Use of ambulatory polysomnography in children with syndromic craniosynostosis
Natalja Bannink1, Irene M J Mathijssen, Koen F M Joosten
1Dutch Craniofacial Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands. n.bannink@erasmusmc.nl
Insights
Home cardiorespiratory monitors are feasible for diagnosing obstructive sleep apnea (OSA) in children with craniosynostosis. Oximetry can screen for OSA, and X flow aids diagnosis when nasal flow data is missing.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Craniofacial Surgery
Background:
- Children with syndromic or complex craniosynostosis often develop obstructive sleep apnea (OSA) due to midface hypoplasia.
- Polysomnography is the gold standard for OSA diagnosis but can be challenging in this population.
Purpose of the Study:
- To assess the feasibility of home cardiorespiratory monitoring for OSA diagnosis in children with craniosynostosis.
- To evaluate oximetry alone and X flow as alternative diagnostic tools when complete polysomnography is not achieved.
Main Methods:
- Prospective study of 129 children with syndromic or complex craniosynostosis.
- Analysis of 200 ambulatory polysomnographies, comparing home monitoring data with full polysomnography.
- Evaluation of oximetry and X flow (sum of thoracic and abdominal movement amplitudes) against nasal flow signals.
Main Results:
- Complete OSA diagnosis was possible in only 41% of home monitoring recordings.
- Oximetry showed 82% positive and 79% negative predictive value for OSA; moderate OSA was excluded with negative oximetry.
- X flow adequately recorded hypopneas (86%) and obstructive apneas (55%), with a 10% underestimation of OSA severity.
Conclusions:
- Home cardiorespiratory monitoring is a feasible option for diagnosing OSA in children with craniosynostosis.
- Oximetry serves as a useful screening tool, capable of excluding moderate OSA.
- X flow can assist in OSA diagnosis when nasal flow data is unavailable.
Abstract:
Children with syndromic or complex craniosynostosis are at risk of developing obstructive sleep apnea (OSA) because of midface hypoplasia and collapse of the pharynx. The criterion standard in diagnosing OSA is polysomnography. The aims of this study were to analyze the feasibility of a home cardiorespiratory monitor in children with syndromic or complex craniosynostosis and to analyze whether oximetry alone or the sum of the amplitudes of the thoracic and abdominal movements (X flow) are valuable alternative assessments to diagnose OSA at home, when complete recording was not achieved. We performed a prospective study of 129 children and analyzed 200 different ambulatory polysomnographies. In 41% of the measurements, a complete analysis of the obstructive apnea-hypopnea index was possible based on the adequate recording of all sensors. Oximetry in comparison with polysomnography had a positive predictive value of 82% and a negative predictive value of 79% for diagnosing OSA. Moderate OSA could be excluded with a negative oximetry. Comparing the X flow and the nasal flow signals that the hypopneas were adequately recorded in 86% and the obstructive apneas in 55%, resulting in an underestimation of the severity of OSA in 10%. In conclusion, in children with syndromic or complex craniosynostosis, diagnosing OSA using home cardiorespiratory monitoring is feasible. Oximetry alone can be used as a rough estimate screening, and with a negative test result, moderate OSA can be excluded. X flow can be helpful in diagnosing OSA in the absence of nasal flow.
