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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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Varis M, Karhu T, Leppänen T, Nikkonen S. Utilizing Envelope Analysis of a Nasal Pressure Signal for Sleep Apnea Severity Estimation. Diagnostics (Basel) 2023; 13:diagnostics13101776. [PMID: 37238259 DOI: 10.3390/diagnostics13101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Obstructive sleep apnea (OSA) severity assessment is based on manually scored respiratory events and their arbitrary definitions. Thus, we present an alternative method to objectively evaluate OSA severity independently of the manual scorings and scoring rules. A retrospective envelope analysis was conducted on 847 suspected OSA patients. Four parameters were calculated from the difference between the nasal pressure signal's upper and lower envelopes: average (AV), median (MD), standard deviation (SD), and coefficient of variation (CoV). We computed the parameters from the entirety of the recorded signals to perform binary classifications of patients using three different apnea-hypopnea index (AHI) thresholds (5-15-30). Additionally, the calculations were undertaken in 30-second epochs to estimate the ability of the parameters to detect manually scored respiratory events. Classification performances were assessed with areas under the curves (AUCs). As a result, the SD (AUCs ≥ 0.86) and CoV (AUCs ≥ 0.82) were the best classifiers for all AHI thresholds. Furthermore, non-OSA and severe OSA patients were separated well with SD (AUC = 0.97) and CoV (AUC = 0.95). Respiratory events within the epochs were identified moderately with MD (AUC = 0.76) and CoV (AUC = 0.82). In conclusion, envelope analysis is a promising alternative method by which to assess OSA severity without relying on manual scoring or the scoring rules of respiratory events.
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Affiliation(s)
- Mikke Varis
- Department of Technical Physics, University of Eastern Finland, Canthia, P.O. Box 1627, FI-70211 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, FI-70210 Kuopio, Finland
| | - Tuomas Karhu
- Department of Technical Physics, University of Eastern Finland, Canthia, P.O. Box 1627, FI-70211 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, FI-70210 Kuopio, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Canthia, P.O. Box 1627, FI-70211 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, FI-70210 Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Sami Nikkonen
- Department of Technical Physics, University of Eastern Finland, Canthia, P.O. Box 1627, FI-70211 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, FI-70210 Kuopio, Finland
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Jurado MJ, Sampol G, Quintana M, Romero O, Cambrodí R, Ferré A, Sampol J. Nasal cannula use during polysomnography in children aged under three with suspected sleep apnea. Sleep Med 2022; 99:41-48. [PMID: 35947888 DOI: 10.1016/j.sleep.2022.07.009] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Early diagnosis of obstructive sleep apnea (OSA) in children is important. The use of a nasal cannula as an airflow sensor during polysomnography has not been evaluated in younger children. The study aims to evaluate the use of nasal cannula in detecting respiratory events in children under three with suspected OSA during daytime nap studies. METHODS A total of 185 patients were prospectively included. Respiratory events were scored using nasal cannula alone, thermistor alone, and both methods simultaneously as the airflow sensor. Agreement and diagnostic accuracy were assessed. RESULTS One hundred and seventy-two children were finally analyzed and 110 (64.0%) presented OSA. Total sleep time with an uninterpretable signal was longer with the nasal cannula than with the thermistor (17.8% vs 1.9%; p < 0.001), and was associated with poor sensor tolerance and adenotonsillar hypertrophy. In the estimation of the apnea-hypopnea index, the nasal cannula showed lower agreement than the thermistor with the joint use of the two sensors (intraclass correlation coefficient: 0.79 vs 0.996 with thermistor). Compared with the thermistor, the nasal cannula presented lower sensitivity for detecting OSA (82.7% vs 95.5%) and a lower negative predictive value (76.5% vs 92.4%). Overall, fewer children were diagnosed with severe OSA with the nasal cannula (19.8% vs 30.8% with the thermistor, and 32.6% with both). CONCLUSIONS In children under the age of three, the ability of the nasal cannula to detect obstructive events was relatively low. Therefore, other non-invasive measurements for identifying respiratory events during sleep may be of additional value.
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Affiliation(s)
- María José Jurado
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Gabriel Sampol
- Department of Respiratory Care, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Manuel Quintana
- Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Odile Romero
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Roser Cambrodí
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Alex Ferré
- Department of Clinical Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Júlia Sampol
- Department of Respiratory Care, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de la Salud Carlos III (ISCIIII), Avenida de Monforte de Lemos, 3-5, 28029, Madrid, Spain.
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Garde AJ, Gibson NA, Samuels MP, Evans HJ. Recent advances in paediatric sleep disordered breathing. Breathe (Sheff) 2022; 18:220151. [PMID: 36340818 PMCID: PMC9584598 DOI: 10.1183/20734735.0151-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Abstract
This article reviews the latest evidence pertaining to childhood sleep disordered breathing (SDB), which is associated with negative neurobehavioural, cardiovascular and growth outcomes. Polysomnography is the accepted gold standard for diagnosing SDB but is expensive and limited to specialist centres. Simpler tests such as cardiorespiratory polygraphy and pulse oximetry are probably sufficient for diagnosing obstructive sleep apnoea (OSA) in typically developing children, and new data-processing techniques may improve their accuracy. Adenotonsillectomy is the first-line treatment for OSA, with recent evidence showing that intracapsular tonsillectomy results in lower rates of adverse events than traditional techniques. Anti-inflammatory medication and positive airway pressure respiratory support are not always suitable or successful, although weight loss and hypoglossal nerve stimulation may help in select comorbid conditions. Educational aims To understand the clinical impact of childhood sleep disordered breathing (SDB).To understand that, while sleep laboratory polysomnography has been the gold standard for diagnosis of SDB, other diagnostic techniques exist with their own benefits and limitations.To recognise that adenotonsillectomy and positive pressure respiratory support are the mainstays of treating childhood SDB, but different approaches may be indicated in certain patient groups.
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Affiliation(s)
- Alison J.B. Garde
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Martin P. Samuels
- Staffordshire Children's Hospital, Royal Stoke University Hospital, Stoke-on-Trent, UK,Great Ormond Street Hospital, London, UK
| | - Hazel J. Evans
- University Hospital Southampton NHS Foundation Trust, Southampton, UK,Corresponding author: Hazel J. Evans ()
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Coluzzi D, Baselli G, Bianchi AM, Guerrero-Mora G, Kortelainen JM, Tenhunen ML, Mendez MO. Multi-Scale Evaluation of Sleep Quality Based on Motion Signal from Unobtrusive Device. SENSORS 2022; 22:s22145295. [PMID: 35890975 PMCID: PMC9323867 DOI: 10.3390/s22145295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 02/05/2023]
Abstract
Sleep disorders are a growing threat nowadays as they are linked to neurological, cardiovascular and metabolic diseases. The gold standard methodology for sleep study is polysomnography (PSG), an intrusive and onerous technique that can disrupt normal routines. In this perspective, m-Health technologies offer an unobtrusive and rapid solution for home monitoring. We developed a multi-scale method based on motion signal extracted from an unobtrusive device to evaluate sleep behavior. Data used in this study were collected during two different acquisition campaigns by using a Pressure Bed Sensor (PBS). The first one was carried out with 22 subjects for sleep problems, and the second one comprises 11 healthy shift workers. All underwent full PSG and PBS recordings. The algorithm consists of extracting sleep quality and fragmentation indexes correlating to clinical metrics. In particular, the method classifies sleep windows of 1-s of the motion signal into: displacement (DI), quiet sleep (QS), disrupted sleep (DS) and absence from the bed (ABS). QS proved to be positively correlated (0.72±0.014) to Sleep Efficiency (SE) and DS/DI positively correlated (0.85±0.007) to the Apnea-Hypopnea Index (AHI). The work proved to be potentially helpful in the early investigation of sleep in the home environment. The minimized intrusiveness of the device together with a low complexity and good performance might provide valuable indications for the home monitoring of sleep disorders and for subjects’ awareness.
