Performance of Nasal Prongs in Sleep Studies

Hernández, Lourdes; Ballester, Eugeni; Farré, Ramón; Badia, Joan R.; Lobelo, Rafael; Navajas, Daniel; Montserrat, Josep M.

doi:10.1378/chest.119.2.442

Cited by 69 publications

(67 citation statements)

References 15 publications

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“…Disadvantages include an increased amount of uninterpretable signal (4,16), occurring with sensor dislocation or occlusion, or during periods of mouth breathing (39). In the present study, one third of children had at least 5 minutes of uninterpretable nasal pressure signal.…”

Section: Discussionmentioning

confidence: 52%

Reference Values for Nocturnal Home Polysomnography in Primary Schoolchildren

et al. 2005

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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 populationbased 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. The gold standard for diagnosing sleep-disordered breathing (SDB) is full polysomnography in a sleep laboratory (1). Unattended home sleep studies using portable systems, however, are increasingly recognized as an alternative. Advantages include convenience, improved sleep quality, and costeffectiveness (2,3). Nonetheless, such studies are yet rarely used in the evaluation of pediatric SDB. One reason for this may be the lack of reference values.There are also no reference data for respiratory events in children measured by nasal prongs/pressure transducers, although these are more sensitive in detecting hypopnea and FL than thermal sensors (e.g. thermistor or thermocouples) (4,5). This is important because children are more likely than adults to have partial rather than complete upper airway obstruction (6).We, thus, aimed to establish reference values for respiratory and other sleep study variables obtained at home using portable devices and nasal prongs/pressure transducers. The current study was conducted as a part of a population-based crosssectional study on prevalence, risk factors, and consequences of various expressions of SDB in children (7-10). Primary school children were screened for signs and symptoms of SDB using parental questionnaires (8) and nocturnal home pulse oximetry (11). Children with and without signs and symptoms of SDB subsequently underwent nocturnal home polysomnography (8). In this report, we focus on the feasibility of performing unattended home sleep studies in children, the data quality achieved, and the presentation of reference values obtained from healthy school-age children. METHODS Subjects.The source population for the current study were subjects who had participated in the main study (8) and had (1) no history of habitual snorin...

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Section: Discussionmentioning

confidence: 52%

Reference Values for Nocturnal Home Polysomnography in Primary Schoolchildren

et al. 2005

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“…Moreover, thoracoabdominal bands are already widely used in polysomnography to evaluate whether apnoeic events are obstructive or central. Therefore, if thoracoabdominal bands are useful to detect RERAs, they could be used in combination with a thermistor or as a complement to other methods that can detect apnoeas, hypopnoeas and RERAs, for example nasal cannula [15][16][17].…”

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confidence: 99%

Assessment of thoracoabdominal bands to detect respiratory effort-related arousal

Masa¹,

Corral²,

Martín³

et al. 2003

Eur Respir J

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It would be helpful to be able to identify respiratory effort-related arousal (RERA) without needing to measure oesophageal pressure. Thoracoabdominal movements yield an indirect flow measurement from which reduction of amplitude and alteration of the inspiratory flow curve can be detected. The aim of this study was to evaluate the accuracy of using the shape and amplitude of signals from thoracoabdominal bands (inductance plethysmography) to detect RERAs.Altogether, 94 subjects suspected of having sleep apnoea but with an apnoea/ hypopnoea index f10 in full polysomnography with oesophageal pressure were studied. A routine polysomnographical analysis was carried out. The polysomnographies were then reanalysed at random to determine which of the identified arousals were due to RERA, as determined either by oesophageal pressure or by induction bands without an oesophageal pressure signal. Altogether, 14,617 arousals were analysed.The sensitivity and specificity to find RERA (arousal by arousal) from bands versus oesophageal pressure were both 94%. The average difference of RERA index between oesophageal pressure and bands was -0.6. The correlation between RERA index determined by oesophageal pressure and bands was 0.98. To evaluate the intra and interobserver agreement, 1183 arousals were additionally analysed. The intraobserver agreement was 91% for RERAs by oesophageal pressure and 80% by bands. The interobserver agreement was 89% by oesophageal pressure and 85% by bands.The thoracoabdominal bands can be used to identify respiratory effort-related arousal (obstructive events not detected by thermistor) with similar efficacy to oesophageal pressure measurement. Since bands are routinely used in most polysomnographies, they can be used as the usual method to detect respiratory effort-related arousal, using a thermistor to evaluate apnoeas and hypopnoeas or as a complement to other methods, such as nasal cannula, which can detect apnoeas, hypopnoeas and respiratory effort-related arousal. Eur Respir J 2003; 22: 661-667.

