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Landry V, Semsar-Kazerooni K, Chen T, Gurberg J, Nguyen LHP, Constantin E. Diagnostic accuracy of portable sleep monitors in pediatric sleep apnea: A systematic review. Sleep Med Rev 2024; 78:101991. [PMID: 39173472 DOI: 10.1016/j.smrv.2024.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/01/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
In recent years, a plethora of new type III and IV portable sleep monitors (PSM) have been developed, although evidence regarding their diagnostic accuracy for use in children remains heterogeneous. This study systematically reviews the literature addressing the diagnostic accuracies of type III and IV PSM for pediatric sleep apnea. Publications indexed in Medline, Embase, or Web of Science were reviewed using the PRISMA framework. Of 1054 studies, 62 fulfilled the inclusion criteria. Of the studies evaluating oximetry-based type IV PSM, one (6.25 %) demonstrated a balanced set of high (≥80 %) sensitivities and specificities for the diagnosis of any pediatric sleep apnea, while five studies (27.8 %) showed similar accuracies for moderate-to-severe sleep apnea. For non-oximetry-based type IV PSM, two studies (40 %) reported a balanced set of high diagnostic accuracies for moderate-to-severe sleep apnea. Type III PSM repeatedly demonstrated higher diagnostic accuracies, with six studies (66.7 %) reporting a balanced set of high diagnostic accuracies for moderate-to-severe sleep apnea. This review highlights the potential of type III PSM to detect moderate-to-severe pediatric sleep apnea, although current evidence is limited to support the stand-alone use of type IV PSM for the diagnosis of sleep apnea in most children.
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Affiliation(s)
- Vivianne Landry
- Division of Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, QC, Canada
| | | | - Tanya Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Joshua Gurberg
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Evelyn Constantin
- Department of Pediatrics, Pediatric Sleep Medicine, McGill University, Montreal, QC, Canada.
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2
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Al Mawla M, Chaccour K, Fares H. A Novel Enhancement Approach Following MVMD and NMF Separation of Complex Snoring Signals. IEEE Trans Biomed Eng 2024; 71:494-503. [PMID: 37616136 DOI: 10.1109/tbme.2023.3308296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Snoring is a prominent characteristic of sleep-disordered breathing, and its detection is critical for determining the severity of the upper airway obstruction and improving daily quality of life. Home snoring analysis is a highly invasive method, but it becomes challenging when a sleeping partner also snores, leading to distorted evaluations in such environments. In this article, we tackle the problem of complex snore signal separation of multiple snorers. This article introduces two audio-based methods that efficiently extract an individual's snoring signal, allowing for the analysis of sleep-breathing disorders in a normal sleeping environment without isolating individuals. In the first method, Principal Component Analysis (PCA) identifies the source components from the finite number of modes generated by the decomposition of the snoring mixture using Multivariate Variational Mode Decomposition (MVMD). The second method applies Blind Source Separation (BSS) based on Non-Negative Matrix Factorization (NMF) to separate the single-channel snoring mixture. Furthermore, the decomposed signals are tuned using the iterative enhancement algorithm to adequately match the source snoring signals. These methods were evaluated by simulating various real-time snoring recordings of 7 subjects (2 men, 2 women, and 3 children). The correlation coefficient between the source and its separated signal was computed to assess the separation results, exhibiting good performance of the methods used. The enhancement approach also demonstrated its efficiency by increasing the correlation over to 80% in both methods. The experimental results show that the proposed algorithms are effective and practical for separating mixed snoring signals.
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Teplitzky TB, Zauher AJ, Isaiah A. Alternatives to Polysomnography for the Diagnosis of Pediatric Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:diagnostics13111956. [PMID: 37296808 DOI: 10.3390/diagnostics13111956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Diagnosis of obstructive sleep apnea (OSA) in children with sleep-disordered breathing (SDB) requires hospital-based, overnight level I polysomnography (PSG). Obtaining a level I PSG can be challenging for children and their caregivers due to the costs, barriers to access, and associated discomfort. Less burdensome methods that approximate pediatric PSG data are needed. The goal of this review is to evaluate and discuss alternatives for evaluating pediatric SDB. To date, wearable devices, single-channel recordings, and home-based PSG have not been validated as suitable replacements for PSG. However, they may play a role in risk stratification or as screening tools for pediatric OSA. Further studies are needed to determine if the combined use of these metrics could predict OSA.
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Affiliation(s)
- Taylor B Teplitzky
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Audrey J Zauher
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Kissow Lildal T, Boudewyns A, Kamperis K, Rittig S, Bertelsen JB, Otto M, Nørregaard O, Ovesen T. Validity of in-lab and home respiratory polygraphy for detecting obstructive sleep apnea in children. Sleep Med 2023; 103:195-203. [PMID: 36857990 DOI: 10.1016/j.sleep.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Tina Kissow Lildal
- University Clinic for Balance, Flavour and Sleep, ENT Department, Gødstrup Hospital, Herning, Denmark; Department of Otorhinolaryngology Head & Neck Surgery, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - An Boudewyns
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Faculty of Medicine and Translational Neurosciences, Antwerp, Belgium
| | | | - Søren Rittig
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jannik B Bertelsen
- University Clinic for Balance, Flavour and Sleep, ENT Department, Gødstrup Hospital, Herning, Denmark
| | - Marit Otto
- Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Nørregaard
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Therese Ovesen
- University Clinic for Balance, Flavour and Sleep, ENT Department, Gødstrup Hospital, Herning, Denmark
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Pedersen MJ, Leonthin H, Mahler B, Rittig S, Jennum PJ, Kamperis K. Two nights of home polysomnography in healthy 7-14-year-old children - Feasibility and intraindividual variability. Sleep Med 2023; 101:87-92. [PMID: 36368073 DOI: 10.1016/j.sleep.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Attended polysomnography (PSG) is the gold standard for childhood sleep evaluation. There is, however, only limited information regarding repeated ambulatory PSG in children. We aimed to test whether in hospital attached level 2 home PSG is feasible and reproducible in healthy children. METHODS We recruited healthy children aged 7-14 years to undergo two nights of full level 2 PSG. The PSG equipment was attached at the hospital on the day of the sleep test and all recordings were performed at home. Subjective sleep quality, nocturnal urine production, sleep time and number of awakenings were documented for a week in connection to the first PSG night. RESULTS Thirty-three children were recruited of whom 32 children (aged 11 ± 2.1 years) underwent two nights of PSG. All 64 PSGs were technically adequate for sleep evaluation. We found mean sleep efficiency of 94% and mean total sleep time of 8.4 h. Sleep stages distribution with 5.9% N1, 46.8% N2, 24.3% N3 and 22.8% REM sleep. We found poorer subjective sleep quality, more self-reported awakenings, and shorter total sleep time on nights with PSG compared to nights without PSG with no differences between PSG study nights. No differences in nocturnal urine production were found between nights with and without PSG. The comparison of PSG variables between the two PSG nights revealed no first night effect. CONCLUSIONS Type 2 PSG recording is feasible for sleep evaluation in children 7-14 years of age producing good data quality. We found no first night effect on PSG variables. www. CLINICALTRIALS gov Registration number: NCT03477812.
