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Feasibility of parent-attended ambulatory polysomnography in children with suspected obstructive sleep apnea
Iulia Ioan1,2,3, Diane Weick4,3, Cyril Schweitzer1,2
1Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, Nancy, France.
Insights
Ambulatory polysomnography (PSG-home) is feasible for children aged 3-16 suspected of obstructive sleep apnea (OSA). This method, with equipment set up at a clinic, offers a viable alternative to in-lab testing for pediatric sleep apnea diagnosis.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Diagnostic Technology
Background:
- Limited pediatric sleep center availability poses challenges for diagnosing obstructive sleep apnea (OSA) in children.
- Ambulatory polysomnography (PSG-home) offers a potential solution to increase accessibility for pediatric sleep studies.
Purpose of the Study:
- To assess the feasibility and technical acceptability of ambulatory polysomnography (PSG-home) for children aged 3-16 years suspected of having OSA.
- To evaluate the utility of PSG-home in a French pediatric population.
Main Methods:
- Prospective inclusion of 57 children (3-16 years) undergoing one-night PSG-home with device setup at a pediatric sleep physician's office.
- Technical feasibility defined by artifact-free sleep duration and channel integrity; OSA diagnosis based on established indices (OAHI, RAI).
- Parental questionnaires included severity hierarchy, Conners Parent Rating Scale, and Epworth Sleepiness Scale.
Main Results:
- PSG-home was technically acceptable in 81% (46/57) of children, with minor failures related to nasal cannula or oximetry.
- Feasibility was consistent across age groups, sexes, OSA severity, and comorbidities.
- Obstructive sleep apnea (OSA) was diagnosed in 75% of children (43/57), with varying severity levels.
Conclusions:
- Ambulatory polysomnography (PSG-home) is a feasible and technically acceptable method for diagnosing OSA in children aged 3-16 years when set up professionally and monitored by parents.
- The reduced delay and improved feasibility of PSG-home can potentially enhance the management of pediatric OSA.
- Clinical assessments and questionnaires did not reliably predict OSA diagnosis in this cohort.
Study Objectives:
Due to a limited number of pediatric sleep centers, the aim was to test the feasibility of ambulatory polysomnography (PSG-home) in a group of French children suspected of OSA.
Methods:
Children undergoing one-night PSG-home, with the device installed at the pediatric sleep physician's office, were prospectively included. General failure was considered when PSG-home recording captured < 5 h of artifact-free sleep or when ≥ 1 channel (nasal flow, thoraco-abdominal belts, oximetry) presented artifacts > 75% of the recording time. No-OSA was defined as an obstructive apnea-hypopnia index (OAHI) < 1 event/h and respiratory-related arousals index (RAI) < 1 event/h. OSA was defined as upper airways resistance syndrome (UARS) with OAHI < 1 event/h with RAI ≥ 1 event/h, or mild OSA (OAHI ≥ 1 event/h-5 events/h), moderate OSA (OAHI ≥ 5 events/h-10 events/h), or severe OSA (OAHI ≥ 10 events/h). Parents completed a severity hierarchy score questionnaire, Conners Parent Rating Scale, and an adapted Epworth Sleepiness Scale.
Results:
Fifty-seven children aged 3 through 16 years were included. PSG-home was technically acceptable in 46 (81%). Failure due to nasal cannula was observed in 11% (n = 6), oximetry in 7% (n = 4), and both in 2% (n = 1) of cases. No difference in feasibility was found according to age, sex, OSA severity, or comorbidities. There were 14 (25%) children categorized as no-OSA, 43 (75%) as OSA, 4 (7%) as UARS, 26 (46%) as mild, 6 (10%) as moderate, and 7 (12%) as severe OSA. Neither questionnaires nor clinical and physical examination predicted OSA diagnosis.
Conclusions:
When equipment is installed at the professional's office and a parent monitors the child, PSG-home is feasible and technically acceptable in children aged 3 through 16 years old. The short delay and feasibility provided by PSG-home could improve the management of children suspected of OSA.
