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Frontiers in Medicine 2022Obstructive sleep apnea (OSA) severity is based on the apnea-hypopnea index (AHI). The AHI is a simplistic measure that is inadequate for capturing disease severity and...
INTRODUCTION
Obstructive sleep apnea (OSA) severity is based on the apnea-hypopnea index (AHI). The AHI is a simplistic measure that is inadequate for capturing disease severity and its consequences in cardiovascular diseases (CVDs). Deleterious effects of OSA have been suggested to influence the prognosis of specific endotypes of patients with acute coronary syndrome (ACS). We aim to identify respiratory polygraphy (RP) patterns that contribute to identifying the risk of recurrent cardiovascular events in patients with ACS.
METHODS
analysis of the ISAACC study, including 723 patients admitted for a first ACS (NCT01335087) in which RP was performed. To identify specific RP patterns, a principal component analysis (PCA) was performed using six RP parameters: AHI, oxygen desaturation index, mean and minimum oxygen saturation (SaO), average duration of events and percentage of time with SaO < 90%. An independent HypnoLaus population-based cohort was used to validate the RP components.
RESULTS
From the ISAACC study, PCA showed that two RP components accounted for 70% of the variance in the RP data. These components were validated in the HypnoLaus cohort, with two similar RP components that explained 71.3% of the variance in the RP data. The first component (component 1) was mainly characterized by low mean SaO and obstructive respiratory events with severe desaturation, and the second component (component 2) was characterized by high mean SaO and long-duration obstructive respiratory events without severe desaturation. In the ISAACC cohort, component 2 was associated with an increased risk of recurrent cardiovascular events in the third tertile with an adjusted hazard ratio (95% CI) of 2.44 (1.07 to 5.56; -value = 0.03) compared to first tertile. For component 1, no significant association was found for the risk of recurrent cardiovascular events.
CONCLUSION
A RP component, mainly characterized by intermittent hypoxemia, is associated with a high risk of recurrent cardiovascular events in patients without previous CVD who have suffered a first ACS.
PubMed: 35833104
DOI: 10.3389/fmed.2022.870906 -
Journal of Clinical Neurophysiology :... Apr 1985
Review
Topics: Brain; Brain Diseases; Electroencephalography; Humans; Infant, Newborn; Infant, Premature, Diseases; Monitoring, Physiologic; Reference Values
PubMed: 3916839
DOI: 10.1097/00004691-198504000-00002 -
Swiss Medical Weekly Feb 2007Sleep related breathing disorders (SBD) are common and associated with morbidity and mortality. Since polysomnography, the conventional diagnostic gold standard is... (Review)
Review
BACKGROUND
Sleep related breathing disorders (SBD) are common and associated with morbidity and mortality. Since polysomnography, the conventional diagnostic gold standard is costly and not generally available, ambulatory respiratory polygraphic sleep studies (RP) are used. To evaluate whether RP reimbursement by health insurance companies was justified, the Swiss Federal Office of Public Health (FOPH) requested registration of RP during 36 months and a literature review on RP. The results are reported here.
METHODS
RP reimbursed from July 2002 to December 2005 by Swiss health insurance companies were analysed. A review of the literature from 2003 comparing RP with PSG was updated. The outcome of interest was the apnoea/hypopnoea index.
RESULTS
Datasets on 11,485 RP were evaluated, 8179 were performed to evaluate suspected obstructive sleep apnoea syndrome (OSAS). In patients with snoring, witnessed apnoea and hypersomnia (n = 4180), 80.2% of RP confirmed OSAS, 3.5% of RP were inconclusive prompting polysomnography. Six studies published between 2003 and 2005 were pooled with a former review of 12 studies. With a mean pre-test probability of 64% for OSAS, the post-test probability after a negative result ranged from 8% (negative likelihood ratio of 0.05) to 23% (negative likelihood ratio of 0.20). The post-test probability after a positive result was within a range of 98% (positive likelihood ratio of 23.8) to 90% (positive likelihood ratio of 5.7).
CONCLUSIONS
In selected patients with clinically suspected OSAS RP allows accurate and simple diagnosis of OSAS. According to the practice in Switzerland as reflected by the registry additional PSG are rarely required, suggesting relevant cost savings by RP. Granting reimbursement for RP as introduced in the meantime by the FOPH seems justified.
