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Validation of automated sleep analysis in normal children
Insights
Automated polysomnography scoring in children is unreliable, often misinterpreting sleep stages and respiratory events. While convenient, computer analysis requires further development before replacing manual scoring for pediatric sleep studies.
Area of Science:
- Pediatric Sleep Medicine
- Medical Technology Evaluation
Background:
- Establishing normative data for pediatric polysomnography is crucial.
- Automated analysis tools are increasingly used in sleep studies.
- The reliability of automated scoring in children requires validation.
Purpose of the Study:
- To determine normal reference values for pediatric polysomnography.
- To evaluate the accuracy of automated sleep scoring in children.
- To compare automated scoring with expert visual scoring.
Main Methods:
- Polysomnograms were recorded in 16 healthy children using a 16-channel computer system.
- Data were acquired on optical disk for computer-assisted interpretation.
- Sleep stages and respiratory events were scored both visually and by the automated system.
Main Results:
- The automated system significantly overscored wakefulness and stage IV sleep.
- Stage II and rapid eye movement (REM) sleep were underscored by the automated system.
- Automated scoring resulted in higher apnea index (AI) and hypopnea index (HI) than visual scoring, with correlations for central and obstructive apnea.
Conclusions:
- Current computer-based scoring systems are not yet reliable for unsupervised pediatric polysomnography.
- Automated systems offer convenience in data management but require significant improvement in accuracy.
- Further development is needed to enhance the reliability of automated scoring for pediatric sleep studies.
Abstract:
With the aim of determining normal reference values for our sleep laboratory and evaluating the reliability of automated analysis for scoring polysomnographic studies in children, we recorded polysomnograms in 16 healthy boarding-school children. Sleep recordings were obtained with a computer system (Medilog SAC, Oxford Instruments). Polysomnographic variables were monitored continuously on a 16-channel recorder equipped with a video. Data were acquired on optical disk for computer-assisted data interpretation. Sleep stages and respiratory events were also scored visually by operator. Comparison with visual scores showed that the computer system significantly overscored wakefulness (W) (p<0.02) and stage IV (p<0.001) and underscored stage II (p<0.001) and rapid eye movement (REM) sleep (p<0.001). It also assigned respiratory events a higher score than did visual scoring, as shown by the higher apnoea index (AI) and hypopnoea index (HI) (AI p<0.03; HI p<0.001). Regression analysis showed a significant correlation between visual and automated scores for central (r=0.679; p<0.004) and obstructive apnoea (r=0.631; p<0.008). Computer apnoea scores did not correlate with visual scores. Much remains to be done before computer-based scoring systems can be relied upon, without visual scoring, for polysomnographic sleep studies in children. Their main advantage at present is that they offer a convenient means of saving paper, space and time.