The utility of a portable sleep monitor to diagnose sleep-disordered breathing in a pediatric population

Colin Massicotte, Suhail Al-Saleh, Manisha Witmans, Indra Narang, Colin Massicotte, Suhail Al-Saleh, Manisha Witmans, Indra Narang

Abstract

Background: Central and⁄or obstructive sleep-disordered breathing (SDB) in children represents a spectrum of abnormal breathing during sleep. SDB is diagnosed using the gold standard, overnight polysomnography (PSG). The limited availability and access to PSG prevents its widespread use, resulting in significant delays in diagnosis and treatment of SDB. As such, portable sleep monitors are urgently needed.

Objective: To evaluate the utility of a commercially available portable sleep study monitor (PSS-AL) (ApneaLink, ResMed, USA) to diagnose SDB in children.

Methods: Children referred to a pediatric sleep facility were simultaneously monitored using the PSS-AL monitor and overnight PSG. The apnea-hypopnea index (AHI) was calculated using the manual and autoscoring function of the PSS-AL, and PSG. Sensitivity and specificity were compared with the manually scored PSS-AL and PSG. Pearson correlations and Bland-Altman plots were constructed.

Results: Thirty-five children (13 female) completed the study. The median age was 11.0 years and the median body mass index z-score was 0.67 (range -2.3 to 3.8). SDB was diagnosed in 17 of 35 (49%) subjects using PSG. The AHI obtained by manually scored PSS-AL strongly correlated with the AHI obtained using PSG (r=0.89; P<0.001). Using the manually scored PSS-AL, a cut-off of AHI of >5 events⁄h had a sensitivity of 94% and a specificity of 61% to detect any SDB diagnosed by PSG.

Conclusions: Although PSG is still recommended for the diagnosis of SDB, the ApneaLink sleep monitor has a role for triaging children referred for evaluation of SDB, but has limited ability to determine the nature of the SDB.

Figures

Figure 1)
Figure 1)
Correlation comparing manual scoring of apnea-hypopnea index (AHI) using the portable sleep study-ApneaLink (PSS-AL, ResMed, USA) monitor and polysomnography AHI
Figure 2)
Figure 2)
Correlation between manual and automated apnea-hypopnea index (AHI) scoring using the portable sleep study (PSS)-ApneaLink (ResMed, USA) monitor
Figure 3)
Figure 3)
Bland-Altman plot showing the difference between manually scored portable sleep study-ApneaLink (PSS-AL, ResMed, USA) apnea-hypopnea index (AHI) and the polysomnography (PSG) AHI against the mean of the AHI values. The mean difference is ±3.9 events events/h. There are two outliers with a mean difference > ±2 SDs. One subject was awake for a significant proportion of the study, causing an overestimation of his AHI on the PSS-AL. The second outlier was a subject with sickle-cell disease who almost exclusively experienced hypopneas related to arousals rather than desaturations, accounting for the lower PSS-AL AHI (5.0 events/h) compared with PSG AHI (10.4 events/h). Dashed line represents ±2 SDs

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