Identification of sleep-disordered breathing in children: variation with event definition

Area of Science:

• Pediatric Sleep Medicine
• Respiratory Physiology
• Diagnostic Accuracy

Background:

• Sleep disordered breathing (SDB) is a common condition in children with potential long-term health consequences.
• Accurate identification of SDB is crucial for timely diagnosis and intervention.
• The respiratory disturbance index (RDI) is a key metric used to quantify SDB severity.

Purpose of the Study:

• To evaluate the impact of different measurement approaches for the respiratory disturbance index (RDI) on the identification and classification of sleep disordered breathing (SDB) in a pediatric cohort.
• To assess the variability in SDB prevalence estimates based on diverse RDI calculation methods.

Main Methods:

• A cross-sectional study involving 433 children aged 8-11 years from a birth cohort.
• Unattended, in-home overnight polysomnography using respiratory inductance plethysmography, pulse oximetry, and heart rate monitoring.
• Analysis of RDI variations based on different definitions of respiratory events (apneas, hypopneas) and desaturation thresholds.

Main Results:

• Median RDI values demonstrated a >20-fold variation across different event definitions, ranging from liberal criteria (all events) to conservative criteria (obstructive apneas only with 5% desaturation).
• SDB prevalence estimates were 40% to 140% higher when central apneas were included in RDI calculations compared to their exclusion.
• The choice of RDI definition significantly influenced the classification of SDB severity.

Conclusions:

• Diverse methodologies for calculating the RDI lead to substantial discrepancies in identifying and classifying SDB in children.
• These variations result in significantly different estimates of SDB presence and severity, highlighting the need for standardized RDI measurement protocols.