Validity and Cost-Effectiveness of Pediatric Home Respiratory Polygraphy for the Diagnosis of Obstructive Sleep Apnea in Children: Rationale, Study Design, and Methodology

Oceja, Esther; Rodríguez, Paula; Jurado, María José; Alonso, M.L.; Rio, Genoveva Del; Villar, M.A.; Mediano, Olga; Martínez, M Gómez; Juarros, Santiago; Merino, Milagros; Corral, Jaime; Luna, Carmen; Kheirandish‐Gozal, Leila; Gozal, David; Durán-Cantolla, Joaquín

doi:10.3390/mps4010009

Cited by 9 publications

(5 citation statements)

References 75 publications

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“…Due to the scarcity of accredited sleep laboratories for children and important resources required to perform PSG, there has been a considerable effort to develop alternative diagnostic methods that are more widely available. However, more simplified tests have been developed, but insufficiently evaluated to be generally implemented in the pediatric population [ 56 , 57 ]. Hospital RP includes measures based on snoring, oronasal airflow, body position, chest movements, electrocardiography, and pulse oximeter saturation and has been used in Europe and Spain as a valid alternative to PSG [ 1 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Sleep Apnea in Children: A Future Perspective Is Needed

Solano-Pérez,

Coso,

Castillo-García

et al. 2023

Biomedicines

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Obstructive sleep apnea (OSA) in children is a prevalent, but still, today, underdiagnosed illness, which consists of repetitive episodes of upper airway obstruction during sleep with important repercussions for sleep quality. OSA has relevant consequences in the pediatric population, mainly in the metabolic, cardiovascular (CV), and neurological spheres. However, contrary to adults, advances in diagnostic and therapeutic management have been scarce in the last few years despite the increasing scientific evidence of the deleterious consequences of pediatric OSA. The problem of underdiagnosis and the lack of response to treatment in some groups make an update to the management of OSA in children necessary. Probably, the heterogeneity of OSA is not well represented by the classical clinical presentation and severity parameters (apnea/hypopnea index (AHI)), and new strategies are required. A specific and consensus definition should be established. Additionally, the role of simplified methods in the diagnosis algorithm should be considered. Finally, the search for new biomarkers for risk stratification is needed in this population. In conclusion, new paradigms based on personalized medicine should be implemented in this population.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Sleep Apnea in Children: A Future Perspective Is Needed

Solano-Pérez,

Coso,

Castillo-García

et al. 2023

Biomedicines

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“…Therefore, home-based HRP has clearly emerged as a less onerous alternative to in-laboratory PSG and is likely more representative of the child’s habitual nocturnal sleep [ 19 ]. HRP requires easy-to-use portable monitors in the child’s home, thereby leading to substantial relief in the natural hospital-induced child stress and apprehension [ 38 , 39 ]. Although Level 3 devices traditionally employed at least three channels (oximetry, airflow, and respiratory effort), we implemented HRP systems that included six channels, thereby providing greater detail and accuracy in the scoring analysis and interpretation of observed events.…”

Section: Discussionmentioning

confidence: 99%

Cluster Analysis of Home Polygraphic Recordings in Symptomatic Habitually-Snoring Children: A Precision Medicine Perspective

