Respiratory polygraphy for follow-up of obstructive sleep apnea in children

Alonso-Álvarez, María Luz; Navazo-Egüia, Ana Isabel; Cordero-Guevara, José; Ordax-Carbajo, Estrella; Mata, Gregorio De La; Barba-Cermeño, José Luis; Terán-Santos, Joaquín

doi:10.1016/j.sleep.2011.11.014

Cited by 19 publications

(17 citation statements)

References 21 publications

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“…14 Th is study showed that an RDI cutoff Ն 4.6 exhibited excellent sensitivity and specifi city for identifying OSAS in children and was useful in both the diagnosis and follow-up of children with OSAS. 14,33 Th e present study confi rms our previous fi ndings on the LRP cutoff value of the RDI (ie, 4.6). Of note, a recent study using LRP and standard diagnostic criteria suggested that use of LRP may significantly aff ect clinical management decisions, particularly in children with mild and moderate OSAS.…”

Section: Discussionsupporting

confidence: 89%

Reliability of Home Respiratory Polygraphy for the Diagnosis of Sleep Apnea in Children

Alonso-Álvarez

Terán-Santos

Carbajo

et al. 2015

Chest

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138

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OBJECTIVE:Th e objective of this study was to evaluate the diagnostic reliability of home respiratory polygraphy (HRP) in children with a clinical suspicion of OSA-hypopnea syndrome (OSAS). METHODS:A prospective blind evaluation was performed. Children between the ages of 2 to 14 years with clinical suspicion of OSAS who were referred to the Sleep Unit were included. An initial HRP followed by a later date , same night, in-laboratory overnight respiratory polygraphy and polysomnography (PSG) in the sleep laboratory were performed. Th e apneahypopnea index (AHI)-HRP was compared with AHI-PSG, and therapeutic decisions based on AHI-HRP and AHI-PSG were analyzed using intraclass correlation coeffi cients, BlandAltman plots, and receiver operator curves (ROCs). RESULTS:Twenty-seven boys and 23 girls, with a mean age of 5.3 Ϯ 2.5 years, were studied, and 66% were diagnosed with OSAS based on a PSG-defi ned obstructive respiratory disturbance index Ն 3/h total sleep time. Based on the availability of concurrent HRP-PSG recordings, the optimal AHI-HRP corresponding to the PSG-defi ned OSAS criterion was established as Ն 5.6/h Th e latter exhibited a sensitivity of 90.9% (95% CI, 79.6%-100%) and a specifi city of 94.1% (95% CI, 80%-100%).CONCLUSIONS: HRP recordings emerge as a potentially useful and reliable approach for the diagnosis of OSAS in children. However, more research is required for the diagnosis of mild OSAS using HRP in children. ENT 5 ear, nose, and throat; HRP 5 home respiratory polygraphy; ICC 5 interclass correlation coeffi cient; LRP 5 in-laboratory respiratory polygraphy; OAHI 5 obstructive apnea-hypopnea index; ORDI 5 obstructive respiratory disturbance index; OSAS 5 OSAhypopnea syndrome; PSG 5 polysomnography; RDI 5 respiratory disturbance index; ROC 5 receiver operating characteristic; RP 5 respiratory polygraphy; Sp o 2 5 oxygen saturation using pulse oximetry; SU 5 Sleep Unit AFFILIATIONS: From the Sleep Unit (Drs Alonso-Álvarez, Terán-Santos, Ordax Carbajo, Cordero-Guevara, and Navazo-Egüia), the CIBER of Respiratory Diseases (Drs Alonso-Álvarez and Terán-Santos), Instituto Carlos III, CIBERES, and the

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Section: Discussionsupporting

confidence: 89%

Reliability of Home Respiratory Polygraphy for the Diagnosis of Sleep Apnea in Children