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Affiliation(s)
| | - Helle Leonthin
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Birgitte Mahler
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Søren Rittig
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Konstantinos Kamperis
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark
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6
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Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Jiang W, Bhattacharjee R, Nation J, Brigger MT. Completion of postoperative polysomnography for children with severe obstructive sleep apnea: A quality improvement project. Laryngoscope Investig Otolaryngol 2022; 7:1667-1674. [PMID: 36258867 PMCID: PMC9575080 DOI: 10.1002/lio2.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/16/2022] [Accepted: 07/23/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Pediatric patients with severe obstructive sleep apnea (OSA) are at risk for residual OSA following tonsillectomy with/without adenoidectomy (T ± A). We initiated a quality improvement (QI) project to increase the percentage of postoperative (postop) polysomnography (PSG) completion to identify residual OSA. Methods This is a prospective QI project carried out at a tertiary pediatric academic hospital. Children ≤18 years of age who underwent T ± A for severe OSA were included. Our Specific, Measurable, Attainable, Relevant, and Time-based (SMART) aim was to increase the percentage of completed postop PSGs in this cohort from a baseline of 70% to95% by May 31, 2021. We focused on patient education and leveraged both clinical decision support and reporting functionalities of the electronic medical record for project implementation. Results During the pre-intervention period between January 1, 2019 to June 30, 2020, 472 patients met the inclusion criteria with an average age of 8.6 years (SD 4.6). The rate of postop PSG completion was 69.7% (SD 11.4%) with an average time of 99 days (SD 66) between surgery and the postop PSG. A shift was observed starting in September 2020, and the PSG completion rate improved to 94.9% by September 30, 2021. Post-intervention, there were 178 patients with an average age of 9.3 years (SD 4.9). The average time between surgery and the postop PSG was significantly reduced to 57 days (SD 16; p < .001). Conclusions Through a multidisciplinary approach, we successfully completed our SMART aim. With the establishment of QI infrastructure, our goal is to deliver better care in a sustainable fashion using QI methodology.
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Affiliation(s)
- Wen Jiang
- Department of OtolaryngologyUniversity of California San DiegoSan DiegoCaliforniaUSA
- Rady Children's Hospital in San DiegoSan DiegoCaliforniaUSA
| | - Rakesh Bhattacharjee
- Rady Children's Hospital in San DiegoSan DiegoCaliforniaUSA
- Division of Respiratory Medicine, Department of PediatricsUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Javan Nation
- Department of OtolaryngologyUniversity of California San DiegoSan DiegoCaliforniaUSA
- Rady Children's Hospital in San DiegoSan DiegoCaliforniaUSA
| | - Matthew T. Brigger
- Department of OtolaryngologyUniversity of California San DiegoSan DiegoCaliforniaUSA
- Rady Children's Hospital in San DiegoSan DiegoCaliforniaUSA
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8
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Nassi TE, Ganglberger W, Sun H, Bucklin AA, Biswal S, van Putten MJAM, Thomas RJ, Westover MB. Automated Scoring of Respiratory Events in Sleep With a Single Effort Belt and Deep Neural Networks. IEEE Trans Biomed Eng 2022; 69:2094-2104. [PMID: 34928786 PMCID: PMC9119908 DOI: 10.1109/tbme.2021.3136753] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Automatic detection and analysis of respiratory events in sleep using a single respiratoryeffort belt and deep learning. METHODS Using 9,656 polysomnography recordings from the Massachusetts General Hospital (MGH), we trained a neural network (WaveNet) to detect obstructive apnea, central apnea, hypopnea and respiratory-effort related arousals. Performance evaluation included event-based analysis and apnea-hypopnea index (AHI) stratification. The model was further evaluated on a public dataset, the Sleep-Heart-Health-Study-1, containing 8,455 polysomnographic recordings. RESULTS For binary apnea event detection in the MGH dataset, the neural network obtained a sensitivity of 68%, a specificity of 98%, a precision of 65%, a F1-score of 67%, and an area under the curve for the receiver operating characteristics curve and precision-recall curve of 0.93 and 0.71, respectively. AHI prediction resulted in a mean difference of 0.41 ± 7.8 and a r2 of 0.90. For the multiclass task, we obtained varying performances: 84% of all labeled central apneas were correctly classified, whereas this metric was 51% for obstructive apneas, 40% for respiratory effort related arousals and 23% for hypopneas. CONCLUSION Our fully automated method can detect respiratory events and assess the AHI accurately. Differentiation of event types is more difficult and may reflect in part the complexity of human respiratory output and some degree of arbitrariness in the criteria used during manual annotation. SIGNIFICANCE The current gold standard of diagnosing sleep-disordered breathing, using polysomnography and manual analysis, is time-consuming, expensive, and only applicable in dedicated clinical environments. Automated analysis using a single effort belt signal overcomes these limitations.