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“…As expected, indices derived from the nasal pressure sensor alone were almost always larger than from the combina- AHI from a nasal pressure transducer and thermal sensor. 10,[29][30][31][32][33] Consistently, these studies reported the detection of a higher number of apneas when a nasal pressure transducer is used, compared with a thermal sensor, with differences ranging from 30% to 50%. 34,35 This is similar to this study, in which the mean difference between AI np and AI th was 5.3 (4.0, 6.7) events per hour (mean, 95% confidence interval), a difference of 51%.…”

Section: Signal Qualitymentioning

confidence: 59%

“…They have been used for many years in polysomnography, and it has long been recognized that the signal produced is not proportional or even related to airflow. [18][19][20][21][22][23][24] As suggested in the evidence review 25 underpinning the AASM manual, the sensitivity of oronasal thermal sensors to small flow makes them appropriate for use in the detection of complete airflow cessation, and, hence, the AASM recommend that they be the sensor used for detecting apnea.…”

Section: Discussionmentioning

confidence: 99%

“…36 One of the major criticisms of nasal pressure transducers is the absence of an oral breathing sensor. The fact that only 2.5% of the studies had significant portions with inadequate nasal pressure signal quality reflects the proposition that exclusively oral breathing during sleep is uncommon, 19,21,35,37,38 even in patients with OSA. 39 This study provides limited support for the use of nasal pressure sensors as an adequate substitute for oronasal thermal sensors in situations in which the oronasal thermal sensor fails or in which it is impractical or undesirable to place both nasal pressure and thermal sensors on the patient.…”

Section: Discussionmentioning

confidence: 99%

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AASM Criteria for Scoring Respiratory Events: Interaction between Apnea Sensor and Hypopnea Definition

Thornton

Singh

Ruehland

et al. 2012

Sleep

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425Choice of Apnea Sensor-Thornton et al reduction and the sensor to be used for apnea detection. The guidelines require that "the sensor to detect absence of airflow for identification of an apnea is an oronasal thermal sensor." 1 The alternative sensor for apnea detection, and the AASM recommended sensor for hypopnea detection, is nasal pressure. These recommendations supercede those in the AASM consensus report of 1999, also known as "Chicago Criteria," 9 which had emphasized nasal pressure as a semi-quantitative measure of airflow and recommended against the routine use of thermal sensors.Despite the AASM recommendations, there is no direct evidence to support the need for both sensors. Nasal-pressure sensors are less sensitive to low levels of flow 10,11 and will not detect oral airflow; hence, it may be that some apneas scored by nasal pressure would be scored as hypopneas with the addition of thermal sensors. It might also follow that there will be little or no net effect on the AHI but simply a shift between event categories-from apnea to hypopnea. On the other hand, because the apnea definition does not require an associated oxygen desaturation or cortical arousal, it is at least possible that apneas scored with nasal pressure alone would not qualify as an apnea or hypnopea with the addition of a thermal sensor, resulting in a reduction in the AHI. INTRODUCTIONIn 2007, the American Academy of Sleep Medicine (AASM) published the Manual for the Scoring of Sleep and Associated Events.1 Following the publication of the manual, there have been a number of criticisms 2-7 ; the major criticism has been the endorsement by the AASM of 2 quite disparate definitions of hypopnea.6,7 Quantification of respiratory events is critical to the diagnosis of sleep apnea, with the apnea-hypopnea index (AHI) being the primary metric for determination of abnormality and severity; the 2 definitions have been shown to result in substantial differences in AHI. 6,8 The AASM manual also clarified the definition of apnea, providing rules for measuring event duration, the extent of airflow Study Objectives: To examine the impact of using a nasal pressure sensor only vs the American Academy of Sleep Medicine (AASM) recommended combination of thermal and nasal pressure sensors on (1) the apnea index (AI), (2) the apnea-hypopnea index (AHI), where the AHI is calculated using both AASM definitions of hypopnea, and (3) the accuracy of a diagnosis of obstructive sleep apnea (OSA). Design: Retrospective review of previously scored in-laboratory polysomnography. Setting: A tertiary-hospital clinical sleep laboratory. AASM CRITERIA FOR SCORING RESPIRATORY EVENTS Patients or Participants:One hundred sixty-four consecutive adult patients with a potential diagnosis of OSA, who were examined during a 3-month period. Interventions: N/A. Measurements and Results: Studies were scored with and without the use of the oronasal thermal sensor. AIs and AHIs, using the nasal pressure sensor alone (AI np and AHI np ), were compared with those using both a...

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Performance of Nasal Prongs in Sleep Studies

Cited by 69 publications

References 15 publications

Reference Values for Nocturnal Home Polysomnography in Primary Schoolchildren

Reference Values for Nocturnal Home Polysomnography in Primary Schoolchildren

Assessment of thoracoabdominal bands to detect respiratory effort-related arousal

AASM Criteria for Scoring Respiratory Events: Interaction between Apnea Sensor and Hypopnea Definition

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