Feasibility of Comprehensive, Unattended Ambulatory Polysomnography in School-Aged Children

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%). Artifactfree 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 airfl ow 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 effi ciency (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 effi cacy of this approach, and generalizability of the fi ndings to a clinical population, are warranted. Keywords: polysomnography, sleep study, ambulatory, home, child Citation: Marcus CL, Traylor J, Biggs SN, Roberts RS, Nixon GM, Narang I, Bhattacharjee R, Davey MJ, Horne RS, 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(8):913-918.

Sleep/Wake Patterns and Parental Perceptions of Sleep in Children Born Preterm

“…7 In brief, a subset of children enrolled in follow-up studies for the Caffeine for Apnea of Prematurity (CAP) trial 15,16 underwent 2-week actigraphy monitoring prior to a single night of comprehensive, ambulatory polysomnography. Polysomnography results are published elsewhere 7,17 and will not be reported here. Caregivers completed questionnaires relating to general sleep at the end of the 2-week actigraphy study.…”

Comparison of Commercial Wrist-Based and Smartphone Accelerometers, Actigraphy, and PSG in a Clinical Cohort of Children and Adolescents

“…8,9 This technique, which uses sophisticated technology to assess brain, cardiovascular and respiratory activity during sleep usually in a laboratory environment, is expensive and labor-intensive and typically only provides one or two nights of information, which may not be reflective of sleep in the home. 10 Actigraphy, which use accelerometer technology to provide estimates of sleep and wake based on the level of activity, is used to provide objective assessments of sleep-wake patterns over long periods of time 11,12 and assist in diagnosis and treatment monitoring of sleep disorders such as delayed sleep phase syndrome and behavioral insomnia. 13 Validation studies in infants, children and adolescents have shown that actigraphy is sensitive in assessing actual sleep, however over-or underestimates wake after sleep onset, providing a poor estimate of sleep disruption when compared to PSG.…”

American Academy of Sleep Medicine Position Paper for the Use of a Home Sleep Apnea Test for the Diagnosis of OSA in Children

“…The data sets were then compared, which revealed that AHI was understated with the HSAT data set; this disparity could have significantly affected clinical management decisions in 23% of patients in the study, including 27.5% of patients with an AHI of 1 to 5 and 60% of patients with an AHI of 5 to 10. 22 In total these validation studies report data from 208 children in whom the gold standard of PSG was directly compared with HSATs for the diagnosis of OSA 9,10,[14][15][16][17][18] ; however, an HSAT was only performed at home in 2 of the studies. 18,19 Overall, these validation studies reported a relatively wide range of sensitivities and specificities that varied to some extent with severity of OSA.…”

“…More recently, Marcus and colleagues conducted a large multisite study to examine the clinical feasibility of HSATs to evaluate OSA in children. 15 This study included 201 children, ages 5 to 12 years, all with a history of prematurity. Technically acceptable studies were obtained on the first night in 91% of the children and 98% when an additional study was performed.…”

“…14 A small pilot study was performed prior to the larger multisite study to assess validity of the data. 15 Four children underwent both PSG and an HSAT on separate nights within a 7-month period. Similar respiratory parameters were seen with the PSG and HSAT.…”