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Griffiths A, Mukushi A, Adams AM. Telehealth-supported level 2 pediatric home polysomnography. J Clin Sleep Med 2022; 18:1815-1821. [PMID: 35393937 DOI: 10.5664/jcsm.9982] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The gold standard for diagnosis of pediatric obstructive sleep apnea is level 1 polysomnography (PSG). Some children are selected for unattended level 2 home sleep apnea testing (HSAT) with telehealth support, and we sought to review this home service. METHODS A retrospective audit was conducted from 2013 to 2020. All level 2 HSAT reports in children aged 5-18 years referred for suspected OSA were analyzed. American Academy of Sleep Medicine compliant portable PSG acquisition equipment with EEG was used. The primary outcome was the proportion of technically successful tests achieved, and of these the % with potential underestimation of diagnostic category. Secondary outcomes included sleep quality and parental acceptance by non-validated service-specific questionnaire. Data were analyzed using descriptive & inferential statistics. χ² tests were used for categorical variables. RESULTS There were 233 (139 male, 59.6%) patients studied between 2013 and 2020 (7 years). The mean age was 10.8 (SD 3.6) years. 67 patients (28.8%) had comorbidities. Technically successful studies were obtained in almost 90% (209/233) and failed studies occurred in just over 10% (24/233). One failed study still achieved a diagnosis. There was no significant difference between failed studies set up by HITH nurses compared with Sleep scientists (p=0.2). Overall, an accurate diagnosis was made in 80% (167/209) of patients, with potential for under-estimation in 20% (42/209). Six hours or more of sleep was obtained in 89.5%. Parental questionnaires revealed 89.3% perceived high-level care, 91% perceived increased convenience and 76% good/excellent telehealth support. CONCLUSIONS Telehealth-supported pediatric HSAT achieves technical success in almost 90% of patients investigated for OSA, with 89.5% achieving ≥6 hours sleep duration, and excellent family acceptability.
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Affiliation(s)
- Amanda Griffiths
- Sleep Unit, Department of Respiratory & Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Department of Paediatrics, Melbourne, Australia
| | - Amanda Mukushi
- Oximetry and Sleep Services, Department of Respiratory & Sleep Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Anne-Marie Adams
- Sleep Unit, Department of Respiratory & Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Department of Paediatrics, Melbourne, Australia
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10
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Improved diagnostic accuracy for pediatric obstructive sleep apnea using an out-of-center sleep test. Auris Nasus Larynx 2022; 49:980-985. [DOI: 10.1016/j.anl.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/24/2022] [Accepted: 03/04/2022] [Indexed: 11/20/2022]
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Withers A, Maul J, Rosenheim E, O’Donnell A, Wilson A, Stick S. Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children. J Clin Sleep Med 2022; 18:393-402. [PMID: 34323688 PMCID: PMC8804994 DOI: 10.5664/jcsm.9576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES To compare type 2 polysomnography (T2PSG) to the gold standard type 1 in-laboratory polysomnography (T1PSG) for diagnosing obstructive sleep apnea (OSA) in children; validate home T2PSG in children with suspected OSA. METHODS Eighty-one participants (ages 6-18) with suspected OSA had simultaneous T1PSG and T2PSG in the sleep laboratory, 47 participants (ages 5-16) had T1PSG in the sleep laboratory and T2PSG performed at home. Sleep scientists staged and scored polysomnography data, and pediatric sleep physicians assigned a diagnosis of normal or OSA. Participant demographics, polysomnography variables, and diagnoses were compared using chi-square and Fisher's exact tests for nominal variables, t test for continuous variables and Cohen's kappa to assess concordance. RESULTS Acceptable recordings were obtained for every home T2PSG. When T1PSG and T2PSG were simultaneous, correlation between the number of arousals, respiratory disturbance index, and sleep stages was excellent. T2PSG at home demonstrated less stage 2 sleep, more rapid eye movement sleep, and higher sleep efficiency. Comparison of home T2PSG to T1PSG for diagnosing OSA showed a false-positive rate of 6.6% and false-negative rate of 3% for those performed at home. CONCLUSIONS T2PSG in the home is feasible with excellent concordance with T1PSG for the purposes of diagnosing OSA in children aged 5-18 years. Home T2PSG may be more representative of a "normal" night for children and could benefit those suspected of having OSA by reducing waiting times for laboratory PSG, improving access to PSG and possibly reducing costs of investigating and treating OSA. CITATION Withers A, Maul J, Rosenheim E, O'Donnell A, Wilson A, Stick S. Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children. J Clin Sleep Med. 2022;18(2):393-402.
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Affiliation(s)
- Adelaide Withers
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia,Telethon Kids Institute, Perth, Western Australia, Australia,Wal-yan Respiratory Research Centre, Perth, Western Australia, Australia,Curtin University, Perth, Western Australia, Australia,Address correspondence to: Adelaide Withers, MBBS, Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Hospital Ave, Nedlands WA 6009, Australia;
| | - Jennifer Maul
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
| | | | - Anne O’Donnell
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Andrew Wilson
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia,Telethon Kids Institute, Perth, Western Australia, Australia,Curtin University, Perth, Western Australia, Australia,Division of Paediatrics and Child Health, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Stephen Stick
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia,Telethon Kids Institute, Perth, Western Australia, Australia,Wal-yan Respiratory Research Centre, Perth, Western Australia, Australia,Division of Paediatrics and Child Health, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia,University of Western Australia, Perth, Western Australia, Australia
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12
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Donskoy I, Loghmanee D, Fields BG, Troester M, Martin W. Telemedicine-based sleep services for a complex child: optimizing care during a pandemic and beyond. J Clin Sleep Med 2022; 18:325-327. [PMID: 34402782 PMCID: PMC8807920 DOI: 10.5664/jcsm.9616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 12-year-old male with nonverbal autism and morbid obesity was referred to a pediatric sleep center during the SARS-CoV-2 pandemic for complaints of snoring with tonsillar hypertrophy and difficulty falling asleep. Due to social challenges, the family had not sought in-person care in the past. Through telemedicine consultation and home sleep apnea testing, the patient was diagnosed with obstructive sleep apnea as well as an irregular sleep-wake disorder. This unique utilization of the health care system in the care of a complex patient with multiple sleep disorders demonstrates the utility of remote care and testing. There is a great benefit to continuing to provide pediatric sleep care in this way beyond the pandemic.
