The Utility of a Portable Sleep Monitor to Diagnose Sleep‐Disordered Breathing in a Pediatric Population

Massicotte, Colin; Al-Saleh, Suhail; Witmans, Manisha; Narang, Indra

doi:10.1155/2014/271061

Cited by 38 publications

(36 citation statements)

References 24 publications

(29 reference statements)

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“…In the present study, we observed that HPG overestimated AHI compared with the PSG, similar to Massicotte et al and incorrectly diagnosed patients with OSAS. The over‐diagnosis of OSAS with polygraphy may be due to events scored during wakefulness, reduced flow observed on a nasal flow channel during mouth breathing even in the absence of apnea and/or post‐arousal artifacts mistaken as reduced airflow.…”

Section: Discussionsupporting

confidence: 91%

“…In a previous study by Rosen et al a subgroup of 55 children in the study group had in‐lab PSG and HPG performed within 3 months for comparison, and when using an AHI ≥ 5/h total sleep time (TST) as cut‐off for the diagnosis of OSAS, the sensitivity of HPG was 88% and the specificity was 98%. Massicotte et al studied 35 children with PSG and polygraphy simultaneously in the sleep lab and using a cut‐off AHI ≥ 1.5 events/h, the manually scored polygraphy had a sensitivity of 94% and specificity of 16% to detect OSAS (AHI ≥ 1.5 events/h) diagnosed by PSG. When the cut‐off was increased (AHI of ≥5 events/h) polygraphy still had good sensitivity of 94% and specificity increased to 61% in detecting OSAS (AHI ≥ 1.5 events/h) diagnosed by PSG.…”

Section: Discussionmentioning

confidence: 99%

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Are home sleep studies useful in diagnosing obstructive sleep apnea in children with down syndrome?

İkizoğlu

Kıyan

Polat

et al. 2019

Pediatric Pulmonology

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Introduction and Aim Obstructive sleep apnea syndrome (OSAS) is frequent in children with Down syndrome (DS) and polysomnography (PSG) is recommended for all children with DS. However PSG is not always available and alternative diagnostic methods are needed. The aim of the study was to evaluate the feasibility and validity of home polygraphy (HPG) in children with DS. Methods A national DS association was contacted and children aged 6 to 18 years who accepted to participate were recruited. Otorhinolaryngologic evaluation, in‐lab PSG and HPG were performed. OSAS was diagnosed by PSG with an apnea‐hypopnea index (AHI) more than or equal to 1. OSAS severity was classified as moderate‐to‐severe if AHI was more than or equal to 5. Receiver operating characteristic curves were calculated for HPG using PSG as the gold standard. Results Nineteen children (12 girls) completed the study. Median age was 11.3 years. Demographic and clinical characteristics were similar in children with and without OSAS. Eighty‐nine percent of HPG studies were technically acceptable at the initial night and the success rate was 100% when two failed studies were repeated. PSG revealed OSAS in six (32%) children, two had mild and four had moderate‐to‐severe OSAS. All four patients with moderate‐to‐severe OSAS diagnosed with PSG have been diagnosed with the same severity on HPG. HPG had 100% sensitivity and 83% specificity when AHI ≥ 3 was set as diagnostic criteria. Conclusion HPG is a feasible and reliable test of OSAS in children with DS and may be useful in diagnosis and treatment of patients with moderate‐to‐severe OSAS in this patient group.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Are home sleep studies useful in diagnosing obstructive sleep apnea in children with down syndrome?

İkizoğlu

Kıyan

Polat

et al. 2019

Pediatric Pulmonology

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“…Although some data have been published to support the ability of the ApneaLink™ to make this distinction [20], portable SDB screening tests overall are not considered to provide reliable assessments of obstructive versus central etiologies [21,22]. Further, SDB after stroke is known to be predominantly (94%) obstructive in nature [23].…”