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Affiliation(s)
- Davide Coluzzi
- Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano, 20133 Milano, Italy; (A.M.B.); (M.O.M.)
- Correspondence: (D.C.); (G.B.)
| | - Giuseppe Baselli
- Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano, 20133 Milano, Italy; (A.M.B.); (M.O.M.)
- Correspondence: (D.C.); (G.B.)
| | - Anna Maria Bianchi
- Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano, 20133 Milano, Italy; (A.M.B.); (M.O.M.)
| | - Guillermina Guerrero-Mora
- Unidad Académica Multidisciplinaria Zona Media, Universidad Autónoma de San Luis Potosí, San Luis Potosí 79615, Mexico;
| | | | - Mirja L. Tenhunen
- Department of Clinical Neurophysiology, Medical Imaging Centre, Pirkanmaa Hospital District, Tampere, Finland;
- Department of Medical Physics, Tampere University Hospital, Medical Imaging Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Martin O. Mendez
- Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano, 20133 Milano, Italy; (A.M.B.); (M.O.M.)
- Laboratorio Nacional—Centro de Investigación, Instrumentación e Imagenología Médica, Facultad de Ciencias, Universidad Autónoma de San Luis Potosí, San Luis Potosí 78210, Mexico
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6
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Textile-Based Pressure Sensing Matrix for In-Bed Monitoring of Subject Sleeping Posture and Breathing Activity. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11062552] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
According to current trends in healthcare sensing technologies, we describe a textile-based pressure sensing matrix that can be integrated in the mattress of a smart bed to characterize sleeping posture/movement of a subject and to extract breathing activity. The pressure mapping layer is developed as a matrix of 195 piezoresistive sensors, it is entirely made of textile materials, and it is the basic component of a smart bed that can perform sleep analysis, can extract physiological parameters, and can detect environmental data related to subject’s health. In this paper, we show the principle of the pressure mapping layer and the architecture of the dedicated electronic system that we developed for signal acquisition. In addition, we describe the algorithms for posture/movement classification (dedicated artificial neural network) and for extraction of the breathing rate (frequency domain analysis). We also perform validation of the system to quantify the accuracy/precision of the posture classification and the statistical analysis to compare our breathing rate estimation with the gold standard.
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7
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Sabil A, Marien C, LeVaillant M, Baffet G, Meslier N, Gagnadoux F. Diagnosis of sleep apnea without sensors on the patient's face. J Clin Sleep Med 2020; 16:1161-1169. [PMID: 32267226 DOI: 10.5664/jcsm.8460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Thermistors, nasal cannulas, and respiratory inductance plethysmography (RIP) are the recommended reference sensors of the American Academy of Sleep Medicine (AASM) for the detection and characterization of apneas and hypopneas; however, these sensors are not well tolerated by patients and have poor scorability. We evaluated the performance of an alternative method using a combination of tracheal sounds (TSs) and RIP signals. METHODS Consecutive recordings of 70 adult patients from the Pays de la Loire Sleep Cohort were manually scored in random order using the AASM standard signals and the combination TS and RIP signals, without respiratory sensors placed on the patient's face. The TS-RIP scoring used the TS and RIP-flow signals for detection of apneas and hypopneas, respectively, and the suprasternal pressure and RIP belt signals for the characterization of apneas. RESULTS Sensitivity and specificity of the TS-RIP combination were 96.21% and 91.34% for apnea detection and 89.94% and 93.25% for detecting hypopneas, respectively, with a kappa coefficient of 0.87. For the characterization of apneas, sensitivity and specificity were 98.67% and 96.17% for obstructive apneas, 92.66% and 99.36% for mixed apneas, and 96.14% and 98.89% for central apneas, respectively, with a kappa coefficient of 0.94. The TS-RIP scoring revealed a high agreement for classifying obstructive sleep apnea into severity classes (none, mild, moderate, and severe obstructive sleep apnea) with a Cohen's kappa coefficient of 0.96. CONCLUSIONS Compared with the AASM reference sensors, the TS-RIP combination allows reliable noninvasive detection and characterization of respiratory events with a high degree of sensitivity and specificity. TS-RIP combination could be used for diagnosis of obstructive sleep apnea in adults, either as an alternative to the AASM sensors or in combination with the recommended AASM sensors.
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Affiliation(s)
| | - Caroline Marien
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France
| | - Marc LeVaillant
- Institut de Recherche en Santé Respiratoire des Pays de la Loire, Beaucouzé, France
| | | | - Nicole Meslier
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France.,Inserm UMR 1063, Université d'Angers, Angers, France; *Contributed equally
| | - Frédéric Gagnadoux
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France.,Inserm UMR 1063, Université d'Angers, Angers, France; *Contributed equally
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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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9
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Amaddeo A, Sabil A, Arroyo JO, De Sanctis L, Griffon L, Baffet G, Khirani S, Fauroux B. Tracheal sounds for the scoring of sleep respiratory events in children. J Clin Sleep Med 2020; 16:361-369. [PMID: 31992398 DOI: 10.5664/jcsm.8206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Oronasal thermistor and nasal cannula are recommended for the scoring of respiratory events (RE) but these sensors are poorly tolerated in children. The aim of the study was to evaluate tracheal sounds (TS) and suprasternal pressure (SSP) for the scoring of RE during sleep in children. METHODS We compared the detection and characterization of RE by AASM-recommended sensors ("AASM" scoring), with the detection and characterization of RE by the combination of TS and SSP with respiratory inductance plethysmography-sum (TS-RIP scoring), and TS and SSP only (TS scoring). RESULTS The recordings of 17 patients were analyzed. The TS, SSP, and RIP flow signals were present during 95%, 95%, and 99% of the validated recording time, respectively, as compared to 79% and 86% for nasal cannula and oronasal thermistor. A total of 1,456 RE were scored with the "AASM" scoring, 1,335 with the TS-RIP scoring, and 1,311 with the TS scoring. Sensitivity for apnea and hypopnea detection was 88% and 84% for the TS-RIP scoring, and 86% and 77% for the TS scoring. For apnea characterization, the TS-RIP scoring sensitivities and specificities were 97% and 100%, 76% and 98%, and 95% and 97%, for obstructive, mixed, and central apnea, respectively. For the TS scoring, they were 95% and 100%, 95% and 97%, and 91% and 97%, respectively. CONCLUSIONS TS and SSP + RIP-sum has a good sensitivity and specificity for the detection and characterization of apnea and hypopnea in children. TS and SSP alone have good sensitivity and specificity for apnea detection and characterization but lower sensitivity for hypopnea detection.
