Comparison of home sleep apnea testing versus laboratory polysomnography for the diagnosis of obstructive sleep apnea in children

Scalzitti, Nicholas J; Hansen, Shana; Maturo, Stephen; Lospinoso, Joshua; O’Connor, Peter

doi:10.1016/j.ijporl.2017.06.013

Cited by 46 publications

(54 citation statements)

References 23 publications

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“…considered 240 min of artifact‐free signal sufficient for a successful study (Goodwin et al., ) and Scalzitti et al. set the limit at 360 min (Scalzitti, Hansen, Maturo, Lospinoso, & O'connor, ). We defined an acceptable study as 180 min of interpretable data from three leads.…”

Section: Discussionmentioning

confidence: 99%

“…No clear criteria exist regarding the minimum duration of recordings in sleep apnea evaluation in children and definitions of acceptable and successful recordings vary greatly (Poels et al, 2003). Goodwin et al consid-ered 240 min of artifact-free signal sufficient for a successful study (Goodwin et al, 2001) and Scalzitti et al set the limit at 360 min (Scalzitti, Hansen, Maturo, Lospinoso, & O'connor, 2017). We defined an acceptable study as 180 min of interpretable data from three leads.…”

Section: Discussionmentioning

confidence: 99%

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Respiratory polygraphy in children with sleep‐disordered breathing

Gudnadottir

Hafsten

Redfors

et al. 2019

Journal of Sleep Research

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Respiratory polygraphy in children with sleep‐disordered breathing

Gudnadottir

Hafsten

Redfors

et al. 2019

Journal of Sleep Research

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“…Further, estimation of OSA severity by a limited channel PSG study may underestimate OAHI when based on total recording time (ie, without an EEG‐based measure of sleep), rather than total sleep time . In addition, while home sleep studies are less expensive than in‐lab PSG, they still require the setup of technically complex diagnostic equipment as well as expert interpretation of the acquired data.…”

Section: Home Sleep Studymentioning

confidence: 99%

Preoperative identification of children at high risk of obstructive sleep apnea

Ohn

Eastwood

Ungern‐Sternberg

2020

Pediatric Anesthesia

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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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“…In general, studies that have shown successful data acquisition and good correlation with laboratory PSG are those that have utilized a professionally trained technician or nurse to perform the initial setup of the device . When attempts at caregiver setup have been made, the results have been far less successful in obtaining accurate diagnostic information . Recently, comparison of a commercially available, caregiver‐applied home sleep apnea test with in‐laboratory PSG in 33 children revealed a sensitivity of 70% and specificity of 83% for diagnosing OSA, but this degree of accuracy required two nights of home use of the monitor .…”

Section: Identifying Obstructive Sleep Apneamentioning

confidence: 99%

Diagnosis and perioperative management in pediatric sleep‐disordered breathing

Scalzitti

Sarber

2018

Pediatric Anesthesia

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Summary 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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Comparison of home sleep apnea testing versus laboratory polysomnography for the diagnosis of obstructive sleep apnea in children

Cited by 46 publications

References 23 publications

Respiratory polygraphy in children with sleep‐disordered breathing

Respiratory polygraphy in children with sleep‐disordered breathing

Preoperative identification of children at high risk of obstructive sleep apnea

Diagnosis and perioperative management in pediatric sleep‐disordered breathing

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