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Affiliation(s)
- Innessa Donskoy
- Advocate Children’s Hospital, Park Ridge, Illinois;,Address correspondence to: Innessa Donskoy, MD, FAAP, FAASM, 1675 Dempster Street, Park Ridge, IL 60068;
| | | | - Barry G. Fields
- Emory University School of Medicine, Atlanta, Georgia;,Atlanta VA Medical Center, North Druid Hills, Georgia
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13
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Abstract
Digital phenotyping (DP) provides opportunities to study child and adolescent psychiatry from a novel perspective. DP combines objective data obtained from digital sensors with participant-generated "active data," in order to understand better an individual's behavior and environmental interactions. Although this new method has led to advances in adult psychiatry, its use in child psychiatry has been more limited. This review aims to demonstrate potential benefits of DP methodology and passive data collection by reviewing studies specifically in child and adolescent psychiatry. Twenty-six studies were identified that collected passive data from four different categories: accelerometer/actigraph data, physiological data, GPS data, and step count. Study topics ranged from the associations between manic symptomology and cardiac parameters to the role of daily emotions, sleep, and social interactions in treatment for pediatric anxiety. Reviewed studies highlighted the diverse ways in which objective data can augment naturalistic self-report methods in child and adolescent psychiatry to allow for more objective, ecologically valid, and temporally resolved conclusions. Though limitations exist-including a lack of participant adherence and device failure and misuse-DP technology may represent a new and effective method for understanding pediatric cognition, behavior, disease etiology, and treatment efficacy.
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14
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Najjar M. The Utility of Recording Submental Electrical Activity in Polysomnography. Cureus 2021; 13:e17216. [PMID: 34540443 PMCID: PMC8442570 DOI: 10.7759/cureus.17216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/06/2022] Open
Abstract
Background Polysomnography is widely utilized as a diagnostic tool in sleep medicine. It is used to diagnose a variety of sleep disorders, including obstructive and central sleep apnea, periodic limb movements, parasomnia, and other sleep disorders. The objective of this study is to discuss the utility of recording submental electrical activity as a tool that provides the additional information needed in producing accurate results of a polysomnogram and emphasize the importance of including this recording in home sleep apnea tests. Methods A total of 1472 consecutive polysomnograms were used to assess the usefulness of submental activity in contributing to the accurate reporting of polysomnographic findings. These records were gathered over a one-year period at a major academic sleep center. Results Some of the observed electrical activities in the submental area are rare, although they may be important in confirming the findings of the polysomnogram or provide additional information. Adding an electroencephalographic channel and submental electromyographic recording is likely to increase the accuracy of home sleep apnea tests. Conclusions Recording of submental electrical activity is an integral part of polysomnography and provides more information than just recording the muscle tone of the submental area and is important in increasing the accuracy of home sleep apnea tests.
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Affiliation(s)
- Muhammad Najjar
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
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15
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Gozal D, Ismail M, Brockmann PE. Alternatives to surgery in children with mild OSA. World J Otorhinolaryngol Head Neck Surg 2021; 7:228-235. [PMID: 34430830 PMCID: PMC8356096 DOI: 10.1016/j.wjorl.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/17/2021] [Accepted: 03/18/2021] [Indexed: 12/01/2022] Open
Abstract
Precision medicine requires coordinated and integrated evidence-based combinatorial approaches so that diagnosis and treatment can be tailored to the individual patient. In this context, the treatment approach to mild obstructive sleep apnea (OSA) is fraught with substantial debate as to what is mild OSA, and as to what constitutes appropriate treatment. As such, it is necessary to first establish a proposed consensus of what criteria need to be employed to reach the diagnosis of mild OSA, and then examine the circumstances under which treatment is indicated, and if so, whether and when anti-inflammatory therapy (AIT), rapid maxillary expansion (RME), and/or myofunctional therapy (MFT) may be indicated.
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Affiliation(s)
- David Gozal
- Department of Child Health and Child Health Research Institute, and MU Women and Children's Hospital, University of Missouri School of Medicine, Columbia, MO, USA
| | - Mahmoud Ismail
- Department of Neurology and Sleep Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Pablo E Brockmann
- Department of Pediatric Cardiology and Pulmonology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Pediatric Sleep Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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16
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Oceja E, Rodríguez P, Jurado MJ, Luz Alonso M, del Río G, Villar MÁ, Mediano O, Martínez M, Juarros S, Merino M, Corral J, Luna C, Kheirandish-Gozal L, Gozal D, Durán-Cantolla J. Validity and Cost-Effectiveness of Pediatric Home Respiratory Polygraphy for the Diagnosis of Obstructive Sleep Apnea in Children: Rationale, Study Design, and Methodology. Methods Protoc 2021; 4:9. [PMID: 33477929 PMCID: PMC7838960 DOI: 10.3390/mps4010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) in children is a prevalent, albeit largely undiagnosed disease associated with a large spectrum of morbidities. Overnight in-lab polysomnography remains the gold standard diagnostic approach, but is time-consuming, inconvenient, and expensive, and not readily available in many places. Simplified Home Respiratory Polygraphy (HRP) approaches have been proposed to reduce costs and facilitate the diagnostic process. However, evidence supporting the validity of HRP is still scarce, hampering its implementation in routine clinical use. The objectives were: Primary; to establish the diagnostic and therapeutic decision validity of a simplified HRP approach compared to PSG among children at risk of OSA. Secondary: (a) Analyze the cost-effectiveness of the HRP versus in-lab PSG in evaluation and treatment of pediatric OSA; (b) Evaluate the impact of therapeutic interventions based on HRP versus PSG findings six months after treatment using sleep and health parameters and quality of life instruments; (c) Discovery and validity of the urine biomarkers to establish the diagnosis of OSA and changes after treatment.