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Affiliation(s)
- Alessandro Amaddeo
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Paris Descartes University, EA 7330, VIFASOM, Paris, France
| | - Abdelkebir Sabil
- Cloud Sleep Lab, Paris, France.,Cidelec, Sainte Gemmes sur Loire, France
| | - Jorge Olmo Arroyo
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France
| | - Livio De Sanctis
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France
| | - Lucie Griffon
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Paris Descartes University, EA 7330, VIFASOM, Paris, France
| | | | - Sonia Khirani
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,ASV Santé, Gennevilliers, France
| | - Brigitte Fauroux
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Paris Descartes University, EA 7330, VIFASOM, Paris, France
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10
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Bertoni D, Isaiah A. Towards Patient-centered Diagnosis of Pediatric Obstructive Sleep Apnea—A Review of Biomedical Engineering Strategies. Expert Rev Med Devices 2019; 16:617-629. [DOI: 10.1080/17434440.2019.1626233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Dylan Bertoni
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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11
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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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Stehling F, Keull J, Olivier M, Große-Onnebrink J, Mellies U, Stuck BA. Validation of the screening tool ApneaLink ® in comparison to polysomnography for the diagnosis of sleep-disordered breathing in children and adolescents. Sleep Med 2017; 37:13-18. [PMID: 28899523 DOI: 10.1016/j.sleep.2017.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/06/2017] [Accepted: 05/30/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE While out-of-center testing was introduced as an alternative for the diagnosis of obstructive sleep apnea in adults, polysomnography (PSG) is still considered mandatory in the diagnosis of sleep-disordered breathing (SDB) in children. The purpose of this study was to validate the outpatient screening device ApneaLink® in comparison to PSG in children and adolescents for the diagnosis of SDB. METHODS Sixty consecutive children and adolescents (10.4 ± 6.2, 0-22 years) with suspected SDB admitted to the sleep laboratory underwent simultaneous recording with full PSG and the screening device ApneaLink® based on flow measurement and oxygen saturation. RESULTS The mean apnea-hypopnea index (AHI) was 11.8 ± 19.7 in PSG and 10.3 ± 12.0 in ApneaLink®. When the AHI threshold was set to 5/h to diagnose SDB, the overall sensitivity for ApneaLink® was 79% and the specificity was 63%. After reducing the AHI threshold to 1/h, the sensitivity and specificity were 94% and 29%. In children older than 10 years, the performance of ApneaLink® improved (AHI 5/h: sensitivity 80%, specificity 64%; AHI 1/h: sensitivity 100%, specificity 50%). CONCLUSION These results show that the outpatient screening device ApneaLink® reliably identifies SDB in preselected children older than 10 years. In contrast, it may not be used for the exclusion of SDB.
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Affiliation(s)
- Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Children's Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Judith Keull
- Pediatric Pulmonology and Sleep Medicine, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Margarete Olivier
- Pediatric Pulmonology and Sleep Medicine, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Jörg Große-Onnebrink
- Department of General Pediatrics, Pediatric Respiratory Medicine Unit, University Children's Hospital Muenster, Muenster, Germany
| | - Uwe Mellies
- Pediatric Pulmonology and Sleep Medicine, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Essen, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps Universität Marburg, Germany
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Medical Devices for Pediatric Apnea Monitoring and Therapy: Past and New Trends. IEEE Rev Biomed Eng 2017; 10:199-212. [DOI: 10.1109/rbme.2017.2757899] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Das pädiatrische obstruktive Schlafapnoesyndrom. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0079-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Archbold KH, Giordani B, Ruzicka DL, Chervin RD. Cognitive Executive Dysfunction in Children with Mild Sleep-Disordered Breathing. Biol Res Nurs 2016; 5:168-76. [PMID: 14737917 DOI: 10.1177/1099800403260261] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In children, moderate or severe sleep-disordered breathing (SDB) may impair cognitive executive functions (EFs), including working memory, attention, and mental flexibility. The main objective of this study was to assess EFs in children with mild levels of SDB. Subjects for this descriptive study were 12 children (5 girls, 7 boys) aged 8.0 to 11.9 years (M = 9.0 ± 0.85) participating in an ongoing study of the effects of adenotonsillectomy on behavior. Each subject had a nocturnal polysomnogram (PSG) and multiple sleep latency test (MSLT). Mild SDB was considered present if the child’s apnea/hypopnea index (AHI) was ≥ 1 and < 10. Between MSLT nap attempts, each child completed standardized tests of EFs. The sample showed significant impairment of sustained attention and vigilance on a computerized continuous performance test. Children with low mental flexibility scores on the Children’s Category Test (CCT) spent more time in stage 1 sleep (12.2% v. 9.5%, P = 0.028 on PSG) and showed a marginally higher arousal index (9.7 v. 6.5, P = 0.06 on PSG) than children with average or above-average CCT scores. AHI accounted for significant proportion of the variance in CCT scores when 1 outlier was removed (N = 11, Rsq = 0.67, P = 0.002). Mild levels of SDB and associated sleep architecture disruptions may be associated with impairment of EFs in children.
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Affiliation(s)
- Kristen Hedger Archbold
- Biobehavioral Nursing and Health Systems, Box 357266, University of Washington School of Nursing, Seattle, WA 98195-7266, USA.
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Müller-Hagedorn S, Bacher M, Poets C, Urschitz M. Zephalometrische Risikofaktoren der obstruktiven Schlafapnoe beim Kind. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3348-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Marcus CL, Traylor J, Biggs SN, Roberts RS, Nixon GM, Narang I, Bhattacharjee R, Davey MJ, Horne RSC, Cheshire M, Gibbons KJ, Dix J, Asztalos E, Doyle LW, Opie GF, D'ilario J, Costantini L, Bradford R, Schmidt B. Feasibility of comprehensive, unattended ambulatory polysomnography in school-aged children. J Clin Sleep Med 2014; 10:913-8. [PMID: 25126039 DOI: 10.5664/jcsm.3970] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although unattended ambulatory polysomnography (PSG) is frequently performed in adults, few studies have been performed in children. The objective of this study was to evaluate the feasibility of comprehensive, ambulatory PSG, including electroencephalography, in school-aged children in the home environment. METHODS A total of 201 children, born premature with birth weights of 500-1,250 grams, currently aged 5-12 years and living in Canada and Australia, underwent unattended ambulatory PSG. RESULTS PSG was initially technically satisfactory in 183 (91%) cases. Fourteen studies were satisfactory when repeated, resulting in an overall satisfactory rate of 197 (98%). Artifact-free signals were obtained for ≥ 75% of recording time in more than 92% of subjects, with the exception of nasal pressure, which was satisfactory for ≥ 75% of recording time in only 67% of subjects. However, thermistry signals were satisfactory for ≥ 75% of recording time in 92% of subjects, and some measure of airflow was present for ≥ 75% of recording time in 96% of subjects. Children slept very well, with a long total sleep time (534 ± 73 [mean ± SD] minutes), high sleep efficiency (92% ± 5%), and low arousal index (9 ± 3/h). Parents and children reported a high rate of satisfaction with the study. CONCLUSIONS This large, international study has shown that comprehensive, unattended, ambulatory PSG is feasible, technically adequate and well-tolerated in school-aged children when performed under research conditions. Further studies regarding the cost efficacy of this approach, and generalizability of the findings to a clinical population, are warranted.
