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Chest Dec 2015Pediatric OSA can result in significant neurocognitive, behavioral, cardiovascular, and metabolic morbidities. Prompt diagnosis and treatment are, therefore, of... (Review)
Review
Pediatric OSA can result in significant neurocognitive, behavioral, cardiovascular, and metabolic morbidities. Prompt diagnosis and treatment are, therefore, of paramount importance. The current gold standard for diagnosis of OSA in children is in-laboratory polysomnography (PSG). Home sleep apnea testing has been considered as an alternative as it is potentially more cost effective, convenient, and accessible. This review concentrates mainly on the use of type 2 and 3 portable monitoring devices. The current evidence on the feasibility and diagnostic accuracy of home testing in the diagnosis of pediatric OSA was examined. Overall, the evidence in children is limited. Feasibility studies that have been performed have on the whole shown good results, with several reporting > 90% of their home recordings as meeting predetermined quality criteria regarding signal artifact and minimum recording time. The limited data comparing type 2 studies with in-laboratory PSG have shown no significant differences in respiratory parameters. The results pertaining to diagnostic accuracy of type 3 home sleep apnea testing devices are conflicting. Although more research is needed, home testing with at least a type 3 portable monitor offers a viable alternative in the diagnosis of otherwise healthy children with moderate to severe OSA, particularly in settings where access to polysomnography is scarce or unavailable. Of note, since most studies have been performed in habitually snoring healthy children, home sleep apnea testing may not be applicable to children with other comorbid conditions. In particular, CO2 monitoring is important in children in whom there is concern regarding nocturnal hypoventilation, such as children with neuromuscular disease, underlying lung disease, or obesity hypoventilation, and most home testing devices do not include a transcutaneous or end-tidal CO2 channel.
Topics: Child; Diagnostic Equipment; Dimensional Measurement Accuracy; Home Care Services; Humans; Point-of-Care Testing; Polysomnography; Sleep Apnea, Obstructive
PubMed: 26270608
DOI: 10.1378/chest.15-1365 -
Archives Italiennes de Biologie 2015Sleep research carried out on rat and mouse model led to the publication of more than 5000 papers in the last 15 years, of which more than 500 in 2014. Wake-sleep... (Review)
Review
Sleep research carried out on rat and mouse model led to the publication of more than 5000 papers in the last 15 years, of which more than 500 in 2014. Wake-sleep scoring represents a crucial step of the work performed in pre- clinical sleep laboratories; it is a time consuming task and a potential source of errors affecting research outcomes. Several algorithms have been developed to perform automatic sleep scoring. Automatic scoring can accelerate the work of researchers substantially. Moreover, the use of sleep scoring algorithms facilitates the direct comparison of the results produced in different laboratories, with clear advantages from the viewpoint of the advancement of science and reduction of the number of animals used for research. The intent of this review is to provide the readers with the last developments in scoring in rodent sleep and to stress about the need of a cross-lab and cross-species validated algorithm.
Topics: Algorithms; Animals; Polysomnography; Rodentia; Sleep; Species Specificity
PubMed: 26742660
DOI: 10.12871/000398292015231 -
Sleep Health Aug 2023Compare the accuracy and reliability of sleep/wake classification between the Fitbit Charge 3 and the Micro Motionlogger actigraph when applying either the...
GOAL AND AIMS
Compare the accuracy and reliability of sleep/wake classification between the Fitbit Charge 3 and the Micro Motionlogger actigraph when applying either the Cole-Kripke or Sadeh scoring algorithms. Accuracy was established relative to simultaneous Polysomnography recording. Focus technology: Fitbit Charge 3 and actigraphy. Reference technology: Polysomnography.
SAMPLE
Twenty-one university students (10 females).
DESIGN
Simultaneous Fitbit Charge 3, actigraphy, and polysomnography were recorded over 3 nights at the participants' homes.
CORE ANALYTICS
Total sleep time, wake after sleep onset, sensitivity, specificity, positive predictive value, and negative predictive value.
ADDITIONAL ANALYTICS AND EXPLORATORY ANALYSES
Variability of specificity and negative predictive value across subjects and across nights.
CORE OUTCOMES
Fitbit Charge 3 and actigraphy using the Cole-Kripke or Sadeh algorithms exhibited similar sensitivity in classifying sleep segments relative to polysomnography (sensitivity of 0.95, 0.96, and 0.95, respectively). Fitbit Charge 3 was significantly more accurate in classifying wake segments (specificity of 0.69, 0.33, and 0.29, respectively). Fitbit Charge 3 also exhibited significantly higher positive predictive value than actigraphy (0.99 vs. 0.97 and 0.97, respectively) and a negative predictive value that was significantly higher only relative to the Sadeh algorithm (0.41 vs. 0.25, respectively).