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Affiliation(s)
- Esther Oceja
- Domiciliary Hospitalization, Sleep Unit, OSI Araba University Hospital, 01004 Vitoria, Spain;
| | - Paula Rodríguez
- Research Service and Bioaraba Research Institute, OSI Araba University Hospital, UPV/EHU, 01004 Vitoria, Spain;
| | - María José Jurado
- Sleep Unit, Hospital Universitario Valle de Hebrón, 08035 Barcelona, Spain;
| | - Maria Luz Alonso
- Sleep Unit, Complejo Hospitalario de Burgos, 09006 Burgos, Spain
| | | | | | - Olga Mediano
- Sleep Unit, Hospital de Guadalajara, 19002 Guadalajara, Spain;
| | - Marian Martínez
- Sleep Unit, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Santiago Juarros
- Sleep Unit, Hospital Universitario de Valladolid, 47012 Valladolid, Spain;
| | - Milagros Merino
- Sleep Unit, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Jaime Corral
- Sleep Unit, Complejo Hospitalario de Cáceres, 100003 Cáceres, Spain;
| | - Carmen Luna
- Sleep Unit, Hospital Universitario 12 de Octubre, 280035 Madrid, Spain;
| | - Leila Kheirandish-Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65201, USA; (L.K.-G.); (D.G.)
| | - David Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65201, USA; (L.K.-G.); (D.G.)
| | - Joaquín Durán-Cantolla
- Research Service and Bioaraba Research Institute, OSI Araba University Hospital, UPV/EHU, 01004 Vitoria, Spain;
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17
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Ferry AM, Wright AE, Ohlstein JF, Khoo K, Pine HS. Efficacy of a Pediatric Sleep Questionnaire for the Diagnosis of Obstructive Sleep Apnea in Children. Cureus 2020; 12:e12244. [PMID: 33500863 PMCID: PMC7819429 DOI: 10.7759/cureus.12244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/23/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a source of significant morbidity in children. Polysomnography (PSG), the gold standard diagnostic tool for OSA, is often unavailable due to patient financial and geographic constraints. Our objective is to analyze the relationship between a patient's subjective complaints and the results from their PSG to determine the diagnostic value of the Pediatric Sleep Questionnaire (PSQ) for detecting OSA in children. METHODS A retrospective chart review was conducted for pediatric patients with suspected OSA from March 2012 to January 2014. Preoperative PSQ scores were compared with the results from PSG in the form of Apnea-Hypopnea Index (AHI) and Respiratory Disturbance Index (RDI) values. AHI and RDI values ranging from 1 to 5 were classified as mild OSA while values ranging from 5 to 10 were classified as moderate OSA. RESULTS A total of 161 patients were recruited for this study with 63 patients (39%) both completing the PSQ and undergoing PSG. Sensitivity of the positive questionnaire was higher in patients with AHI and RDI values indicative of moderate OSA (95% and 100% respectively) versus values indicative of mild OSA (83% and 86% respectively). Conversely, the positive predictive value of the positive questionnaire (n=49) was lower in patients with AHI and RDI values indicative of moderate OSA (39% and 46% respectively) versus values indicative of mild OSA (70% and 80% respectively). CONCLUSION The PSQ has high diagnostic value for screening patients with suspected OSA. We recommend the use of the PSQ in the primary care setting for children with suspected OSA.
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Affiliation(s)
- Andrew M Ferry
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Alex E Wright
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Jason F Ohlstein
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Kim Khoo
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
| | - Harold S Pine
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, USA
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18
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Van Steenkiste T, Groenendaal W, Dreesen P, Lee S, Klerkx S, de Francisco R, Deschrijver D, Dhaene T. Portable Detection of Apnea and Hypopnea Events Using Bio-Impedance of the Chest and Deep Learning. IEEE J Biomed Health Inform 2020; 24:2589-2598. [DOI: 10.1109/jbhi.2020.2967872] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Ioan I, Weick D, Schweitzer C, Guyon A, Coutier L, Franco P. Feasibility of parent-attended ambulatory polysomnography in children with suspected obstructive sleep apnea. J Clin Sleep Med 2020; 16:1013-1019. [PMID: 32056538 PMCID: PMC7954050 DOI: 10.5664/jcsm.8372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Due to a limited number of pediatric sleep centers, the aim was to test the feasibility of ambulatory polysomnography (PSG-home) in a group of French children suspected of OSA. METHODS Children undergoing one-night PSG-home, with the device installed at the pediatric sleep physician's office, were prospectively included. General failure was considered when PSG-home recording captured < 5 h of artifact-free sleep or when ≥ 1 channel (nasal flow, thoraco-abdominal belts, oximetry) presented artifacts > 75% of the recording time. No-OSA was defined as an obstructive apnea-hypopnia index (OAHI) < 1 event/h and respiratory-related arousals index (RAI) < 1 event/h. OSA was defined as upper airways resistance syndrome (UARS) with OAHI < 1 event/h with RAI ≥ 1 event/h, or mild OSA (OAHI ≥ 1 event/h-5 events/h), moderate OSA (OAHI ≥ 5 events/h-10 events/h), or severe OSA (OAHI ≥ 10 events/h). Parents completed a severity hierarchy score questionnaire, Conners Parent Rating Scale, and an adapted Epworth Sleepiness Scale. RESULTS Fifty-seven children aged 3 through 16 years were included. PSG-home was technically acceptable in 46 (81%). Failure due to nasal cannula was observed in 11% (n = 6), oximetry in 7% (n = 4), and both in 2% (n = 1) of cases. No difference in feasibility was found according to age, sex, OSA severity, or comorbidities. There were 14 (25%) children categorized as no-OSA, 43 (75%) as OSA, 4 (7%) as UARS, 26 (46%) as mild, 6 (10%) as moderate, and 7 (12%) as severe OSA. Neither questionnaires nor clinical and physical examination predicted OSA diagnosis. CONCLUSIONS When equipment is installed at the professional's office and a parent monitors the child, PSG-home is feasible and technically acceptable in children aged 3 through 16 years old. The short delay and feasibility provided by PSG-home could improve the management of children suspected of OSA.
