Related Experiment Videos
Can sleep and wakefulness be distinguished in children by cardiorespiratory and videotape recordings?
A Morielli1, S Ladan, F M Ducharme
1Department of Pediatrics, McGill University/Montreal Children's Hospital, Quebec, Canada.
Insights
A simplified cardiorespiratory-video (CRV) method accurately distinguishes sleep from wakefulness in children evaluated for obstructive sleep apnea (OSA). This method avoids EEG, simplifying diagnosis and enabling home monitoring for pediatric sleep disorders.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Diagnostic Technology
Background:
- Polysomnography (PSG) with EEG is the gold standard for diagnosing obstructive sleep apnea (OSA) in children.
- EEG recording can be cumbersome and may disturb sleep, especially in children.
- A simplified method to distinguish sleep from wakefulness without EEG could greatly aid OSA diagnosis.
Purpose of the Study:
- To compare the accuracy of a simplified cardiorespiratory-video (CRV) method against standard polysomnography (PSG) for sleep/wakefulness classification in children evaluated for OSA.
- To assess the feasibility of using CRV for unattended, home-based sleep monitoring.
Main Methods:
- Twenty children undergoing in-hospital evaluation for OSA were simultaneously recorded using standard PSG and a simplified CRV montage.
- The CRV montage included channels suitable for home use, capturing cardiorespiratory signals and movement/arousals without head/face attachments.
- Sleep/wake classification by both methods was performed blinded to the other's results, analyzing over 21,000 epochs.
Main Results:
- The CRV method achieved excellent agreement with PSG for sleep/wake classification, with 93.8% epoch agreement.
- The CRV method correctly identified 97.7% of sleep epochs and had a high positive predictive value for sleep (95.2%).
- Agreement between CRV and PSG was substantial (average Kappa value of 0.8), indicating reliability beyond chance.
Conclusions:
- A simplified cardiorespiratory-video (CRV) method effectively distinguishes sleep from wakefulness in children evaluated for OSA.
- The CRV method offers a viable alternative to EEG-based polysomnography in pediatric settings and for home monitoring.
- This approach could simplify OSA diagnosis and facilitate broader access to sleep evaluations for children.
Abstract:
Polysomnography, including EEG recording, is the standard method to diagnose obstructive sleep apnea (OSA) in children and adults. Diagnosis of OSA would be considerably simplified if it was shown that sleep could be distinguished from wakefulness without EEG recordings. Therefore, we compared sleep/wakefulness classification using a simplified cardiorespiratory-video (CRV) method with standard polysomnography in 20 children undergoing in-hospital evaluation for OSA. The channels for the simplified montage were chosen because they (1) were suitable for unattended, home recordings, (2) allowed the diagnosis of apneas, hypopneas, desaturation, and movement/arousals, and (3) did not require attachment to the head or face that might disturb the childs sleep. Sleep staging by the two methods was blinded to results of the other method. We evaluated 21,832 30-s epochs--1,092+/-111 (SD) per child. Across 20 subjects, 79.7+/-7.1% of the epochs were sleep. The simplified montage agreed with polysomnographic classification of sleep/wakefulness for 93.8+/-2.5% of the epochs. Of all sleep epochs, 97.7 (96.4, 98.1%) median (interquartile range), were correctly classified; sleep predictive value of the CRV method was 95.2+/-2.8%. Of all epochs classified as wakefulness by polysomnography, 80.1+/-12.8% were correctly classified by the CRV method. The wakeful predictive value was 88.7+/-2.6%. Kappa values averaged 0.8+/-0.1, indicating that agreement between the CRV method and polysomnography did not occur by chance and that the level of agreement was excellent. Thus, sleep can be distinguished from wakefulness in children being evaluated for OSA using a combination of cardiorespiratory and videotape recordings. These results suggest that the CRV method would be useful in a pediatric laboratory setting where EEG recordings are not always possible. They also suggest that overnight, unattended CRV recordings in a childs own home could correctly distinguish sleep from wakefulness.