IMPORTANT ADDITIONAL OUTCOMES
Fitbit Charge 3 exhibited significantly lower standard deviation in specificity values across subjects and negative predictive value across nights.
CORE CONCLUSION
This study demonstrates that Fitbit Charge 3 is more accurate and reliable in identifying wake segments than the examined FDA-approved Micro Motionlogger actigraphy device. The results also highlight the need to create devices that record and save raw multi-sensor data, which are necessary for developing open-source sleep or wake classification algorithms.
Topics: Female; Humans; Polysomnography; Actigraphy; Reproducibility of Results; Sleep; Fitness Trackers
PubMed: 37270397
DOI: 10.1016/j.sleh.2023.04.001 -
Ear, Nose, & Throat Journal Jul 2016The management of sleep disordered breathing (SDB) in children differs between institutions, and there is a need for an updated review of current practice. Literature... (Review)
Review
The management of sleep disordered breathing (SDB) in children differs between institutions, and there is a need for an updated review of current practice. Literature was reviewed using the PubMed database from 1995 to 2015 by four tertiary care providers experienced in the management of children with SDB. Articles were selected for clinical applicability, strength of evidence, and practicality for practicing clinicians. Fifty-five articles were identified by tertiary care providers in pediatric anesthesiology, pediatric pulmonology, sleep medicine, and pediatric otolaryngology. Each reviewed and analyzed literature independently based on their specialties, and a consensus document was created. The consensus was that the majority of children with SDB do not undergo polysomnography (PSG) before adenotonsillectomy (T&A). Indications for PSG are presented, with a practical approach recommended for the otolaryngologist. Clinical practice guidelines are available from leading national societies, but their recommendations differ. T&A is the first-line treatment and is highly effective in normal-weight but not in obese children. The perioperative management of children is challenging and needs to be individualized. Young children, those with severe obstructive sleep apnea, and those with significant comorbidities need to be observed overnight.
Topics: Adenoidectomy; Adolescent; Child; Child, Preschool; Disease Management; Humans; Otolaryngology; Polysomnography; Practice Guidelines as Topic; Sleep Apnea, Obstructive; Tonsillectomy
PubMed: 27434480
DOI: No ID Found -
Journal of Clinical Sleep Medicine :... Jul 2024Wearable devices that monitor sleep stages and heart rate offer the potential for longitudinal sleep monitoring in patients with neurodegenerative diseases. Sleep...
STUDY OBJECTIVES
Wearable devices that monitor sleep stages and heart rate offer the potential for longitudinal sleep monitoring in patients with neurodegenerative diseases. Sleep quality reduces with disease progression in Huntington's disease (HD). However, the involuntary movements characteristic of HD may affect the accuracy of wrist-worn devices. This study compares sleep stage and heart rate data from the Fitbit Charge 4 (FB) against polysomnography (PSG) in participants with HD.
METHODS
Ten participants with manifest HD wore an FB during overnight hospital-based PSG, and 9 of these participants continued to wear the FB for 7 nights at home. Sleep stages (30-second epochs) and minute-by-minute heart rate were extracted and compared against PSG data.
RESULTS
FB-estimated total sleep and wake times and sleep stage times were in good agreement with PSG, with intraclass correlations of 0.79-0.96. However, poor agreement was observed for wake after sleep onset and the number of awakenings. FB detected waking with 68.6 ± 15.5% sensitivity and 93.7 ± 2.5% specificity, rapid eye movement sleep with high sensitivity and specificity (78.7 ± 31.9%, 95.6 ± 2.3%), and deep sleep with lower sensitivity but high specificity (56.4 ± 28.8%, 95.0 ± 4.8%). FB heart rate was strongly correlated with PSG, and the mean absolute error between FB and PSG heart rate data was 1.16 ± 0.42 beats/min. At home, longer sleep and shorter wake times were observed compared with hospital data, whereas percentage sleep stage times were consistent with hospital data.
CONCLUSIONS
Results suggest the potential for long-term monitoring of sleep patterns using wrist-worn wearable devices as part of symptom management in HD.
CITATION
Doheny EP, Renerts K, Braun A, et al. Assessment of Fitbit Charge 4 for sleep stage and heart rate monitoring against polysomnography and during home monitoring in Huntington's disease. . 2024;20(7):1163-1171.
