Home testing for pediatric obstructive sleep apnea syndrome secondary to adenotonsillar hypertrophy

Abstract

The objective of this study was to determine the accuracy and practicality of home testing for pediatric obstructive sleep apnea syndrome (OSAS) secondary to adenotonsillar hypertrophy. Twenty-one children aged 2-12 years and referred for possible OSAS were studied twice, once at home and once in the sleep laboratory. The home test consisted of two parts: 1) a cardiorespiratory recording of saturation (SaO2), pulse rate, pulse waveform, electrocardiogram, and respiratory inductive plethysmography; and 2) an 8-hour videotape recording of the sleeping child. In the laboratory, standard nocturnal polysomnography including electroencephalography was performed. Experiences with another 62 children who underwent home testing alone were also reviewed and are reported. At home, saturation, respiratory, and video data were obtained 96.4 +/- 13.3% (mean +/- SD) 99.4 +/- 1.6%, and 90.0 +/- 78% of the time, respectively. The sleep efficiency was greater at home than in the laboratory, 91.1 +/- 3.9% vs. 86.1 +/- 7.2%, with a mean difference of 5.0% (P < 0.01). The median environmentally induced movement/arousal index was lower in the home than in the laboratory, 0.0 (inter-quartile range, 0.0-0.3 vs. 2.4/hr (inter-quartile range 1.2-4.2), with a median difference of 2.4/h (P < 0.001). Study duration, apnea/hypopnea index, desaturation index, respiratory and spontaneous movement/arousal indices, and oxygen saturation during sleep were similar for home and laboratory studies. Although neither sleep state nor PCO2 (transcutaneous or end-tidal) was measured in the home, this information would have modified patient management in, at most, one case. In the second group of 62 children, exclusively studied at home, all studies were successfully recorded despite a wide range of sleep efficiencies, apnea/hypopnea indices, and desaturation indices. We conclude that home testing, using a simplified cardiorespiratory montage plus video recording, is accurate and of practical use in the routine evaluation of OSAS in patients with adenotonsillar hypertrophy.

Planning Adenotonsillectomy in Children With Obstructive Sleep Apnea: The Role of Overnight Oximetry

“…This scoring system (Table 1) was then applied to the overnight oximetry tests performed as part of in-laboratory PSG or a home cardiorespiratory sleep study (CRSS) 18 for evaluation of suspected OSA between 1992 and 1998. Detailed information on the perioperative course of children in this cohort has been published previously.…”

Children with severe OSAS who have adenotonsillectomy in the morning are less likely to have postoperative desaturation than those operated in the afternoon

“…Details of our sleep study recording systems have been published elsewhere. [9][10][11][12] Although the studies were analyzed for several variables, 5 only the OAH index and the preoperative saturation nadir (preSaO 2 nadir) are reported. The preSaO 2 nadir was defined as the minimum hemoglobin oxygen saturation regardless of duration and was validated by visual inspection of a computerized data record.…”

Population prevalence of obstructive sleep apnoea in a community of German third graders

“…This is based on the assumption that if detection of rapid-eye-movement sleep (when OSA is usually present or most severe) is not possible, OSA cannot be reliably ruled out. Three validation studies on abbreviated HPSG showed conflicting results [53][54][55]. However, as previously discussed by MORIELLI et al [56] and JACOB et al [54] there is invariably rapid-eye-movement sleep present in an all night recordings, even though it may not be possible to determine which specific epochs are included.…”

“…Three validation studies on abbreviated HPSG showed conflicting results [53][54][55]. However, as previously discussed by MORIELLI et al [56] and JACOB et al [54] there is invariably rapid-eye-movement sleep present in an all night recordings, even though it may not be possible to determine which specific epochs are included. Meanwhile, abbreviated HPSG has been used by a series of other community-based studies [6,10,12,14], possibly because full HPSG suffers from significant artefacts in the electroencephalographic and myographic channels [57].…”

“…Meanwhile, abbreviated HPSG has been used by a series of other community-based studies [6,10,12,14], possibly because full HPSG suffers from significant artefacts in the electroencephalographic and myographic channels [57]. The convincing advantages of abbreviated HPSG are convenience for both parents and children, and cost-effectiveness [54,58]. Moreover, the omission of sensors and leads attached to the child's face and head should help to improve sleep quality and establish a regular sleep profile in the night of recording.…”