylvania |
More Information
Publications:
| Responsible Party: | McMaster University |
| ClinicalTrials.gov Identifier: | NCT01020357 History of Changes |
| Other Study ID Numbers: | NIH-R01HL098045, R01HL098045 |
| Study First Received: | November 24, 2009 |
| Last Updated: | May 15, 2013 |
| Health Authority: | Canada: Health Canada |
Keywords provided by McMaster University:
|
preterm infants very low birthweight apnea of prematurity methylxanthines |
sleep disturbance obstructive sleep apnea syndrome polysomnography sleep disruption |
Additional relevant MeSH terms:
|
Apnea Respiration Disorders Respiratory Tract Diseases Signs and Symptoms, Respiratory Signs and Symptoms Caffeine Caffeine citrate Central Nervous System Stimulants Physiological Effects of Drugs Pharmacologic Actions |
Central Nervous System Agents Therapeutic Uses Phosphodiesterase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Purinergic P1 Receptor Antagonists Purinergic Antagonists Purinergic Agents Neurotransmitter Agents |
ClinicalTrials.gov processed this record on May 23, 2013