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Affiliation(s)
- Carole L Marcus
- Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Joel Traylor
- Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Sarah N Biggs
- The Ritchie Centre and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Robin S Roberts
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Gillian M Nixon
- The Ritchie Centre and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; ; Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, University of Toronto, Ontario, Canada
| | - Rakesh Bhattacharjee
- Section of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, IL
| | - Margot J Davey
- The Ritchie Centre and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; ; Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Rosemary S C Horne
- The Ritchie Centre and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Maureen Cheshire
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, University of Toronto, Ontario, Canada
| | - K Jeremy Gibbons
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, University of Toronto, Ontario, Canada
| | - Joanne Dix
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Lex W Doyle
- Department of Obstetrics and Gynaecology, the Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia, and Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Gillian F Opie
- Mercy Hospital for Women, Heidelberg, and Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Judy D'ilario
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lorrie Costantini
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Bradford
- Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Barbara Schmidt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; ; Division of Neonatology, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA
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Jambhekar S, Carroll JL. Diagnosis of pediatric obstructive sleep disordered breathing: beyond the gold standard. Expert Rev Respir Med 2014; 2:791-809. [DOI: 10.1586/17476348.2.6.791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Brockmann PE, Schaefer C, Poets A, Poets CF, Urschitz MS. Diagnosis of obstructive sleep apnea in children: A systematic review. Sleep Med Rev 2013; 17:331-40. [DOI: 10.1016/j.smrv.2012.08.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 08/19/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
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Brockmann PE, Urschitz MS, Schlaud M, Poets CF. Primary snoring in school children: prevalence and neurocognitive impairments. Sleep Breath 2011; 16:23-9. [DOI: 10.1007/s11325-011-0480-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 12/28/2010] [Accepted: 01/05/2011] [Indexed: 10/18/2022]
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Verginis N, Davey MJ, Horne RS. Scoring respiratory events in paediatric patients: Evaluation of nasal pressure and thermistor recordings separately and in combination. Sleep Med 2010; 11:400-5. [DOI: 10.1016/j.sleep.2009.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Revised: 07/31/2009] [Accepted: 08/05/2009] [Indexed: 11/27/2022]
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Alonso Alvarez ML, Terán Santos J, Cordero Guevara JA, Navazo Egüia AI, Ordax Carbajo E, Masa Jiménez JF, Pelayo R. [Reliability of respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome in children]. Arch Bronconeumol 2008. [PMID: 18559221 DOI: 10.1016/s1579-2129(08)60052-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Overnight polysomnography (PSG) is the gold standard diagnostic tool for sleep apnea-hypopnea syndrome (SAHS) in children. The aim of the present study was to evaluate the usefulness of diagnostic respiratory polygraphy in children with clinically suspected SAHS referred to our sleep-disordered breathing clinic. PATIENTS AND METHODS We studied 53 children referred with clinical suspicion of SAHS; 29 (54.7%) were boys and the mean (SD) age was 6.4 (2.9) years. After a medical history was taken and a physical examination performed, patients underwent respiratory polygraphy (Edentec) simultaneously with overnight PSG in the sleep laboratory. The 2 diagnostic tools were compared using statistical analysis. RESULTS SAHS was defined by an obstructive apnea-hypopnea index (OAHI) of 3 or more in overnight PSG and a respiratory disturbance index (RDI) of 3 or more in respiratory polygraphy. The rate of diagnostic agreement was 84.9%. The difference between the mean OAHI and RDI values was not significant (0.7 +/- 5.4; P=.34). The intraclass correlation coefficient between the OAHI and RDI was 89.4 (95% confidence interval, 82.4-93.7; P< .001). When receiver operating characteristic curves were calculated for the OAHI cutoff points used for the diagnosis of SAHS (> or =1, > or =3, and > or =5), the best RDI cutoff for all 3 OAHI values considered was found to be 4.6. When age strata were considered, in children 6 years or older the best RDI cutoff for the 3 OAHI values was 2.1. In children younger than 6 years the best RDI cutoff was 3.35 for OAHI > or =1 and 5.85 for OAHI > or =3 and > or =5. CONCLUSIONS Respiratory polygraphy in the sleep laboratory is a valid method for the diagnosis of SAHS in children.
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Affiliation(s)
- María Luz Alonso Alvarez
- Unidad de Trastornos Respiratorios del Sueño, Sección de Neumología, Complejo Asistencial de Burgos, Burgos, Spain.
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Luz Alonso Álvarez M, Terán Santos J, Aurelio Cordero Guevara J, Isabel Navazo Egüia A, Ordax Carbajo E, Fernando Masa Jiménez J, Pelayo R. Fiabilidad de la poligrafía respiratoria para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en niños. Arch Bronconeumol 2008. [DOI: 10.1016/s0300-2896(08)70439-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Halbower AC, Ishman SL, McGinley BM. Childhood obstructive sleep-disordered breathing: a clinical update and discussion of technological innovations and challenges. Chest 2008; 132:2030-41. [PMID: 18079240 DOI: 10.1378/chest.06-2827] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Childhood sleep-disordered breathing (SDB) has been known to be associated with health and cognitive impacts for more than a century, and yet our understanding of this disorder is in its infancy. Neuropsychological consequences in children with snoring or subtle breathing disturbances not meeting the traditional definition of sleep apnea suggest that "benign, or primary snoring" may be clinically significant, and that the true prevalence of SDB might be underestimated. There is no standard definition of SDB in children. The polysomnographic technology used in many sleep laboratories may be inadequate to diagnose serious but subtle forms of clinically important airflow limitation. In the last several years, advances in digital technology as well as new observational studies of respiratory and arousal patterns in large populations of healthy children have led to alternative views of what constitutes sleep-related breathing and arousal abnormalities that may refine our diagnostic criteria. This article reviews our knowledge of childhood SDB, highlights recent advances in technology, and discusses diagnostic and treatment strategies that will advance the management of children with pediatric SDB.
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Affiliation(s)
- Ann C Halbower
- Department of Pediatrics, John Hopkins University, Baltimore, MD, USA.
