Peripheral arterial tonometry events and electroencephalographic arousals in children
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Riva Tauman1, Louise M O'Brien, Benjamin T Mast
1Kosair Children's Hospital Research Institute and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA.
Insights
Peripheral arterial tonometry (PAT) detects sympathetic activity during sleep in children. While PAT events correlate with arousals, they often occur without electroencephalographic arousals, limiting its use for measuring pediatric sleep arousals.
Area of Science:
- Pediatric Sleep Medicine
- Autonomic Nervous System Function
- Cardiorespiratory Physiology
Background:
- Peripheral arterial tonometry (PAT) measures sympathetic nervous system activity and arousals in adults.
- Its utility in identifying sleep arousals in children, particularly those with sleep-disordered breathing, requires investigation.
Purpose of the Study:
- To assess the association between PAT events and electroencephalographic (EEG) arousals in healthy children and those with sleep-disordered breathing (SDB).
- To determine the sensitivity and specificity of PAT for detecting arousals in pediatric populations.
Main Methods:
- A prospective cohort study involving 60 children (20 with obstructive sleep apnea syndrome, 20 with mild SDB, 20 controls) aged 5.7-16.5 years.
- Polysomnography with simultaneous PAT recording was performed.
- PAT events were defined by signal attenuation, and various PAT indexes were calculated.
Main Results:
- Total PAT index significantly correlated with total and spontaneous arousal indexes, particularly in children with obstructive sleep apnea syndrome (r=0.71, P<.0001).
- PAT demonstrated high sensitivity (95%) but low specificity (35%) for identifying EEG arousals.
- PAT detected pathologic arousal indexes with good accuracy (AUC=0.79, P=.002).
- 92% of respiratory events were associated with PAT attenuations, compared to only 35% with EEG arousals.
Conclusions:
- Sleep arousals in children involve increased sympathetic discharge, reflected by PAT signal changes.
- A substantial number of PAT attenuations occurred without concurrent EEG arousals, suggesting autonomic arousals not captured by standard criteria.
- PAT cannot currently replace EEG for measuring arousals in children, and adult arousal criteria may be insufficient for pediatric populations.
Study Objectives:
Peripheral arterial tonometry (PAT) is a sensitive measure of moment-to-moment changes in sympathetic activity and reliably identifies arousals in adult subjects. We investigated whether PAT events during sleep are associated with visually recognizable electroencephalographic arousals in healthy children and in children with sleep-disordered breathing.
Design:
Prospective cohort.
Setting:
Pediatric Sleep Research Laboratory.
Participants:
Twenty children with obstructive sleep apnea syndrome, 20 children with mild sleep-disordered breathing, and 20 control children with a mean age of 7.6 +/- 2.6 years (range: 5.7-16.5 years); 53% of children were boys.
Interventions And Measurements:
Polysomnographic evaluation in the sleep laboratory with concomitant recording of PAT. PAT events were defined as attenuations from immediately preceding baseline of 20% to 50% (PAT20) and > 50% (PAT50) for at least 5 seconds and the indexes calculated per hour of sleep time that included good-quality PAT signals. Total PAT index (the sum of PAT20 index and PAT50 index) was also calculated.
Results:
Total PAT index correlated with total arousal index and spontaneous arousal index (r = 0.55, P < .0001, r = 0.64, P < .001, respectively), especially in the group with obstructive sleep apnea syndrome (r = 0.71, P < .0001). The sensitivity and specificity of PAT for identifying electroencephalographic arousals were 95% and 35%, respectively. The PAT device identified pathologic arousals indexes (> or = 16 per hour) (area under the curve 0.79, P = .002). Thirty-five percent of respiratory events (eg, obstructive apnea or hypopnea) were associated with a visual electroencephalographic arousal, compared to 92% being associated with PAT attenuation events.
Conclusions:
Arousals in sleeping children are associated with increased sympathetic discharge, as evidenced by attenuations in PAT signal. However, a significant proportion of PAT attenuations were not accompanied by visual electroencephalographic arousals. Thus, the importance of these autonomic arousals has yet to be explored in association with morbidities related to sleep-disordered breathing and, therefore, PAT technology cannot be recommended as an alternative tool for measuring arousals in children. Nevertheless, these data further support the contention that adult criteria for the measurement for arousals may not be adequate in children.
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