Validation of the MediByte Portable Monitor for the Diagnosis of Sleep Apnea in Pediatric Patients

Abstract

Study Objectives: Polysomnography (PSG) is considered the gold standard in the diagnosis of sleep apnea. In pediatric patients, because of limited availability and access to laboratory-based PSG, there can be significant delays in the diagnosis and management of sleep apnea that can result in progressive associated comorbidities. The main objective of the current study was to test the diagnostic value of a portable sleep monitor (PM), the MediByte, in comparison with laboratory PSG in pediatric patients wearing both setups simultaneously. Methods: A consecutive series of pediatric patients referred to the University of Illinois Sleep Science Center wore the MediByte during simultaneous PSG. The apnea-hypopnea index (AHI) was calculated for PSG and both manual and autoscoring functions of the PM. Pearson correlation and Bland-Altman plots were assessed. Results: A total of 70 patients successfully completed simultaneous PSG and PM studies (median age 10.8 years). The AHI obtained both manually and automatically scored PM studies strongly correlated with the AHI obtained from the PSG (r ≥ .932, P < .001). The oxygen saturation obtained by the PM showed significant correlation with that obtained by PSG among children aged 12 to 17 years (P < .001), but not among children aged 7 to 11 years (P ≥ .24). The sensitivity and specificity for detection of severe sleep apnea diagnosed by PSG (AHI ≥ 10 events/h) using both PM scoring methods was very high (> 93% for both). Conclusions: Although PSG is still recommended for the diagnosis of sleep apnea, PMs can play a valuable role in diagnosing moderate and severe sleep apnea, especially in older pediatric patients.

Screening Severe Obstructive Sleep Apnea in Children with Snoring

“…Home sleep apnea tests with technically adequate devices have been used to diagnose moderate to severe OSA in uncomplicated adult patients [ 40 ] and school-aged children [ 41 , 42 ] with sleep-disturbed breathing; however, these devices are not recommended for the diagnosis of pediatric OSA [ 43 ]. Home sleep apnea tests have fewer first-night effects compared to overnight in-lab polysomnography [ 44 ].…”

“…However, easy dislodgement of the finger sensor is a major disadvantage of unattended pulse oximetry. Approximately 10% to 20% of hospital and home sleep pulse oximetry failed to provide technically acceptable data due to poor contact between the sensor and the child’s finger [ 33 , 42 , 52 ]. Therefore, Bhattacharjee commented that the failure rate of home pulse oximetry and cardiorespiratory measures was relatively high for studies that were attended by night technologists and for older children [ 53 ].…”

Polysomnography Is an Important Method for Diagnosing Pediatric Sleep Problems: Experience of One Children’s Hospital

“…PSG can be performed using either a level 1 laboratory PSG or a portable PSG. Some studies have attempted to evaluate the accuracy of portable PSGs in children, suggesting that a portable PSG may play an important role in the diagnosis of moderate and severe sleep apnea in older pediatric patients; however, a level 1 PSG remains the recommended method for diagnosis in children with sleep issues [16][17][18]. The disadvantages of a level 1 PSG include higher costs, limited availability, and the first night effect, which is characterized by decreased total sleep time, lower sleep efficiencies, reduction in REM (rapid eye movement) sleep, and longer REM latencies on the first night of testing [16,19].…”

Apnea Monitor Using Pulse Oxymetry with Tactile Stimulation to Reduce Respiration Failure

“…Prolonged respiratory failure leads to low oxygen concentrations, resulting in brain damage and death [4]. Some studies monitor apnea using one or two physiological signals such as an ECG, EEG, pulse oximetry, snoring, or nasal airflow [5], [6]. An oximeter signal indicates oxygen saturation in the blood which can identify apnea [7].…”