Section: Methodsmentioning

confidence: 99%

High prevalence of poststroke sleep-disordered breathing in Mexican Americans

et al. 2017

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Objective The purpose of this study is to compare sleep-disordered breathing (SDB) prevalence and severity after stroke between Mexican Americans (MAs) and non-Hispanic whites (NHWs). Patients/methods Ischemic stroke (IS) patients within ~30 days of onset were identified from the population-based BASIC Project (2010–2014) and offered screening with an overnight cardiopulmonary monitoring device, ApneaLink Plus™. The number of apneas and hypopneas per hour, as reflected by the apnea/hypopnea index (AHI), was used to measure SDB severity; SDB was defined as AHI ≥10. Ethnicity, demographics, and risk factors were collected from interviews and medical records. Log and negative-binomial regression models were used to determine prevalence ratios (PRs) and apnea/hypopnea event rate ratios (RRs) comparing MAs with NHWs after adjustment for demographics, risk factors, and stroke severity. Results A total of 549 IS cases had AHI data. The median age was 65 years (interquartile range (IQR): 57–76), 55% were men, and 65% were MA. The MAs had a higher prevalence of SDB (68.5%) than NHWs (49.5%) in unadjusted (PR = 1.38; 95% confidence interval (CI): 1.14–1.67) and adjusted analyses (PR = 1.21; 95% CI: 1.01–1.46). The median AHI was 16 (IQR: 7–31) in MAs and nine (IQR: 5–24) in NHWs. The severity of SDB (rate of apneas/hypopneas) was higher in MAs than NHWs in unadjusted (RR = 1.31; 95% CI: 1.09–1.58) but not adjusted analysis (RR = 1.14; 95% CI: 0.95–1.38). There was no ethnic difference in severity among subjects with SDB. Conclusion More than two-thirds of MA stroke patients had SDB, which was almost 40% more common among MAs than NHWs. Physicians treating MA patients after stroke should have a high index of suspicion for SDB, a treatable condition that could otherwise have adverse impact.

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“…Breathing disorders were assessed using a specific and light device ApneaLink ® (ResMed Germany Inc., ref 22301) in all study sites, allowing a non‐invasive measurement of respiratory parameters. This device has been previously described and used in several studies for identification of sleep apnea in patients 18, 19, 20. Briefly, ApneaLink ® is a single‐channel screening device that measures airflow through a simple nasal cannula connected to a pressure transducer, providing an apnea‐hypopnea index (AHI) based on recording time 18.…”

Section: Methodsmentioning

confidence: 99%

Effect of desipramine on patients with breathing disorders in RETT syndrome

Mancini

Dubus

Jouve

et al. 2017

Ann Clin Transl Neurol

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ObjectiveRett Syndrome (RTT) is a severe neurodevelopmental condition with breathing disorders, affecting around one in 10,000 female births. Desipramine, a noradrenaline reuptake inhibitor, reduced the number of apneas in Mecp2‐deficient mice, a model of RTT. We planned a phase 2 trial to test its efficacy and its safety on breathing patterns in 36 girls with RTT.MethodsThe trial was a 6‐month, multicenter, randomized, double‐blind, placebo‐controlled study registered with ClinicalTrials.gov, number NCT00990691. Girls diagnosed according to clinical examination and confirmed by genotyping were randomly assigned in a 1:1:1 ratio to receive 2–3 mg/kg Desipramine per day (high Desipramine), 1–2 mg/kg Desipramine per day (low Desipramine), or a placebo. The primary outcome was the change of apnea hypopnea index (AHI), defined by the number of apnea and hypopnea events per hour, assessed at 6 months from baseline. Intention‐to‐treat analysis was applied.ResultsThe median change in AHI from baseline to 6 months was −31 (IQR: −37 to −11) for the high Desipramine, −17.5 (IQR: −31 to 13) for the low Desipramine, and −13 (IQR:−31 to 0) for the placebo group. We did not find any significant difference in these changes between the groups (P = 0.781). A significant inverse correlation between Desipramine plasma concentration and AHI (r = −0.44; P = 0.0002) was underlined.InterpretationThis first clinical trial of desipramine did not show clinical efficacy. Although required further studies, the significant correlation between Desipramine concentrations and improvement of AHI provided additional and relevant reasons to test the noradrenergic pathway in RTT.

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The Utility of a Portable Sleep Monitor to Diagnose Sleep‐Disordered Breathing in a Pediatric Population

Abstract: Although PSG is still recommended for the diagnosis of SDB, the ApneaLink sleep monitor has a role for triaging children referred for evaluation of SDB, but has limited ability to determine the nature of the SDB.

Cited by 38 publications

References 24 publications

Are home sleep studies useful in diagnosing obstructive sleep apnea in children with down syndrome?

Are home sleep studies useful in diagnosing obstructive sleep apnea in children with down syndrome?

High prevalence of poststroke sleep-disordered breathing in Mexican Americans

Effect of desipramine on patients with breathing disorders in RETT syndrome

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