Topics: Humans; Polysomnography; Male; Huntington Disease; Female; Heart Rate; Middle Aged; Wearable Electronic Devices; Sleep Stages; Adult; Monitoring, Ambulatory
PubMed: 38450553
DOI: 10.5664/jcsm.11098 -
The Laryngoscope Dec 2017To quantify trends and characteristics of sleep studies performed for Medicare beneficiaries in the United States.
OBJECTIVES/HYPOTHESIS
To quantify trends and characteristics of sleep studies performed for Medicare beneficiaries in the United States.
STUDY DESIGN
Retrospective longitudinal study of the Centers for Medicare and Medicaid Services' Part B National Summary Data and Medicare Provider Utilization and Payment Data from 2000 to 2014.
METHODS
Sleep study data were analyzed according to type of study performed, total expenditure amount, provider specialty, and geographic location.
RESULTS
In 2014, 845,569 sleep studies were completed by 1.4% of Medicare beneficiaries for a total of $189 million. Since 2010, annual expenditures for sleep studies have declined, whereas the number of studies performed has increased by 9.1%. In 2014, polysomnography, split-night polysomnography, and unattended home sleep studies accounted for 40%, 48%, and 12%, respectively, of total sleep studies. This represents a dramatic growth in the number of unattended sleep studies performed since 2000, when they represented only 0.9%. Pulmonologists, independent diagnostic testing facilities, and neurologists are the top specialties that bill for sleep studies. Sleep medicine is a growing specialty and ranked fifth among providers, whereas otolaryngologists ranked eighth.
CONCLUSIONS
The healthcare burden of administering sleep studies is substantial, although the annual cost is declining. Unattended sleep studies contribute to decreasing costs and should be considered for patients who meet the correct indications.
LEVEL OF EVIDENCE
4. Laryngoscope, 127:2891-2896, 2017.
Topics: Costs and Cost Analysis; Health Expenditures; Humans; Longitudinal Studies; Medicare; Polysomnography; Retrospective Studies; United States
PubMed: 28626986
DOI: 10.1002/lary.26736 -
Sleep Medicine Reviews Jun 2022Sleep is characterized by an intricate variation of brain activity over time. Measuring these temporal sleep dynamics is relevant for elucidating healthy and... (Review)
Review
Sleep is characterized by an intricate variation of brain activity over time. Measuring these temporal sleep dynamics is relevant for elucidating healthy and pathological sleep mechanisms. The rapidly increasing possibilities for obtaining and processing sleep registrations have led to an abundance of data, which can be challenging to analyze and interpret. This review provides a structured overview of approaches to represent temporal sleep dynamics, categorized based on the way the source data is compressed. For each category of representations, we describe advantages and disadvantages. Standard human-defined 30-s sleep stages have the advantages of standardization and interpretability. Alternative human-defined representations are less standardized but offer a higher temporal resolution (in case of microstructural events such as sleep spindles), or reflect non-categorical information (for example spectral power analysis). Machine-learned representations offer additional possibilities: automated sleep stages are useful for handling large quantities of data, while alternative sleep stages obtained from clustering data-driven features could aid finding new patterns and new possible clinical interpretations. While newly developed sleep representations may offer relevant insights, they can be difficult to interpret in for example a clinical context. Therefore, there should always be a balance between developing these sophisticated sleep analysis techniques and maintaining clinical explainability.
Topics: Electroencephalography; Humans; Learning; Polysomnography; Sleep; Sleep Stages
PubMed: 35278893
DOI: 10.1016/j.smrv.2022.101611 -
Behavioral Sleep Medicine 2022Children with ADHD are reported to have sleep problems and neuropsychological deficits, but studies examining a potential association between the two are scarce and the...
BACKGROUND
Children with ADHD are reported to have sleep problems and neuropsychological deficits, but studies examining a potential association between the two are scarce and the use of varying methodology can complicate conclusions.
PARTICIPANTS
A clinical sample of 59 medication-naïve children with ADHD between the ages of 6 and 14 years (71% male).
METHODS
Children underwent polysomnography and multiple sleep latency test, and parent rated sleep habits on the Children's Sleep Habits Questionnaire. Children also completed an extensive neuropsychological battery of executive function and delay aversion tasks, and parents and teachers rated executive function behavior on the Behavior Rating Inventory of Executive Function. Linear regression analyses were conducted with each of the neuropsychological outcomes included as the outcome variable and the sleep parameters as the predictor variables.
RESULTS
The correlations between sleep and neuropsychological outcomes were generally modest, but some sleep parameters (primarily sleep stages and sleep latencies) were associated with objectively and subjectively measured executive function and delay aversion.