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Muzumdar H, Arens R. Diagnostic issues in pediatric obstructive sleep apnea. PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY 2008; 5:263-73. [PMID: 18250220 PMCID: PMC2645257 DOI: 10.1513/pats.200707-113mg] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 10/27/2007] [Indexed: 01/01/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) in children includes a spectrum of respiratory disorders with significant morbidities. Diagnosis of OSAS is based on clinical suspicion, history, and physical findings, and confirmation is made by polysomnography. There has been significant progress in recent years in technologies available for diagnosis of OSAS since the consensus statement of the American Thoracic Society in 1996. The current review describes methodologies that are available today for assessment and diagnosis of OSAS in children and summarizes the most recent recommendations of the American Academy of Sleep Medicine Task Force regarding scoring sleep-related respiratory events in children.
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Affiliation(s)
- Hiren Muzumdar
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10467-2490, USA
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Sleep-Related Breathing Disorders of Childhood: Description and Clinical Picture, Diagnosis, and Treatment Approaches. Sleep Med Clin 2007. [DOI: 10.1016/j.jsmc.2007.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Chau KW, Ng DK, Kwok KL, Chow PY, Cheung JM, Leung SY, Chan CH. Application of videotape in the screening of obstructive sleep apnea in children. Sleep Med 2007; 9:442-5. [PMID: 17761454 DOI: 10.1016/j.sleep.2007.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 05/04/2007] [Accepted: 06/26/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if watching a videotape that shows features of obstructive sleep apnea (OSA) will improve the accuracy of a verbally administered questionnaire in the prediction of OSA in pediatric snorers. PATIENTS AND METHODS In a prospective single-blinded, randomized, controlled study at a pediatric clinic for sleep-disordered breathing, we studied children aged 0-18 years, who had been referred to a sleep laboratory for overnight polysomnography (PSG), and their parents from November 1999 to November 2000. The parents were randomized to answer a standard verbally administered panel of three questions (SQ) or a verbally administered panel of questions assisted by videotape (VQ). RESULTS The parents of 52 and 56 pediatric snorers were assigned to answer SQ and VQ, respectively. The areas under the receiver operating characteristic [ROC] curves (AUCs) for screening of OSA in patients were similar at 0.709 (95% confidence interval (CI)=0.561-0.851) for SQ and 0.714 (95% CI=0.571-0.858) for VQ. The two questionnaires had a reasonable negative predictive value to rule out the presence of OSA (VQ=0.816 and 95% CI=0.726-0.885, SQ=0.828, 95% CI=0.714-0.913). CONCLUSION The addition of a videotape showing important features of OSA achieved no better accuracy than a standard questionnaire.
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Affiliation(s)
- Kin-wai Chau
- Department of Pediatrics, Kwong Wah Hospital, Waterloo Road, Hong Kong SAR, PR China
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Abstract
The demand for sleep services for young patients has escalated due to the increased recognition of pediatric sleep disorders over the past two decades. In this overview, we will highlight the essentials of pediatric sleep monitoring and stress particular issues that require the awareness of clinicians evaluating children for sleep disorders. While many techniques used in the "adult" sleep centers may suffice for the older adolescent patient, specific tailoring of the design of the sleep center to younger children and their families, and attention to the age-sensitive components of sleep data acquisition and interpretation are increasingly important in younger children. Several promising newer technologies and their potential for future clinical utility will be also reviewed.
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Affiliation(s)
- Jyoti Krishna
- Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
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Villa Asensi JR, Martínez Carrasco C, Pérez Pérez G, Cortell Aznar I, Gómez-Pastrana D, Alvarez Gil D, González Pérez-Yarza E. Guía de diagnóstico y tratamiento del síndrome de apneas-hipopneas del sueño en el niño. An Pediatr (Barc) 2006; 65:364-76. [PMID: 17020730 DOI: 10.1157/13092492] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- J R Villa Asensi
- Sección Neumología. Hospital Infantil Universitario Niño Jesús. Madrid. España.
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Suratt PM, Peruggia M, D'Andrea L, Diamond R, Barth JT, Nikova M, Perriello VA, Johnson ML. Cognitive function and behavior of children with adenotonsillar hypertrophy suspected of having obstructive sleep-disordered breathing. Pediatrics 2006; 118:e771-81. [PMID: 16894010 DOI: 10.1542/peds.2006-0173] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether risks of impaired cognitive function could be predicted for children or groups of children with adenotonsillar hypertrophy who were suspected of having obstructive sleep-disordered breathing, from historical and polysomnographic variables used separately or in combination. METHODS We studied 114 consecutive 6- to 12-year-old children with adenotonsillar hypertrophy, who were referred because of suspected obstructive sleep-disordered breathing, with questionnaires, assessment of tonsil size, general and memory cognitive tests, and attended polysomnography with the use of nasal pressure recording to detect flow. RESULTS There were important significant relationships between snore group (snored every night versus less often), sleep efficiency, and race and 2 of 3 general cognitive tests (vocabulary and similarities). Significant but weaker relationships were observed between sleep latency and 2 memory indices (verbal memory and general memory) and between sleep efficiency and 2 behavior indices (attention-deficit/hyperactivity disorder summary and hyperactive-impulsive summary). The number of episodes of apnea and hypopnea per 1 hour of sleep predicted the vocabulary score as well as did the snore group, but it did not predict other tests as well as other variables. Tonsil size did not predict any cognitive or behavior score. Confidence intervals for group means were small, whereas prediction intervals for individual children were large. CONCLUSIONS Risk of impaired cognitive function and behavior can be predicted from snoring history, sleep efficiency, sleep latency, and race but not tonsil size. The combination of snoring history and polysomnographic variables predicted impaired cognitive scores better than did either alone. The snoring history predicted more test scores than the number of episodes of apnea and hypopnea per 1 hour of sleep.
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Affiliation(s)
- Paul M Suratt
- Department of Internal Medicine, Pulmonary Critical Care Division, University of Virginia Medical Center, Charlottesville, Virginia 22908, USA.
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Abstract
OBJECTIVE Chronic snoring that does not adhere to the criteria for a diagnosis of obstructive sleep apnea syndrome may be associated with learning and behavioral problems. We investigated the sleep structure of chronic snorers who had an apnea-hypopnea index of < 1 event per hour and analyzed the cyclic alternating pattern. METHODS Fifteen successively seen chronic snorers (9.8 +/- 4 years) with an apnea-hypopnea index of <1 and 15 aged-matched control subjects (10.3 +/- 5 years) underwent an investigation of their sleep with the determination of non-apneic-hypopneic breathing abnormalities polysomnographic scoring using current criteria and analysis of the cyclic alternating pattern. RESULTS Chronic snorers have evidence of flow limitations and tachypnea during sleep even if they do not present with apneas, hypopneas, and decrease in oxygen saturations. They also present with abnormal cyclic alternating pattern rates and changes in phase A of cyclic alternating pattern compared with control subjects. CONCLUSIONS An apnea-hypopnea index value cannot be the sole determinant in evaluating sleep-disordered breathing in children. Children who have chronic snoring and do not respond to the criteria for obstructive sleep apnea syndrome can present with an abnormal sleep electroencephalogram as evidenced by a significant increase in cyclic alternating pattern rates, with a predominance of abnormalities in slow wave sleep.