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Affiliation(s)
- Iulia Ioan
- Service d’Explorations Fonctionnelles Pédiatriques, Hôpital d’Enfants, Centre Hospitalier Universitaire de Nancy, Nancy, France
- Faculté de Médecine, Université de Lorraine, Nancy, France
- Contributed equally
| | - Diane Weick
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Contributed equally
| | - Cyril Schweitzer
- Service d’Explorations Fonctionnelles Pédiatriques, Hôpital d’Enfants, Centre Hospitalier Universitaire de Nancy, Nancy, France
- Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Aurore Guyon
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Laurianne Coutier
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Service de pneumologie infantile, allergologie et centre de référence en mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- U1028, CNRL, Université de Lyon 1, France
| | - Patricia Franco
- Service Epilepsie, Sommeil, Explorations Fonctionnelles Neurologiques Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- U1028, CNRL, Université de Lyon 1, France
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20
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Home Respiratory Polygraphy is Useful in the Diagnosis of Childhood Obstructive Sleep Apnea Syndrome. J Clin Med 2020; 9:jcm9072067. [PMID: 32630238 PMCID: PMC7408887 DOI: 10.3390/jcm9072067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 12/17/2022] Open
Abstract
The utility of home respiratory polygraphy (HRP) was assessed as an alternative to polysomnography (PSG) in the diagnosis of childhood obstructive sleep apnea syndrome (OSAS). PSG was indicated only in patients with concomitant disease or where HRP results were questionable. The follow-up period was 1 year. We recorded clinical and anthropometric data, physical examination findings, respiratory variables, severity level and choice of therapy. We assessed 121 children, 70 boys and 51 girls, with mean age 7 ± 4 years, mean body mass index (BMI) 19 ± 5 kg/m2, and mean BMI percentile 62 ± 38%. We included 104 HRP and 24 PSG recordings. Of the latter, 7 were preceded by HRP (false negatives) and 17 were indicated as the first-choice method owing to concomitant disease. Of the initial HRP recordings, 93% were technically valid. All technically valid HRPs and 96% of PSGs resulted in a diagnosis of OSAS (apnea-hypopnea index 9.5 ± 9.1/h). Thirty-three percent of cases were moderate and 22% severe. Apnea-hypopnea index showed no correlation with BMI or BMI percentile. Adenotonsillectomy was indicated in 93 patients (77%), conservative treatment in 17 (14%), and conservative treatment combined with CPAP/BiPAP in 11 (9%). There were no significant differences between children diagnosed by HRP and by PSG in terms of treatment choice. The prevalence of OSAS in our sample was 96.7%. In conclusion, when the probability of OSAS is high, HRP is usually sufficient for diagnosing the syndrome and establishing therapy in children. PSG is advisable in complex or questionable cases.
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21
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Chandrakantan A, Musso MF, Floyd T, Adler AC. Pediatric obstructive sleep apnea: Preoperative and neurocognitive considerations for perioperative management. Paediatr Anaesth 2020; 30:529-536. [PMID: 32163644 DOI: 10.1111/pan.13855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 03/02/2020] [Accepted: 03/08/2020] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnea (OSA) affects up to 7.5% of the pediatric population and is associated with a variety of behavioral and neurocognitive sequelae. Prompt diagnosis and treatment is critical to halting and potentially reversing these changes. Depending on the severity of the OSA and comorbid conditions, different treatment paradigms can be pursued, each of which has its own unique risk:benefit ratio. Adenotonsillectomy is first-line recommended surgical treatment for pediatric OSA. However, it carries its own perioperative risks and the decision regarding surgical timing is therefore made in the context of procedural risk versus patient benefit. This article presents the seminal perioperative and neurocognitive risks from pediatric OSA to aid with perioperative management.
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Affiliation(s)
- Arvind Chandrakantan
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Mary F Musso
- Baylor College of Medicine, Houston, TX, USA.,Department of Otorhinolaryngology, Texas Children's Hospital, Houston, TX, USA
| | - Thomas Floyd
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, TX, USA.,Department of Cardiothoracic Surgery, University of Texas Southwestern, Dallas, TX, USA.,Department of Radiology, University of Texas Southwestern, Dallas, TX, USA
| | - Adam C Adler
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
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22
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Ohn M, Eastwood P, von Ungern-Sternberg BS. Preoperative identification of children at high risk of obstructive sleep apnea. Paediatr Anaesth 2020; 30:221-231. [PMID: 31841240 DOI: 10.1111/pan.13788] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/08/2019] [Accepted: 12/10/2019] [Indexed: 12/24/2022]
Abstract
Obstructive sleep apnea is a common childhood disorder which can lead to serious health problems if left untreated. Enlarged adenoid and tonsils are the commonest causes, and adenotonsillectomy is the recommended first line of treatment. Obstructive sleep apnea poses as an anesthetic challenge, and it is a well-known risk factor for perioperative adverse events. The presence and severity of an obstructive sleep apnea diagnosis will influence anesthesia, pain management, and level of monitoring in recovery period. Preoperative obstructive sleep apnea assessment is necessary, and anesthetists are ideally placed to do so. Currently, there is no standardized approach to the best method of preoperative screening for obstructive sleep apnea. Focused history, clinical assessments, and knowledge regarding the strengths and limitations of available obstructive sleep apnea assessment tools will help recognize a child with obstructive sleep apnea in the preoperative setting.
