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Published on: October 2, 2019
SleepImage® as a tool for investigating sleep in children at high risk of comorbid sleep disorders
Liam Beaumont1, Lauren C Nisbet2, Nicole Verginis1
1Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia.
Insights
The SleepImage (SI) device shows promise for assessing sleep in children with neurodisability, demonstrating good tolerability and utility in ruling out moderate-severe obstructive sleep apnoea (OSA). Further research is needed to improve its diagnostic yield.
Area of Science:
- Pediatric Sleep Medicine
- Neurodisability Research
- Medical Device Technology
Background:
- Children with neurodisability frequently experience sleep disorders, posing challenges for traditional polysomnography (PSG).
- Home sleep assessment devices offer a potential alternative for monitoring sleep in this population.
Purpose of the Study:
- To evaluate the tolerability of the SleepImage (SI) device in children with neurodisability.
- To compare SI respiratory and non-respiratory sleep outcomes with PSG.
- To assess SI's diagnostic accuracy for obstructive sleep apnoea (OSA) and its correlation with PSG-derived sleep quality.
Main Methods:
- A paired diagnostic accuracy study was conducted in a specialist children's hospital.
- Children aged 3-18 with neurodisability underwent concurrent SI and PSG monitoring.
- Acceptable recordings required at least 4 hours of sleep data on both devices and SI signal quality above 80%.
Main Results:
- Of 48 recruited children, 20 had acceptable recordings; SI tolerance was 70% when excluding technical issues.
- SI's diagnostic yield was 49%.
- SI showed a 100% negative predictive value for moderate-severe OSA, though it overestimated severity in milder cases and underestimated it in severe cases. The SI Sleep Quality Index (SQI) negatively correlated with the arousal index (r=-0.45, p=0.046).
Conclusions:
- The SleepImage device is generally tolerated by children with neurodisability, but signal quality issues limit its diagnostic yield.
- SI is valuable for excluding moderate-to-severe obstructive sleep apnoea.
- The device can help identify non-OSA related causes of poor sleep quality in this population.
Objective:
Children with neurodisability experience high rates of both respiratory and non-respiratory sleep disorders and greater challenges tolerating polysomnography (PSG). This study aimed to assess tolerability of a home sleep assessment device (SleepImage (SI), MyCardio, Denver, USA), compare SI respiratory and non-respiratory outcomes to PSG, assess the diagnostic accuracy of SI for OSA, and assess the correlation of the SI Sleep Quality Index (SQI) with PSG outcomes.
Study Design:
Paired diagnostic accuracy study.
Setting:
Sleep laboratory in a specialist children's hospital.
Patients:
Children with neurodisability aged 3-18 years undergoing diagnostic PSG between April and August 2025.
Interventions:
SI was worn concurrently with attended PSG. Total sleep time ≥4 h on SI and PSG and SI signal quality >80% defined acceptable recordings for comparative analysis.
Main Outcome Measures:
Tolerability and diagnostic yield of SI, severity of obstructive sleep apnoea, sleep quality.
Results:
48 children were recruited, and 20 had acceptable recordings for comparison (median (IQR) age 11.8 (7.0-13.1) years, 45% female). Not including SI recordings affected by technical factors, SI tolerance was 70%. SI diagnostic yield was 49%. The median (IQR) Obstructive Apnoea Hypopnoea Index on PSG was 1.8 (0.8-6.6)/h compared to the comparable SI index (sAHIOBS) of 4.3 (2.8-6.4)/h (p = 0.31), with SI overestimating OSA severity at milder severities but under-estimating it in severe OSA. SI had a negative predictive value for moderate-severe OSA of 100% (95% CI 71.5% - 100%). SQI correlated negatively with arousal index (r = -0.45, p = 0.046).
Conclusion:
SI is tolerated in most children with neurodisability but diagnostic yield is limited by poor signal quality. It is useful for ruling out moderate-severe OSA, and can quantify non-OSA causes of impaired sleep quality.