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Affiliation(s)
- M Cecilia Lopes
- Stanford University Sleep Medicine Program, Stanford, California, USA
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Chervin RD, Ruzicka DL, Giordani BJ, Weatherly RA, Dillon JE, Hodges EK, Marcus CL, Guire KE. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics 2006; 117:e769-78. [PMID: 16585288 PMCID: PMC1434467 DOI: 10.1542/peds.2005-1837] [Citation(s) in RCA: 307] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Most children with sleep-disordered breathing (SDB) have mild-to-moderate forms, for which neurobehavioral complications are believed to be the most important adverse outcomes. To improve understanding of this morbidity, its long-term response to adenotonsillectomy, and its relationship to polysomnographic measures, we studied a series of children before and after clinically indicated adenotonsillectomy or unrelated surgical care. METHODS We recorded sleep and assessed behavioral, cognitive, and psychiatric morbidity in 105 children 5.0 to 12.9 years old: 78 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 27 for unrelated surgical care. One year later, we repeated all assessments in 100 of these children. RESULTS Subjects who had an adenotonsillectomy, in comparison to controls, were more hyperactive on well-validated parent rating scales, inattentive on cognitive testing, sleepy on the Multiple Sleep Latency Test, and likely to have attention-deficit/hyperactivity disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) as judged by a child psychiatrist. In contrast, 1 year later, the 2 groups showed no significant differences in the same measures. Subjects who had an adenotonsillectomy had improved substantially in all measures, and control subjects improved in none. However, polysomnographic assessment of baseline SDB and its subsequent amelioration did not clearly predict either baseline neurobehavioral morbidity or improvement in any area other than sleepiness. CONCLUSIONS Children scheduled for adenotonsillectomy often have mild-to-moderate SDB and significant neurobehavioral morbidity, including hyperactivity, inattention, attention-deficit/hyperactivity disorder, and excessive daytime sleepiness, all of which tend to improve by 1 year after surgery. However, the lack of better correspondence between SDB measures and neurobehavioral outcomes suggests the need for better measures or improved understanding of underlying causal mechanisms.
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Affiliation(s)
- Ronald D Chervin
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
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Griffiths A, Maul J, Wilson A, Stick S. Improved detection of obstructive events in childhood sleep apnoea with the use of the nasal cannula and the differentiated sum signal. J Sleep Res 2006; 14:431-6. [PMID: 16364144 DOI: 10.1111/j.1365-2869.2005.00474.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The efficacy of the nasobuccal thermistor (NT) was compared with the nasal pressure cannula (NC) and the calibrated, time-differentiated respiratory inductance plethysmography sum signal (DS) in the detection of obstructive events in children during polysomnography (PSG). The overnight PSG of 20 consecutive referrals were selected for analysis. Obstructive events were scored in each study three times by one operator using a blinded procedure whereby either the NT, the NC or the DS was visible. The standard PSG channels were also visible. SPSS software was used for statistical analysis. Twenty patients aged 5 weeks to 16 years were studied. Agreement in obstructive apnoea-hypopnoea index (OAHI) was highest between the NT and NC, and the NC and DS. The NC signal was significantly more likely to be uninterpretable than the NT (P = 0.02) and this did not correlate with age. Event detection by the NT was significantly improved by the addition of either the NC (P = 0.01) or the DS (P = 0.001), while the NC stood alone unless the DS was added (P = 0.02). There was no significant difference in OAHI by the NC versus the DS. The NC detected significantly more OA than the NT or the DS (P = 0.04), while the DS trended towards detecting more OH. There was no significant difference in OAHI between any combination pair. The nasal cannula and differentiated sum signal perform better as measures of paediatric airflow than the NT. To optimize the detection of obstructive events in children we recommend using at least one, if not both these methods in paediatric sleep laboratories.
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Affiliation(s)
- Amanda Griffiths
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital, Perth, WA, Australia.
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Sanchez I, Vega-Briceño L, Muñoz C, Mobarec S, Brockman P, Mesa T, Harris P. Polysomnographic findings in 320 infants evaluated for apneic events. Pediatr Pulmonol 2006; 41:215-21. [PMID: 16429436 DOI: 10.1002/ppul.20346] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Apnea is a common problem that causes significant parental anxiety. The aim of this study was to describe polysomnographic findings in infants who were referred over a 4-year period for an apnea and/or cyanotic event. Our hypothesis was that most infants with apnea or cyanosis events will have normal polysomnography (PSG). In total, 320 patients younger than 2 years old were recruited sequentially and prospectively. Patients underwent a day or overnight PSG by computerized polysomnograph; 78% of studies were performed with pH probe in situ. Subjects' ages ranged from 10 days to 21 months (55% male and 84% full-term babies); 55% and 74% were younger than 3 and 6 months, respectively. The average total sleep time was 473.4 min (SD, 52.3), with mean sleep efficiency of 83.5%. The distribution of sleep stages was 56.5% active, 38.5%, quiet and 5.1% indeterminate sleep. Sixty-nine percent (n = 220) of PSG studies were done overnight. There were significant differences in average sleep efficiency (78.1% vs. 83.3%) and REM sleep time (63.6% vs. 59.1%) between PSGs done during the day and overnight (P < 0.05). In total, 34 patients with apneas were studied. The median apnea index for the whole study population was 1.01 (range, 0.1-9.1). In conclusion, our study showed a high prevalence of normal polysomnographic findings in infants referred because of apnea and/or cyanotic events. New clinical prospective studies should be conducted to evaluate whether there is a correlation between PSG findings and outcome at follow-up of infants with a history of apnea and cyanosis.
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Affiliation(s)
- Ignacio Sanchez
- Section of Pulmonology, Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Aguirregomoscorta JI, Altube L, Menéndez I, Romaní A, Basualdo LV, Vallejo G. [Comparison between the 1993 and 2002 Guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) for identifying respiratory events in polysomnography tests]. Arch Bronconeumol 2005; 41:649-53. [PMID: 16373040 DOI: 10.1016/s1579-2129(06)60331-5] [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: 11/28/2022]
Abstract
OBJECTIVE To compare the results of applying both the 1993 and 2002 guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) to identify respiratory events during nighttime polysomnography tests. PATIENTS AND METHODS One hundred twenty consecutive patients with medium to high suspicion of sleep apnea-hypopnea syndrome (SAHS) were included in the study. The 1993 guidelines recommended the use of a thermistor and the evaluation of only apneas and hypopneas. The 2002 guidelines, on the other hand, recommended the use of a thermistor, nasal pressure cannula, and thoracoabdominal bands so that respiratory effort related to arousals could be studied along with apneas and hypopneas. In our study we did not use an esophageal pressure catheter. We calculated the apnea index, hypopnea index, and apnea-hypopnea index (AHI) and determined the number of patients who would be diagnosed with SAHS (AH I > or =10) and the number for whom initiation of continuous positive airway pressure treatment would be recommended (AHI > or =30) according to the 2 sets of guidelines. RESULTS Polysomnographic tests were valid for 118 of the 120 patients (80% men). The mean (SD) age was 51 (11.6) years and the mean body mass index 31.2 (4.3). Using the 1993 guidelines, the AHI was less than 10 in 25 patients, between 20 and 29 in 38, and 30 or more in 50. In the group overall, mean apnea and hypopnea indices and AHI were all significantly higher with the 2002 guidelines than with the 1993 criteria. With the 1993 criteria, the mean AHI was 33.16 and with 2002 criteria, 45.02 (P<.05). Sixty-four percent of the studies considered normal according to the 1993 SEPAR guidelines were considered apneic according to the 2002 guidelines. Of the patients considered not to need continuous positive airway pressure according to the 1993 SEPAR guidelines, 47.61% did need therapy according to the 2002 guidelines. CONCLUSIONS There are significant differences in AHI, and in both apnea and hypopnea indices depending on whether the 1993 or the 2002 SEPAR guidelines are applied.