CONCLUSIONS
Using objective and subjective gold standard assessment procedures this study supports a (modest) association between sleep and neuropsychological function in children with ADHD.
Topics: Adolescent; Attention Deficit Disorder with Hyperactivity; Child; Female; Humans; Male; Neuropsychological Tests; Polysomnography; Sleep; Sleep Wake Disorders; Surveys and Questionnaires
PubMed: 34081546
DOI: 10.1080/15402002.2021.1931222 -
Croatian Medical Journal Dec 2022To establish patterns or themes of dreams and dreamlike mentation content reported in all forms of non-rapid eye movement (NREM) parasomnias and to identify gaps in the... (Review)
Review
AIM
To establish patterns or themes of dreams and dreamlike mentation content reported in all forms of non-rapid eye movement (NREM) parasomnias and to identify gaps in the current understanding of this topic.
METHODS
A scoping review of available evidence on dreams and dreamlike mentation in NREM parasomnias was conducted in accordance with the PRISMA-ScR guidelines. We searched peer-reviewed literature using Google Scholar, PubMed, Ovid (Embase), Ovid Medline®, Global Health, and APA Psych Info. The Mixed Method Appraisal Tool (MMAT) was used to appraise the quality of selected articles.
RESULTS
The final analysis included 16 studies. All of the studies were from high-income countries. The studies reported on dreams and dreamlike mentation in NREM parasomnias, but there was scarcity of literature for sexsomnia, sleep-related eating disorder, and confusional arousal. All of the studies had the highest quality as shown by the MMAT (76%-100%). Emotions such as apprehension and misfortune were associated with sleepwalking and sleep terrors.
CONCLUSION
Sleep studies involving collection of dream content immediately following NREM parasomnia could significantly minimize reporting bias and improve dream data quality.
Topics: Humans; Parasomnias; Polysomnography; Emotions
PubMed: 36597564
DOI: 10.3325/cmj.2022.63.525 -
Sleep & Breathing = Schlaf & Atmung Mar 2022There are no studies comparing tests performed at home with those carried out in the laboratory, using the same device. The only studies that have been performed...
AIM
There are no studies comparing tests performed at home with those carried out in the laboratory, using the same device. The only studies that have been performed have compared the device used at home with the standard polygraph used in the laboratory. The purpose of this study was therefore to verify the accuracy of the home diagnosis of obstructive sleep apnea syndrome (OSAS) via unassisted type 2 portable polysomnography, compared with polysomnography using the same equipment in a sleep laboratory.
METHODS
To avoid any possible order effect on the apnea-hypopnea index (AHI), we randomly created two groups of 20-total 40 patients, according to the test sequence. One of the groups had the first test at home and the second test in the laboratory (H-L); the other group had the first test in the laboratory and the second at home (L-H). The second test always took place on the night immediately following the first test. All polysomnographic monitoring was undertaken with the same equipment, an Embletta X100 system (Embla, Natus Inc., Middleton, USA). The Embletta X100 is a portable polygraph that records eleven polygraph signs: (1) electroencephalogram C4/A; (2) electroencephalogram O2/M1; (3) submental EMG; (4) electrooculogram of the right side; (5) nasal cannula (air flow); (6) respiratory effort against a plethysmographic chest strap; (7) respiratory effort against an abdominal plethysmographic belt; (8) heart rate; (9) saturation of oxyhemoglobin; (10) snoring; and (11) body position.
RESULTS
There was no difference in sleep efficiency between the group monitored in the laboratory and the group tested at home (p = 0.30). There was no difference in total sleep time (p = 0.11) or sleep latency (p = 0.52), or in the latency in phases N2 and N3 between the monitoring in the laboratory and at home (N2 p = 0.24; N3 p = 0.09). Some differences occurred regarding the PSG that took place at home, with longer duration of wake after sleep onset (WASO) and longer latency for REM sleep, due to failure of the patient to start the monitoring by pressing the "events" button on the device. In the distribution of sleep phases, there was no difference between the group monitored in the laboratory and the group tested at home.
CONCLUSION
Results from home sleep monitoring correlate well with the laboratory "gold standard" and may be an option for diagnosing OSAS in selected patients.
Topics: Adult; Diagnostic Equipment; Equipment Design; Female; Humans; Male; Middle Aged; Monitoring, Ambulatory; Polysomnography; Sleep Apnea, Obstructive
PubMed: 33837916
DOI: 10.1007/s11325-021-02372-6