Zaffanello

Pietrobelli

Gozal

et al. 2022

JCM

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(1) Background: Sleep-disordered breathing (SDB) is a frequent problem in children. Cluster analyses offer the possibility of identifying homogeneous groups within a large clinical database. The application of cluster analysis to anthropometric and polysomnographic measures in snoring children would enable the detection of distinctive clinically-relevant phenotypes; (2) Methods: We retrospectively collected the results of nocturnal home-based cardiorespiratory polygraphic recordings and anthropometric measurements in 326 habitually-snoring otherwise healthy children. K-medoids clustering was applied to standardized respiratory and anthropometric measures, followed by Silhouette-based statistics. Respiratory Disturbance Index (RDI) and oxygen desaturation index (≤3%) were included in determining the optimal number of clusters; (3) Results: Mean age of subjects was 8.1 ± 4.1 years, and 57% were males. Cluster analyses uncovered an optimal number of three clusters. Cluster 1 comprised 59.5% of the cohort (mean age 8.69 ± 4.14 years) with a mean RDI of 3.71 ± 3.23 events/hour of estimated sleep (e/ehSleep). Cluster 2 included 28.5% of the children (mean age 6.92 ± 3.43 years) with an RDI of 6.38 ± 3.92 e/ehSleep. Cluster 3 included 12% of the cohort (mean age 7.58 ± 4.73 years) with a mean RDI of 25.5 ± 19.4 e/ehSleep. Weight z-score was significantly lower in cluster 3 [−0.14 ± 1.65] than in cluster 2 [0.86 ± 1.78; p = 0.015] and cluster 1 [1.04 ± 1.78; p = 0.002]. Similar findings emerged for BMI z scores. However, the height z-score was not significantly different among the 3 clusters; (4) Conclusions: Cluster analysis of children who are symptomatic habitual snorers and are referred for clinical polygraphic evaluation identified three major clusters that differed in age, RDI, and anthropometric measures. An increased number of children in the cluster with the highest RDI had reduced body weight. We propose that the implementation of these approaches to a multicenter-derived database of home-based polygraphic recordings may enable the delineation of objective unbiased severity categories of pediatric SDB. Our findings could be useful for clinical implementation, formulation of therapeutic decision guidelines, clinical management, prevision of complications, and long-term follow-up.

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“…Home respiratory polygraphy (hRP) has progressively shown several benefits for the diagnosis of childhood OSAS, to increase the diagnostic accuracy and to simplify the diagnostic process [ 58 , 71 , 72 ]. AHI measurements obtained from hRP appear not to differ significantly from PSG results, especially in older children.…”

Section: What Is the Role Of Alternative Diagnostic Tools In The Diag...mentioning

confidence: 99%

Diagnosis of Paediatric Obstructive Sleep-Disordered Breathing beyond Polysomnography

Borrelli,

Corcione,

Cimbalo

et al. 2023

Children

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Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and intervention. This narrative review provides an overview of the current approaches utilised in the diagnosis of SDB in children. Diagnostic methods for SDB in children involve a combination of clinical assessment, medical history evaluation, questionnaires, and objective measurements. Polysomnography (PSG) is the diagnostic gold standard. It records activity of brain and tibial and submental muscles, heart rhythm, eye movements, oximetry, oronasal airflow, abdominal and chest movements, body position. Despite its accuracy, it is a time-consuming and expensive tool. Respiratory polygraphy instead monitors cardiorespiratory function without simultaneously assessing sleep and wakefulness; it is more affordable than PSG, but few paediatric studies compare these techniques and there is optional recommendation in children. Nocturnal oximetry is a simple and accessible exam that has high predictive value only for children at high risk. The daytime nap PSG, despite the advantage of shorter duration and lower costs, is not accurate for predicting SDB. Few paediatric data support the use of home testing during sleep. Finally, laboratory biomarkers and radiological findings are potentially useful hallmarks of SDB, but further investigations are needed to standardise their use in clinical practice.

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Validity and Cost-Effectiveness of Pediatric Home Respiratory Polygraphy for the Diagnosis of Obstructive Sleep Apnea in Children: Rationale, Study Design, and Methodology

Cited by 9 publications

References 75 publications

Diagnosis and Treatment of Sleep Apnea in Children: A Future Perspective Is Needed

Diagnosis and Treatment of Sleep Apnea in Children: A Future Perspective Is Needed

Cluster Analysis of Home Polygraphic Recordings in Symptomatic Habitually-Snoring Children: A Precision Medicine Perspective

Diagnosis of Paediatric Obstructive Sleep-Disordered Breathing beyond Polysomnography

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