Topics: Humans; Insurance Claim Review; Monitoring, Ambulatory; Polysomnography; Practice Guidelines as Topic; Predictive Value of Tests; Pulmonary Medicine; Registries; Respiration; Sleep Apnea Syndromes; Switzerland
PubMed: 17370146
DOI: 10.4414/smw.2007.11654 -
Thorax Jun 2012Non-invasive ventilation (NIV) is recognised as an effective treatment for chronic hypercapnic respiratory failure. Monitoring NIV during sleep may be preferable to... (Review)
Review
Non-invasive ventilation (NIV) is recognised as an effective treatment for chronic hypercapnic respiratory failure. Monitoring NIV during sleep may be preferable to daytime assessment. This paper reports the findings of an international consensus group which systematically analysed nocturnal polygraphic or polysomnographic tracings recorded with either volume-cycled or pressure-cycled ventilators. A systematic description of nocturnal respiratory events which occur during NIV is proposed: leaks, obstruction at different levels of the upper airway (glottis and/or pharynx), with or without decrease of respiratory drive and asynchrony.
Topics: Consensus Development Conferences as Topic; Humans; Monitoring, Physiologic; Polysomnography; Positive-Pressure Respiration; Practice Guidelines as Topic; Respiratory Function Tests; Respiratory Insufficiency; Respiratory Mechanics; Sleep; Sleep Apnea Syndromes; Treatment Outcome
PubMed: 20971982
DOI: 10.1136/thx.2010.142653 -
Sleep Medicine Apr 2020Sleep-disordered breathing (SDB) in children is common. Interest in sleep tests, such as polygraphy (PG), which can be performed in a non-attended setting, are gaining...
OBJECTIVE
Sleep-disordered breathing (SDB) in children is common. Interest in sleep tests, such as polygraphy (PG), which can be performed in a non-attended setting, are gaining is increasing. PG has, however, been little studied in children with co-morbidities other than obstructive sleep apnea (OSA), and in particular, if performed in a non-attended setting. We report on the feasibility and interpretability of implementing PGs at home versus in hospital.
METHODS
PGs were analyzed according to the setting (hospital or home) and sequence (initial or subsequent) in which they were performed. Non-interpretability was defined as absent or unreliable oxygen saturation by pulse oximetry (SpO), or airflow and respiratory inductance plethysmography flow trace signals during the time analyzed.
RESULTS
We retrospectively analyzed 400 PGs; 332/400 were initial PGs. Indications were: suspected OSA (65%), obesity (13%), craniofacial malformations (5%), neuromuscular disease (4%), and other (13%) which included prematurity. 16% were recorded in hospitals and 84% at home. The mean age was 5.7 ± 5.8 years and 7.3 ± 4.5 years for the hospital and home groups, respectively. Interpretability was similar in both settings (87%). In the 68 subsequent PGs, interpretability was 84% when performed for follow-up and 96% when repeated for non-interpretability. Non-interpretability was predominantly due to a failure of the SpO channel.
CONCLUSIONS
PG performed at home is both feasible and interpretable for a variety of indications. Non-interpretability was not predictable in association with the setting, anthropometric data, or indication, independently of the sequence (initial or subsequent PG) in which the parameters were analyzed.
Topics: Child; Child, Preschool; Humans; Oximetry; Polysomnography; Retrospective Studies; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 32036287
DOI: 10.1016/j.sleep.2019.11.1264 -
Data in Brief Aug 2020This short report describes respiratory indices of polygraphies (PG) performed to investigate several sleep-related disorders of breathing in children. It refers to the...
This short report describes respiratory indices of polygraphies (PG) performed to investigate several sleep-related disorders of breathing in children. It refers to the work of Michelet et al., Successful home respiratory polygraphy to investigate sleep-disordered breathing in children, Sleep Medicine [1]. Indications for PGs were grouped according to 6 categories: craniofacial malformation, neuromuscular disease, obesity, suspected obstructive sleep apnea (OSA), prematurity, and other. The reported data concern the initial interpretable PGs ( = 289); initial was defined as performed for the first time in any subject. Non-interpretability was defined as absent or unreliable oxygen saturation by pulse oximetry (SpO), and/or airflow and respiratory inductance plethysmography (RIP) flow trace signals during time analyzed. Analyzed time is reported. In a subset of patients, transcutaneous carbon dioxide partial pressure (pCO) was also measured. Data may be re-used for comparison in future validating research for PGs in children [2].
PubMed: 32637479
DOI: 10.1016/j.dib.2020.105859 -
Revista Chilena de Pediatria Apr 2017Apnea and apparently lethal events have great etiological diversity thus complementary tests may help diagnosis. The aim of this study was to describe the results of...
UNLABELLED
Apnea and apparently lethal events have great etiological diversity thus complementary tests may help diagnosis. The aim of this study was to describe the results of polygraph studies of children under 3 months hospitalized with suspected apnea.
PATIENTS AND METHODS
Retrospective case series. Children under 3 months with suspected apnea were considered and in whom a polygraphy (PG) was performed during hospitalization. General data, the apnea/hypopnea index (AHI), index of central. apnea, obstructive apnea index, average and minimum saturation were recorded. Desaturation index (ID) below 80% higher 1 per hour, one or more events of desaturation below 80% for more than 20 seconds or an AHI greater than or equal 1 were considered as criteria of sleep disorder breathing (SLB). Descriptive analysis was performed and the associations between AHI and saturation parameters were determined.
