Respiratory polygraphy in children with sleep-disordered breathing

Area of Science:

• Pediatric Pulmonology
• Sleep Medicine
• Diagnostic Technology

Background:

• At-home respiratory polygraphy (RP) is a reliable alternative to in-laboratory polysomnography for diagnosing obstructive sleep apnea in adults.
• Its utility and reliability in pediatric populations, particularly for assessing sleep-disordered breathing (SDB), remain less understood.

Purpose of the Study:

• To evaluate the quality of pediatric at-home RP for diagnosing SDB.
• To assess the interrater reliability of RP scoring in children.
• To determine if calibrated respiratory inductance plethysmography (RIP) flow can reliably score respiratory events when airflow data is compromised.

Main Methods:

• 113 children aged 4-10 years with SDB underwent at-home RP.
• Quality assessment focused on signal availability and artifact presence.
• 17 studies were scored by two independent scorers, with and without nasal airflow data, using RIP flow as a substitute when necessary.
• Apnea-hypopnea index (AHI) interrater reliability and scorer agreement using RIP flow were analyzed using intraclass correlation coefficients (ICC).

Main Results:

• Only 46% of pediatric at-home RPs were of acceptable quality, with 40% experiencing missing nasal airflow data.
• Median artifact-free recording time across three traces was 228 minutes.
• Interrater agreement for AHI was moderate (ICC=0.66 with airflow, ICC=0.53 without).
• One scorer showed good agreement (ICC=0.81) when using RIP flow, while the other showed poor agreement (ICC=0.12).

Conclusions:

• Pediatric at-home RP frequently suffers from poor data quality, primarily due to missing nasal airflow signals.
• The use of RIP flow for scoring respiratory events is scorer-dependent, impacting diagnostic reliability.
• Current limitations hinder the widespread usefulness of at-home RP for diagnosing SDB in children.