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Affiliation(s)
- Mon Ohn
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia.,Medical School, The University of Western Australia, Crawley, WA, Australia.,Telethon Kids Institute, Nedlands, WA, Australia
| | - Peter Eastwood
- Centre for Sleep Science, School of Human Sciences, The University of Western Australia, Crawley, WA, Australia.,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Britta S von Ungern-Sternberg
- Medical School, The University of Western Australia, Crawley, WA, Australia.,Telethon Kids Institute, Nedlands, WA, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia
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23
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Akkari M, Yildiz S, Marianowski R, Monteyrol PJ, Chalumeau F, Fayoux P, Leboulanger N, Franco P, Couloigner V, Mondain M. Role of the ENT specialist in the diagnosis of pediatric obstructive sleep apnea-hypopnea syndrome (POSAHS). Part 3: sleep recordings. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:405-410. [PMID: 32107171 DOI: 10.1016/j.anorl.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The authors present the clinical practice guidelines of the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) concerning the role of the ENT specialist in the management of pediatric obstructive sleep apnea hypopnea syndrome (POSAHS). Part 3 is dedicated to the place of sleep recordings in the diagnosis of POSAHS. METHODS A multidisciplinary work group was commissioned to carry out a review of the scientific literature on the above topic. Based on the articles retrieved and the group members' individual experience, guidelines were drafted and graded as A, B or C or Expert Opinion by decreasing level of evidence, then reviewed by an editorial group independent of the work group. RESULTS Sleep recordings are presented according to the American Sleep Disorders Association's classification as type 1, 2, 3 or 4. Their modalities, interpretation, indications, advantages and limitations are detailed.
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Affiliation(s)
- M Akkari
- UAM d'ORL pédiatrique, département d'ORL et chirurgie cervico-faciale, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - S Yildiz
- Département d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, Paris, France
| | - R Marianowski
- Département d'ORL et chirurgie cervico-faciale, hôpital Morvan, CHU de Brest, Brest, France
| | - P J Monteyrol
- Département d'ORL et chirurgie cervico-faciale, polyclinique du tondu et clinique du sommeil, hôpital Pellegrin, Bordeaux, France
| | | | - P Fayoux
- Département d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Jeanne-de-Flandre, CHU de Lille, Lille, France
| | - N Leboulanger
- Département d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, Paris, France
| | - P Franco
- Unité de sommeil pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, Lyon, France
| | - V Couloigner
- Département d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, Paris, France
| | - M Mondain
- UAM d'ORL pédiatrique, département d'ORL et chirurgie cervico-faciale, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
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24
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Wu R, Wang X, Zhuang P, Zhou Z, Li Y, Zhang F. The performance of a postinduction fentanyl test in identifying severe obstructive sleep apnea syndrome. Paediatr Anaesth 2020; 30:57-62. [PMID: 31742846 DOI: 10.1111/pan.13771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 11/14/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children with severe obstructive sleep apnea syndrome (OSAS) are more sensitive to opioids. Identifying such children and reducing or even eliminating opioids are necessary but difficult. We have previously shown that patients sensitive to intraoperative fentanyl require less opioids postoperatively. AIM The objective of this study was to evaluate the performance of a postinduction fentanyl test in identifying severe obstructive sleep apnea syndrome. METHODS A prospective, observational, assessor-blinded study was carried out with 104 sleep study assessed children undergoing elective adenotonsillectomy. Intravenous fentanyl (1 µg/kg) was administered as a test in nonpremedicated, spontaneously breathing, sevoflurane-induced patients before endotracheal intubation. The respiratory rates before and after fentanyl administration were studied. The primary outcome was the sensitivity and specificity of the postinduction fentanyl test in identifying severe OSAS compared with polysomnography. RESULTS A postinduction fentanyl test had a likelihood ratio of 7.2 (95% CI: 3.6-14.6) and an area under the curve value of 0.896 (95% CI: 0.821-0.947) to identify severe obstructive sleep apnea syndrome. The pragmatic cut-off value for the postinduction fentanyl test was found to be 50%. Using a reduction in respiratory rate of >50%, the postinduction fentanyl test detected severe OSAS with a sensitivity of 87%, a specificity of 88%, a positive predictive value of 85%, and a negative predictive value of 89%. CONCLUSION Our study showed that a postinduction fentanyl test had good predictive value in identifying severe obstructive sleep apnea syndrome and early postoperative adverse respiratory events and could provide a reference for postoperative analgesia in children undergoing adenotonsillectomy.
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Affiliation(s)
- Ru Wu
- Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China
| | - Xuan Wang
- Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China
| | - Peijun Zhuang
- Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhijian Zhou
- Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China
| | - Yihang Li
- Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China
| | - Fan Zhang
- Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China
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25
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Blanc F, Merklen F, Blanchet C, Mondain M, Akkari M. Respiratory polygraphy in children: Feasibility in everyday practice in an ENT department and value of automatic detection of respiratory events. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:235-240. [DOI: 10.1016/j.anorl.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Singh G, Hardin K, Bang H, Nandalike K. The Feasibility and Utility of Level III Portable Sleep Studies in the Pediatric Inpatient Setting. J Clin Sleep Med 2019; 15:985-990. [PMID: 31383236 DOI: 10.5664/jcsm.7878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) may significantly impact the course of medical illness in hospitalized children. Polysomnography (PSG) is the gold standard for establishing diagnosis of SDB, but its availability is limited. The aim of this study was to explore the feasibility and utility of level III portable sleep studies in hospitalized children with SDB. METHODS A retrospective study was conducted at a tertiary hospital over the preceding 2 years in hospitalized children < 18 years who had undergone a level III sleep study using the Nox T3 system. The information obtained included demographic data, comorbidities, indication for admission and sleep study, time interval between the study ordered and done, adequacy of technical data from sleep study, study diagnosis, and subsequent management interventions for SDB. RESULTS A total of 51 hospitalized children had these studies; 32 were female and mean age was 4.3 years. Approximately 90% of children had significant comorbidities, including neurological and craniofacial abnormalities. The majority (80%) of studies were conducted within 24 hours of the time requested and 92.1% studies had technically adequate data for analysis. Thirty-nine (76.5%) children were identified with SDB; all but one patient underwent therapy for SDB during that same hospitalization, including supplemental oxygen (48.7%), positive airway pressure therapy (23%), surgical intervention (38.2%) or caffeine (10.2%). Twelve percent of children had more than one intervention done. CONCLUSIONS The level III portable sleep study is readily available, sufficient to diagnose SDB, and help to provide appropriate medical and/or surgical therapies in hospitalized children with complex medical conditions.
