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Tracheal sounds for the scoring of sleep respiratory events in children
Alessandro Amaddeo1,2, Abdelkebir Sabil3,4, Jorge Olmo Arroyo1
1AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.
Insights
Tracheal sounds (TS) and suprasternal pressure (SSP) offer a well-tolerated alternative for scoring respiratory events in children. These methods show good sensitivity and specificity for detecting and characterizing sleep apnea and hypopnea.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Biomedical Engineering
Background:
- Standard sensors for scoring respiratory events (RE) in children, like oronasal thermistors and nasal cannulas, are poorly tolerated.
- This discomfort limits the effectiveness of polysomnography in pediatric populations.
Purpose of the Study:
- To evaluate the efficacy of tracheal sounds (TS) and suprasternal pressure (SSP) for scoring RE during sleep in children.
- To compare these novel methods with traditional American Academy of Sleep Medicine (AASM)-recommended sensors.
Main Methods:
- Compared "AASM" scoring with TS-RIP scoring (TS, SSP, and respiratory inductance plethysmography-sum) and TS scoring alone.
- Analyzed recordings from 17 pediatric patients, assessing signal availability and RE detection/characterization.
Main Results:
- TS and SSP signals demonstrated high availability (95%) compared to traditional sensors (79-86%).
- TS-RIP and TS scoring achieved high sensitivity for apnea (88%, 86%) and hypopnea (84%, 77%) detection.
- Both methods showed excellent specificity for various apnea types (obstructive, mixed, central).
Conclusions:
- TS and SSP combined with RIP-sum provide sensitive and specific detection and characterization of pediatric sleep apnea and hypopnea.
- TS and SSP alone are effective for apnea, though hypopnea detection sensitivity is lower.
Study Objectives:
Oronasal thermistor and nasal cannula are recommended for the scoring of respiratory events (RE) but these sensors are poorly tolerated in children. The aim of the study was to evaluate tracheal sounds (TS) and suprasternal pressure (SSP) for the scoring of RE during sleep in children.
Methods:
We compared the detection and characterization of RE by AASM-recommended sensors ("AASM" scoring), with the detection and characterization of RE by the combination of TS and SSP with respiratory inductance plethysmography-sum (TS-RIP scoring), and TS and SSP only (TS scoring).
Results:
The recordings of 17 patients were analyzed. The TS, SSP, and RIP flow signals were present during 95%, 95%, and 99% of the validated recording time, respectively, as compared to 79% and 86% for nasal cannula and oronasal thermistor. A total of 1,456 RE were scored with the "AASM" scoring, 1,335 with the TS-RIP scoring, and 1,311 with the TS scoring. Sensitivity for apnea and hypopnea detection was 88% and 84% for the TS-RIP scoring, and 86% and 77% for the TS scoring. For apnea characterization, the TS-RIP scoring sensitivities and specificities were 97% and 100%, 76% and 98%, and 95% and 97%, for obstructive, mixed, and central apnea, respectively. For the TS scoring, they were 95% and 100%, 95% and 97%, and 91% and 97%, respectively.
Conclusions:
TS and SSP + RIP-sum has a good sensitivity and specificity for the detection and characterization of apnea and hypopnea in children. TS and SSP alone have good sensitivity and specificity for apnea detection and characterization but lower sensitivity for hypopnea detection.
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