Reliability of home respiratory polygraphy for the diagnosis of sleep apnea in children

Abstract

Objective: The objective of this study was to evaluate the diagnostic reliability of home respiratory polygraphy (HRP) in children with a clinical suspicion of OSA-hypopnea syndrome (OSAS).

Methods: A prospective blind evaluation was performed. Children between the ages of 2 to 14 years with clinical suspicion of OSAS who were referred to the Sleep Unit were included. An initial HRP followed by a later date, same night, in-laboratory overnight respiratory polygraphy and polysomnography (PSG) in the sleep laboratory were performed. The apnea-hypopnea index (AHI)-HRP was compared with AHI-PSG, and therapeutic decisions based on AHI-HRP and AHI-PSG were analyzed using intraclass correlation coefficients, Bland-Altman plots, and receiver operator curves (ROCs).

Results: Twenty-seven boys and 23 girls, with a mean age of 5.3 ± 2.5 years, were studied, and 66% were diagnosed with OSAS based on a PSG-defined obstructive respiratory disturbance index ≥ 3/h total sleep time. Based on the availability of concurrent HRP-PSG recordings, the optimal AHI-HRP corresponding to the PSG-defined OSAS criterion was established as ≥ 5.6/h The latter exhibited a sensitivity of 90.9% (95% CI, 79.6%-100%) and a specificity of 94.1% (95% CI, 80%-100%).

Conclusions: HRP recordings emerge as a potentially useful and reliable approach for the diagnosis of OSAS in children. However, more research is required for the diagnosis of mild OSAS using HRP in children.

Figures

Figure 1 –

Bland-Altman plots showing the agreement between RP and PSG. A, Bland-Altman plots of differences in the ORDI-PSG and ORDI-LRP as a function of the mean ORDI derived from the two methods. B, Bland-Altman plots of differences in the ORDI-PSG and ORDI-HRP as a function of the mean ORDI derived from the two methods. C, Bland-Altman plots of differences in the OAHI-PSG and OAHI-LRP as a function of the mean OAHI derived from the two methods. D, Bland-Altman plots of differences in the OAHI-PSG and OAHI-HRP as a function of the mean OAHI derived from the two methods. HRP = home respiratory polygraphy; LRP = in-laboratory respiratory polygraphy; OAHI = obstructive apnea-hypopnea index; ORDI = obstructive respiratory disturbance index; PSG = polysomnography; RP = respiratory polygraphy.

Figure 2 –

Receiver operating characteristic (ROC) curves in HRP. A, ROC curve for ORDI in HRP with the criterion for diagnosis of OSA-hypopnea syndrome (OSAS) in children set as an ORDI ≥ 3 in PSG. B, ROC curve for OAHI in HRP with the criterion for diagnosis of OSAS in children set as an OAHI ≥ 3 in PSG. See Figure 1 legend for expansion of other abbreviations.