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Affiliation(s)
- Gurinder Singh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, UC Davis Health, Sacramento, California
| | - Kimberly Hardin
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, UC Davis Health, Sacramento, California
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, California
| | - Kiran Nandalike
- Division of Pulmonary Medicine, Department of Pediatrics, UC Davis Health, Sacramento, California
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27
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Gudnadottir G, Hafsten L, Redfors S, Ellegård E, Hellgren J. Respiratory polygraphy in children with sleep-disordered breathing. J Sleep Res 2019; 28:e12856. [PMID: 30932252 DOI: 10.1111/jsr.12856] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
At-home respiratory polygraphy has been shown to be a reliable substitute for in-laboratory polysomnography in adults for diagnosing obstructive sleep apnea, but this is less well studied in children. One aim of this study was to examine the quality of at-home respiratory polygraphy in children with sleep-disordered breathing and to evaluate the interrater reliability of the results. Another aim was to study whether calibrated respiratory inductance plethysmography (RIP) flow can be used for the scoring of respiratory events when the airflow measurements are unreliable. Children aged 4-10 years, with sleep-disordered breathing, underwent at-home respiratory polygraphy. Of 113 polygraphies, only 46% were of acceptable quality, with missing nasal airflow being the most common problem (40%). The median recorded time with artifact-free signal present in three traces simultaneously was 228 min (0-610 min). Seventeen polygraphy studies were selected for further study. Each study was scored by two independent scorers, with and without the nasal airflow signal present, the latter relying on RIP flow for the scoring of respiratory events. The apnea-hypopnea index (AHI) from the four different measurements was compared using intraclass correlation coefficients (ICC). Comparison of the two scorers showed moderate agreement, with (ICC = 0.66) and without (ICC = 0.53) nasal airflow. One scorer had good agreement between AHI with and without nasal airflow (ICC = 0.81), whereas the other had poor agreement (ICC = 0.12). In conclusion, the scoring of respiratory events based on RIP flow is scorer dependent even for experienced scorers. The nasal airflow signal is frequently missing in paediatric respiratory polygraphies, which limits the usefulness of the method.
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Affiliation(s)
- Gunnhildur Gudnadottir
- Department of Otorhinolaryngology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Louise Hafsten
- Department of Otorhinolaryngology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Staffan Redfors
- Queen Silvia's Children's Hospital at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Ellegård
- Department of Otorhinolaryngology, Halland's Hospital, Kungsbacka, Sweden
| | - Johan Hellgren
- Department of Otorhinolaryngology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Scalzitti NJ, Sarber KM. Diagnosis and perioperative management in pediatric sleep-disordered breathing. Paediatr Anaesth 2018; 28:940-946. [PMID: 30281185 DOI: 10.1111/pan.13506] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
Abstract
Sleep-disordered breathing has a prevalence of 12% in the pediatric population. It represents a spectrum of disorders encompassing abnormalities of the upper airway that lead to sleep disruption, including primary snoring, obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. Sleep-disordered breathing is the most common indication for adenotonsillectomy, one of the most common procedures performed in children. In recent years, the American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, and the American Society of Anesthesiologists have crafted guidelines to help safely manage children with sleep-disordered breathing. Each organization recommends in-laboratory polysomnography for definitive diagnosis of obstructive sleep apnea in certain cases. However, because this test is both costly and inconvenient, there has been significant interest in alternative methods for diagnosing clinically significant sleep-disordered breathing. Accurate diagnosis is critical because sleep-disordered breathing confers certain perioperative risks and increased mortality in some instances. Recent studies have elucidated the danger of anesthesia and opioids in worsening obstructive sleep apnea, and recommendations for alternative analgesia are being created. In addition, determining the most appropriate level and duration of monitoring in the postoperative period is actively being evaluated. This article presents an overview of the recent literature on the perioperative care of pediatric patients with sleep-disordered breathing. It highlights innovative modalities and limitations in diagnosing obstructive sleep apnea, the importance of a tailored anesthetic/analgesic approach to children with obstructive sleep apnea, and the need for postoperative monitoring. It also brings to focus that further studies on the perioperative care of these children are necessary.
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Affiliation(s)
- Nicholas J Scalzitti
- Departments of Otolaryngology and Sleep Medicine, San Antonio Military Medical Center, San Antonio, Texas
| | - Kathleen M Sarber
- Department of Pulmonary Medicine, Sleep Disorders Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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29
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Tapia IE, Noah TL. Pediatric pulmonology year in review 2017: Part 4 (Sleep medicine). Pediatr Pulmonol 2018; 53:1159-1163. [PMID: 29696817 DOI: 10.1002/ppul.24025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 11/06/2022]
Abstract
Pediatric Pulmonology publishes original research, case reports and review articles on topics related to a wide range of children's respiratory disorders. In this article (Part 4 of a 5-part series), we summarize the past year's publications in sleep medicine, in the context of selected literature in this area from other journals. Articles are highlighted on topics including diagnosis and treatment of OSAS, sleep duration and position, and sleep disorders in chronic disease.
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Affiliation(s)
- Ignacio E Tapia
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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