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Aguirregomoscorta J, Altube L, Menéndez I, Romaní A, Basualdo L, Vallejo G. Comparación entre las normativas de la SEPAR de 1993 y 2002 en la lectura de los eventos respiratorios de las mismas polisomnografías. Arch Bronconeumol 2005. [DOI: 10.1016/s0300-2896(05)70719-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ng DK, Cheung JM, Chan CH, Chow PY, Kwok KL. Normal values of obstructive hyponea in children: still uncharted waters? Pediatr Pulmonol 2005; 40:554; author reply 555-6. [PMID: 16206152 DOI: 10.1002/ppul.20302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Moss D, Urschitz MS, von Bodman A, Eitner S, Noehren A, Urschitz-Duprat PM, Schlaud M, Poets CF. Reference values for nocturnal home polysomnography in primary schoolchildren. Pediatr Res 2005; 58:958-65. [PMID: 16183829 DOI: 10.1203/01.pdr.0000181372.34213.13] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abbreviated home polysomnography may be an alternative to laboratory polysomnography in children but is not yet generally accepted, partly due to a lack of reference values. Also, there are no normative data on respiratory events obtained using nasal prongs. We determined the prevalence and frequency of central, obstructive, and mixed apneas and hypopneas in a population-based sample of 50 children (mean age 10.1 years) using abbreviated home polysomnography and nasal prongs. We also determined the frequency of movements/arousals and body position changes. All children had central apneas. Obstructive apneas, mixed apneas, and hypopneas were found in 36%, 6%, and 14% of children, respectively. Average number of central, obstructive, and mixed apneas; hypopneas; movement/arousals; and body position changes per hour of sleep was 1.5, 0.1, 0.01, 0.02, 8.2, and 3.7, respectively. The corresponding cutoff values (mean plus 2 standard deviations or 95th centile) were 3.7, 0.7, 0.1, 0.2, 13.4, and 9.1, respectively. We did not find significant gender differences regarding any sleep variable under study. The presented reference values may help clinicians and researchers to improve the interpretation of abbreviated home polysomnography in school-age children.
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Affiliation(s)
- Dorothee Moss
- Department of Neonatology, University Children's Hospital Tuebingen, 72076 Tuebingen, Germany
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Amorim A, Sucena M, Winck JC, Almeida J. [Home cardiorespiratory sleep study in children. Will it be feasible?]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2005; 10:463-74. [PMID: 15735886 DOI: 10.1016/s0873-2159(15)30617-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Childhood obstructive sleep apnea syndrome is a common condition and can result in serious complications. The nocturnal polysomnography remains the gold standard in the diagnosis of this pathology. Given the scarcity of sleep laboratories, namely with paediatric profile, screening techniques have been commonly used. It was our aim to study the yield of the home cardiorespiratory sleep studies carried out in children. Since January of 1999 until June of 2003, 33 home cardiorespiratory sleep studies were performed in children. We studied 31 children (21 male) with a median age of 10.6+/-3.4 years. Five children had craniofacial malformations, 2 neuromuscular diseases and 10 were obese. The signals of nasal flow and saturation were good/acceptable in 67.7% and 96.8% of the cases, respectively. In 2 cases the register was null. Average of apnea-hypopnea index was of 10.7+/-12.3/hour, average saturation of 95.6%+/-3.0 %, minimum saturation of 82.2 %+/-9.2% and dessaturation index of 12.5+/-10.7/hour. Childhood obstructive sleep apnea syndrome was confirmed/suggested in 30 children. The apnea-hypopnea index and the dessaturation index were significantly higher in the group of children with craniofacial malformations and neuromuscular disorders comparatively to children with obesity (26.3 versus 10.5 and 21.5 versus 11.3, respectively) but without statistical significance. In our experience, home cardiorespiratory sleep studies is a diagnostic method easily used in children. This method gives more information comparatively to other screening techniques so that it can evaluate with more accuracy the existence of sleep disordered breathing and may be a possible alternative to polysomnography.
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Affiliation(s)
- Adelina Amorim
- Interna Complementar de Pneumologia, Hospital de S. João
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Traeger N, Schultz B, Pollock AN, Mason T, Marcus CL, Arens R. Polysomnographic values in children 2-9 years old: additional data and review of the literature. Pediatr Pulmonol 2005; 40:22-30. [PMID: 15858805 DOI: 10.1002/ppul.20236] [Citation(s) in RCA: 228] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The establishment of normal pediatric polysomnographic parameters is important for both clinical and research interests. Our objectives were to describe respiratory events, paradoxical breathing, periodic limb movements, and sleep architecture of children at the age of peak incidence of obstructive sleep apnea syndrome. We performed a retrospective cross-sectional analysis of a prospective cohort study of 66 children, 2-9 years old, at the Sleep Disorders Center at the Children's Hospital of Philadelphia. Subjects screened by questionnaire underwent a standard polysomnogram. The percent of total sleep time spent in sleep stages 1, 2, 3, 4, and rapid eye movement (REM) were 4 +/- 3%, 44 +/- 10%, 10 +/- 6%, 22 +/- 8%, and 21 +/- 6%, respectively. The arousal and awakening index was 11.2 +/- 4.3/hr. Respiratory events included a central apnea index of 0.08 +/- 0.14/hr, obstructive apnea index of 0.01 +/- 0.03/hr, and obstructive hypopnea index of 0.3 +/- 0.5/hr. The baseline arterial oxygen saturation (SpO2) was 97 +/- 1%, with a nadir of 92 +/- 3%. The index of periodic limb movements in sleep (PLMS) was 1.3 +/- 2.2/hr. Paradoxical breathing appeared significantly more frequent with piezo crystal effort belts (40 +/- 24% of epochs) than with respiratory inductive plethysmography (1.5 +/- 3% of epochs). We describe the occurrence of hypopneas during sleep, arousals and awakenings, and PLMS. We illustrate how different technologies can vary the apparent amount of paradoxical breathing. We also confirm previous data on the frequency distribution of sleep stages, SpO2, and relative rarity of respiratory events in this age group.
