Related Experiment Video
Updated: Jun 8, 2026
Multi-Modal Home Sleep Monitoring in Older Adults
Published on: January 26, 2019
Using personal mobile technology to identify obstructive sleep apnea in children with Down syndrome (UPLOAD)
Sherri Lynne Katz1, Roya Shamsi2, Vid Bijelić2
1Division of Pediatric Respirology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Home sleep videos scored with the Monash Score (MS) can help diagnose obstructive sleep apnea (OSA) in children with Down syndrome (DS). Combining MS with oximetry improves accuracy, optimizing access to polysomnography (PSG).
Area of Science:
- Pediatric Sleep Medicine
- Down Syndrome Research
- Diagnostic Accuracy Studies
Background:
- Children with Down syndrome (DS) have a high risk of obstructive sleep apnea (OSA).
- Current screening tools for OSA in DS lack accuracy, and polysomnography (PSG) access is limited.
- Parent-recorded sleep videos using the Monash Score (MS) offer a potential low-cost screening alternative.
Purpose of the Study:
- To evaluate the diagnostic performance of home-recorded sleep videos scored with the Monash Score (MS) for obstructive sleep apnea (OSA) in children with Down syndrome (DS).
- To assess the accuracy of MS, Pediatric Sleep Questionnaire (PSQ), and oximetry metrics (MOS, ODI3) individually and in combination.
- To determine if video-based assessment can improve the triage of children with DS for definitive sleep studies.
Main Methods:
- A cross-sectional study involving 25 children with DS (aged 2-18 years) at a specialized clinic.
- Parents completed the PSQ and recorded home sleep videos scored by blinded physicians using the MS (≥3 indicating OSA).
- Participants underwent overnight PSG for OSA severity classification (oAHI); diagnostic performance metrics were calculated.
Main Results:
- Eight participants (32%) had moderate to severe OSA.
- The MS showed high sensitivity (87.5%) but moderate specificity (47.1%) for moderate to severe OSA.
- Oxygen desaturation index (ODI3 >7) demonstrated high accuracy (100% sensitivity, 88.2% specificity). Combining MS with ODI3 significantly improved diagnostic accuracy (AUC 76.5% to 98.5% for moderate-to-severe OSA).
Conclusions:
- Home-recorded sleep videos scored with the MS are feasible for assessing OSA in children with DS.
- Combining MS with oximetry significantly enhances diagnostic accuracy for OSA in this population.
- Video-based assessment combined with oximetry can effectively triage children with DS for PSG, optimizing resource allocation.
Background:
Children with Down syndrome (DS) are at high risk for obstructive sleep apnea (OSA), but access to polysomnography (PSG), the diagnostic gold standard, is limited and current screening tools have poor accuracy in this population. Parent-recorded sleep videos scored with the Monash Score (MS) may provide a simple, low-cost alternative.
Methods:
This cross-sectional study was conducted at the Children's Hospital of Eastern Ontario (CHEO) DS Clinic. Children with DS aged 2-18 years were recruited. Parents completed the Pediatric Sleep Questionnaire (PSQ) and recorded three short home sleep videos, scored by blinded pediatric sleep physicians using the MS (range 0-8; ≥3 indicating OSA). Within three months, participants underwent overnight PSG. OSA severity was classified by the obstructive apnea-hypopnea index (oAHI). Diagnostic performance of MS, PSQ, McGill Oximetry Score (MOS), and oxygen desaturation index (ODI3, thresholds ≥4.3 and > 7) were evaluated individually and in combination.
Results:
Of 27 enrolled participants, 25 were included in the analysis (median age 7.2 years, IQR 3.9-11.7; 44% female). Eight (32%) had moderate to severe OSA (oAHI ≥5/hr). The MS showed high sensitivity (87.5%) but modest specificity (47.1%) for moderate to severe OSA. ODI3 >7 demonstrated the best accuracy (sensitivity 100%, specificity 88.2%, with a positive likelihood ratio (LR+) of 8.5). Combining MS with ODI3 improved diagnostic accuracy across all OSA severities, with area under the ROC curve increasing from 76.5 to 98.5 for moderate to severe OSA (p = 0.07).
Conclusions:
Home-recorded sleep videos scored using the MS are feasible and improve diagnostic accuracy of oximetry when combined. Video-based assessment may help triage children with DS for definitive sleep studies, optimizing use of limited PSG resources.