Alonso-Álvarez

Terán-Santos

Carbajo

et al. 2015

Chest

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138

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“…21 Alonso Alvarez et al 22 showed that when an obstructive apnea-hypopnea index (OAHI) Ն 3 on PSG or RDI Ն 3 on RP was used as the diagnostic cutoff , the rate of diagnostic agreement between the two was 84.9%. Furthermore, Alonso-Álvarez et al 23 have also shown that in-laboratory RPs are a useful tool in assessing eff ectiveness of surgical treatment. Th is experience contrasts with the results of a small study of 12 children suspected to have OSA who spent two consecutive nights in-hospital undergoing a PSG and RP.…”

Section: Home Rp (Type 3 Portable Monitoring)mentioning

confidence: 99%

Pediatric Home Sleep Apnea Testing

Tan

Kheirandish‐Gozal

Gozal

2015

Chest

108

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“…11 Despite robust published evidence showing that the apneahypopnea index is inherently underestimated, 12 RP is rapidly becoming a widely implemented alternative to PSG in clinical settings. 8,9,11 Furthermore, ambulatory RP at home (HRP) has been suggested as a valid approach in low resource settings when in-laboratory PSG is not available. 11 A recent study demonstrated the feasibility of HRP to evaluate children with OSA at home.…”

Section: Introductionmentioning

confidence: 99%

Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings

Álvarez

Alonso-Álvarez

Gutiérrez‐Tobal

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Nocturnal oximetry has become known as a simple, readily available, and potentially useful diagnostic tool of childhood obstructive sleep apnea (OSA). However, at-home respiratory polygraphy (HRP) remains the preferred alternative to polysomnography (PSG) in unattended settings. The aim of this study was twofold: (1) to design and assess a novel methodology for pediatric OSA screening based on automated analysis of at-home oxyhemoglobin saturation (SpO2), and (2) to compare its diagnostic performance with HRP. Methods: SpO2 recordings were parameterized by means of time, frequency, and conventional oximetric measures. Logistic regression models were optimized using genetic algorithms (GAs) for three cutoffs for OSA: 1, 3, and 5 events/h. The diagnostic performance of logistic regression models, manual obstructive apnea-hypopnea index (OAHI) from HRP, and the conventional oxygen desaturation index ≥ 3% (ODI3) were assessed. Results: For a cutoff of 1 event/h, the optimal logistic regression model significantly outperformed both conventional HRP-derived ODI3 and OAHI: 85.5% accuracy (HRP 74.6%; ODI3 65.9%) and 0.97 area under the receiver operating characteristics curve (AUC) (HRP 0.78; ODI3 0.75) were reached. For a cutoff of 3 events/h, the logistic regression model achieved 83.4% accuracy (HRP 85.0%; ODI3 74.5%) and 0.96 AUC (HRP 0.93; ODI3 0.85) whereas using a cutoff of 5 events/h, oximetry reached 82.8% accuracy (HRP 85.1%; ODI3 76.7) and 0.97 AUC (HRP 0.95; ODI3 0.84). Conclusions: Automated analysis of at-home SpO2 recordings provide accurate detection of children with high pretest probability of OSA. Thus, unsupervised nocturnal oximetry may enable a simple and effective alternative to HRP and PSG in unattended settings. Keywords: at-home respiratory polygraphy, automated pattern recognition, blood oxygen saturation, genetic algorithms, nocturnal oximetry Citation: Álvarez D, Alonso-Álvarez ML, Gutiérrez-Tobal GC, Crespo A, Kheirandish-Gozal L, Hornero R, Gozal D, Terán-Santos J, Del Campo F. Automated screening of children with obstructive sleep apnea using nocturnal oximetry: an alternative to respiratory polygraphy in unattended settings. J Clin Sleep Med. 2017;13(5):693-702.

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Respiratory polygraphy for follow-up of obstructive sleep apnea in children

Cited by 19 publications

References 21 publications

Reliability of Home Respiratory Polygraphy for the Diagnosis of Sleep Apnea in Children

Reliability of Home Respiratory Polygraphy for the Diagnosis of Sleep Apnea in Children

Pediatric Home Sleep Apnea Testing

Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings

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