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Affiliation(s)
- Nadav Traeger
- Division of Pulmonary Medicine and Sleep Disorders Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA
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Ng DK, Chan CH, Kwok KL, Chow PY, Cheung JM. Necessity of 2-Night Polysomnographic Study in Children With Sleep-Related Disordered Breathing. Chest 2005; 128:463-4; author reply 464. [PMID: 16002973 DOI: 10.1378/chest.128.1.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
In the past 25 years there has been increasing recognition of obstructive sleep apnoea (OSA) as a common condition of childhood. Morbidity includes impairment of growth, cardiovascular complications, learning impairment, and behavioural problems. Diagnosis and treatment of this condition in children differs in many respects from that in adults. We review here the key features of paediatric OSA, highlighting differences from adult OSA, and suggest future directions for research.
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Affiliation(s)
- G M Nixon
- Department of Pediatrics, Montréal Children's Hospital, 2300 rue Tupper, Montréal, Québec H3H 1P3, Canada
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Pépin JL, Delavie N, Pin I, Deschaux C, Argod J, Bost M, Levy P. Pulse transit time improves detection of sleep respiratory events and microarousals in children. Chest 2005; 127:722-30. [PMID: 15764750 DOI: 10.1378/chest.127.3.722] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES To evaluate the additional information provided by pulse transit time (PTT), a noninvasive tool, when using during polysomnography for the diagnosis of sleep breathing disorders in a pediatric population. MAIN FINDINGS Respiratory and microarousals events were scored twice. The first scoring was performed using nasal pressure, thermistors, thoracic and abdominal movements, and oxygen saturation. The second scoring, blinded to the first scoring, was performed using PTT in combination with all the other signals. Microarousals were scored once visually on the EEG trace (cortical arousals [CAs]) and once using the PTT signal (autonomic arousals [AAs]) blinded to EEG. For the whole group of 16 children studied (mean age, 9.5 years), there was no significant difference between the respiratory disturbance index (RDI) with or without PTT analysis (22.4 +/- 13.5/h vs 20.4 +/- 14.3/h; not significant [mean +/- SD]). Among the children exhibiting a "without PTT" RDI < 30/h, 5 of 12 children (41.66%) showed a clinically significant >/= 5/h increase in RDI when using PTT. AAs detected by PTT were significantly more frequent than CAs during rapid eye movement (REM) sleep (7.4 +/- 3.9/h vs 3.2 +/- 2.3/h; p < 0.001) and slow wave sleep (SWS) [6.0 +/- 4.3/h vs 0.6 +/- 0.5/h; p < 0.0001]. CONCLUSIONS The quantification of respiratory effort using PTT improves the detection of respiratory events in children. The detection of microarousals is improved particularly in REM and SWS.
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Affiliation(s)
- Jean-Louis Pépin
- Department of Pediatrics and Respiratory Medicine, Intensive Care Unit and Sleep Laboratory, University Hospital, Grenoble, France.
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Melendres MCS, Lutz JM, Rubin ED, Marcus CL. Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing. Pediatrics 2004; 114:768-75. [PMID: 15342852 DOI: 10.1542/peds.2004-0730] [Citation(s) in RCA: 273] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Excessive daytime sleepiness (EDS) is seen less frequently as a presenting complaint in children with sleep-disordered breathing than in adults. Instead, symptoms of hyperactivity are often described. We hypothesized that children with suspected sleep-disordered breathing (S-SDB) were both sleepier and more hyperactive than control subjects. Furthermore, we hypothesized that overnight polysomnographic parameters correlated with sleepiness and hyperactivity. METHODS A cross-sectional study was conducted at a university-affiliated hospital and a community-based pediatric clinic. A total of 108 patients with S-SDB (mean [standard deviation] age: 7 +/- 4 years) and 72 control subjects (8 +/- 4 years) were recruited. A modified Epworth Sleepiness Scale (ESS) and the Conners Abbreviated Symptom Questionnaire were administered. Polysomnography was performed in patients with S-SDB. RESULTS Patients with S-SDB had a higher ESS (8.1 +/- 4.9 vs 5.3 +/- 3.9) and a higher Conners score (12.8 +/- 7.6 vs 9.0 +/- 6.2) than control subjects. On the basis of adult criteria, 28% of patients had EDS. There was no difference in the ESS and Conners scores of patients with primary snoring and patients with obstructive sleep apnea. The ESS had weak correlations with polysomnographic parameters. CONCLUSIONS Although the ESS score of children with S-SDB was within the normal range for adults, these children were sleepier and more hyperactive than control subjects. However, these data should be confirmed by a population-based study.
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Affiliation(s)
- Ma Cecilia S Melendres
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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O'Brien LM, Mervis CB, Holbrook CR, Bruner JL, Klaus CJ, Rutherford J, Raffield TJ, Gozal D. Neurobehavioral implications of habitual snoring in children. Pediatrics 2004; 114:44-9. [PMID: 15231906 DOI: 10.1542/peds.114.1.44] [Citation(s) in RCA: 331] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Current guidelines for the treatment of children with obstructive sleep apnea (OSA) suggest that primary snoring (PS) in children is benign. However, PS has not been well evaluated, and it is unknown whether PS is associated with serious morbidity. This study investigated whether PS is associated with neurobehavioral deficits in children. METHODS Parents of 5- to 7-year-old snoring children in public schools were surveyed about their child's sleeping habits. Children with a history of snoring and nonsnoring children were invited for overnight polysomnographic assessment and a battery of neurobehavioral tests. Only children who did not have a history of attention-deficit/hyperactivity disorder and were not considered hyperactive by parental report were tested. RESULTS Children with a history of snoring, an obstructive apnea index of <1/hour of total sleep time (hrTST), an apnea/hypopnea index <5/hrTST, and no gas exchange abnormalities were classified as PS (n = 87). Control subjects were defined as children without a history of snoring, an obstructive apnea index <1/hrTST, an apnea/hypopnea index <5/hrTST, and no gas exchange abnormalities (n = 31). Although means for both groups were in the normal range, the PS children were found to perform worse on measures related to attention, social problems, and anxious/depressive symptoms. In addition, although within the normal range, both overall cognitive abilities and certain language and visuospatial functions were significantly lower for the PS group than for the control subjects. CONCLUSIONS PS seems to be associated with significant neurobehavioral deficits in a subset of children, possibly related to increased susceptibility to sleep fragmentation. Larger studies are urgently required because current guidelines for treatment of snoring in children may require reevaluation.
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Affiliation(s)
- Louise M O'Brien
- Kosair Children's Hospital Research Institute and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky 40202, USA
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Witmans MB, Keens TG, Davidson Ward SL, Marcus CL. Obstructive hypopneas in children and adolescents: normal values. Am J Respir Crit Care Med 2004; 168:1540. [PMID: 14668259 DOI: 10.1164/ajrccm.168.12.954] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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