RESULTS
51 patients, 32 males, entered the study. 15,6% had altered PG. In 5 of them coexisted more than one diagnostic criterion. Iin 15,6% of the patients was observed an IAH greater 1, in 7.8% a desaturation index below 80% and in 11,8% a desaturation index under 80% for 20 seconds greater than 1. The AHI was associated with the parameters of saturation.
CONCLUSION
Most of the patients had normal PG and among patients with a suggestive SLB a pattern of respiratory immaturity prevailed, which is characteristic of this age.
Topics: Child, Hospitalized; Female; Hospitalization; Humans; Infant; Infant, Newborn; Male; Polysomnography; Retrospective Studies; Sleep Apnea Syndromes
PubMed: 28542657
DOI: 10.4067/S0370-41062017000200006 -
Pediatric Neurology Feb 2014
Topics: Epilepsy; Humans; Rett Syndrome
PubMed: 24269129
DOI: 10.1016/j.pediatrneurol.2013.07.006 -
Pulmonary Medicine 2023It is known that children and adolescents with obesity are more prone to obstructive sleep apnea syndrome (OSAS) and that their lung function may show some disturbance....
AIM
It is known that children and adolescents with obesity are more prone to obstructive sleep apnea syndrome (OSAS) and that their lung function may show some disturbance. Literature is scarce about potential associations; therefore, we aimed to study the relationship between OSAS, lung function, and adiposity in a population of children suspected of OSAS. . We performed home respiratory polygraphy and spirometry in all subjects. The relationships between body mass index -score (zBMI), polygraphy, and spirometry data were analyzed.
RESULTS
We recruited 81 subjects aged between 5 and 16 years, 63% being obese. 43.2% of subjects were diagnosed with OSAS (32.1% mild, 4.9% moderate, and 6.2% severe). We found no correlation between respiratory polygraphy and the zBMI. The mean spirometric value FEV, FVC, and FEV/FVC ratio 's were normal in all subjects, whereas FVC 's and FEV/FVC ratio 's were significantly positively related for obesity and negatively for normal weight ( < 0.05). FEV 's was inversely correlated to the percentage of analyzed time passed below 90% of SpO ( = -0.224, = 0.044). All subjects with FEV ( = 8) and/or FVC ( = 9) 's below the lower limit for normal (LLN) had an AHI ≥ 1 (FEV: = 0.001; FVC: < 0.001), especially subjects with normal weight (FEV: = 0.003; FVC: = 0.010).
CONCLUSION
When comparing normal-weight children and adolescents with obesity, the prevalence of OSAS but not spirometric values was strongly related to BMI -score, probably because obesity engenders advanced puberty and an accelerated growth spurt. FEV was more frequently
Topics: Adolescent; Humans; Child; Child, Preschool; Pediatric Obesity; Forced Expiratory Volume; Spirometry; Body Mass Index; Sleep Apnea, Obstructive; Vital Capacity
PubMed: 36760693
DOI: 10.1155/2023/1532443 -
Minerva Pediatrics Jun 2024Periodic assessment of the need for oxygen supplementation and/or mechanical ventilation in children with severe bronchopulmonary dysplasia (BPD) is crucial. The aim of...
BACKGROUND
Periodic assessment of the need for oxygen supplementation and/or mechanical ventilation in children with severe bronchopulmonary dysplasia (BPD) is crucial. The aim of the study was to analyze the indications and results of respiratory polygraphies (RP) performed in preterm infants with BPD followed at a tertiary university hospital.
METHODS
All subjects <5-year-old with BPD who had a RP between September and February 2018 were included. The indications and results of RP and consequent medical management were analyzed.
RESULTS
Fourteen infants (9 females, mean gestational age 27.6±3.3 weeks) underwent a RP at mean age of 26.4±19.4 months. Five subjects were evaluated for the need of long-term respiratory support (RS), 3 started continuous positive airway pressure (CPAP), 2 were weaned from RS. Four subjects underwent RP for suspected obstructive sleep apnea (OSA), one started on CPAP. Central apnea syndrome (CSA) was confirmed in 2 subjects and one was started on non-invasive ventilation. RP allowed safe tracheostomy decannulation in 2 subjects. Finally, RP was normal in one subject who had a brief resolved unexplained event.
CONCLUSIONS
RP represents an important tool for the evaluation of children with BPD and leads to important therapeutic decisions.
Topics: Humans; Female; Male; Bronchopulmonary Dysplasia; Retrospective Studies; Infant; Infant, Premature; Infant, Newborn; Child, Preschool; Continuous Positive Airway Pressure; Respiration, Artificial; Polysomnography; Sleep Apnea, Obstructive
PubMed: 33305917
DOI: 10.23736/S2724-5276.20.06088-0