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Sleep Science (Sao Paulo, Brazil) 2021To evaluate the economic and technical viability of the sleep study (type III) in children with adenotonsilar hypertrophy.
OBJECTIVE
To evaluate the economic and technical viability of the sleep study (type III) in children with adenotonsilar hypertrophy.
METHODS
141 children were submitted to sleep study (type III), aged between three and 11, all with symptoms of OSA. The frequency of failed examinations and a comparison of cost analysis between complete polysomnography were described.
RESULTS
41 exams lost at least one sensor. The sensor with the highest number of losses was the oximetry, observed in 14.28%. The 100 valid sleep studies allowed the diagnosis of severe OSA in 36 children. Sleep study accounts for approximately 63% of the value of the PSG type I, thus, it showed to be cost effective even with the repetition of the failed one.
CONCLUSION
Sleep study (type III) may have high failure rates and it was a reliable exam for the identification of severe OSA. The cost analysis showed economic feasibility, even with a high failure rate and necessity of repetition.
PubMed: 35087635
DOI: 10.5935/1984-0063.20200094 -
International Journal of Pediatric... Apr 2021The prevalence of obstructive sleep apnea syndrome (OSAS) in children referred for sleep-disordered breathing reaches up to 59%. We aimed to test the adequacy of a...
OBJECTIVES
The prevalence of obstructive sleep apnea syndrome (OSAS) in children referred for sleep-disordered breathing reaches up to 59%. We aimed to test the adequacy of a questionnaire compared to home respiratory polygraphy (HRP), in 45 subjects (5-16 years-old), without maxillofacial malformations nor other comorbidities, presenting with symptoms compatible with OSAS.
METHODS
All children passed a 12-items questionnaire (Obstructive Airway Child test: OACT) and the HRP. OSAS was classified in severity according to the apnea-hypopnea index (AHI).
RESULTS
With HRP, 60% and 15% children were detected to have at least mild (AHI ≥1) and moderate (AHI >5) OSAS, respectively. The sensitivity of the questionnaire to detect mild and moderate OSAS was good (93% and 71%, respectively) but the specificity was very low (11% and 34%). However, an OACT score under 61 showed a very good negative predictive value for moderate and severe OSAS (87%). With the questionnaire, we could have avoided a complementary PSG or HRP in 25/45 (56%) of our subjects as in children with mild OSAS and without comorbidities only clinical observation is usually advised.
CONCLUSIONS
The OACT questionnaire has shown to be a good and quick instrument to exclude moderate and severe OSAS in our population of children without maxillofacial malformations. Indeed children scoring under 61 could avoid a constraining and expensive sleep exam. However, if the score is above this cut-off, the performance to recognize OSAS is low and the child's evaluation must be completed by a HRP or PSG.
Topics: Adolescent; Child; Child, Preschool; Humans; Polysomnography; Sleep; Sleep Apnea, Obstructive; Surveys and Questionnaires
PubMed: 33535090
DOI: 10.1016/j.ijporl.2021.110635 -
Cardiac Electrophysiology Clinics Mar 2021Obstructive sleep apnea (OSA) creates a complex and dynamic substrate for atrial fibrillation (AF), which is characterized by structural remodeling as a result of... (Review)
Review
Obstructive sleep apnea (OSA) creates a complex and dynamic substrate for atrial fibrillation (AF), which is characterized by structural remodeling as a result of long-term OSA as well as transient and acute apnea-associated transient atrial electrophysiological changes. OSA is present in 21% to 74% of patients with AF, and nonrandomized studies suggest that treatment of OSA by continuous positive airway pressure may help to maintain sinus rhythm after electrical cardioversion and improve catheter ablation success rates. Management of OSA in patients with AF requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and sleep specialists.
Topics: Atrial Fibrillation; Catheter Ablation; Continuous Positive Airway Pressure; Humans; Sleep Apnea Syndromes
PubMed: 33516410
DOI: 10.1016/j.ccep.2020.10.003 -
Pediatric Pulmonology Jul 2023Polygraphy (PG) can be used as an alternative test for the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. Night-to-night variability of PG in children...
INTRODUCTION
Polygraphy (PG) can be used as an alternative test for the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. Night-to-night variability of PG in children is not known. Our aim was to determine whether a single night PG was reliable for OSAS diagnosis in children with symptoms of sleep-disordered breathing (SDB).
MATERIALS AND METHODS
Otherwise healthy children who had been evaluated for symptoms of SDB were included. Two nocturnal PGs were performed 2-7 days apart. Demographic and clinical characteristics, Pediatric Sleep Questionnaire, and modified Epworth Sleepiness Scale were recorded. OSAS was diagnosed if obstructive apnea-hypopnea index was (oAHI) ⩾ 1/h and classified as mild (oAHI: 1-4.9/h), moderate (oAHI: 5-9.9/h), and severe (oAHI ⩾ 10/h).
RESULTS
Forty-eight patients were included (37.5% female, age 10.8 ± 3.9 years) to the study. There were no significant differences in oAHI values and other respiratory parameters between the two PGs (p > 0.05). Thirty-nine children were diagnosed with OSAS if the highest oAHI over any single night was used for diagnosis. Thirty-three of the 39 children (84.6%) were diagnosed with OSAS with the first PG while 35 of 39 (89.7%) children were diagnosed with OSAS with the second PG. There was an agreement for identifying OSAS and its severity between the two PGs in our study even though there were few individual intra-subject differences in oAHI.
CONCLUSION
There was no significant first-night effect for PG in this study which suggests that a single night PG is adequate for diagnosis of OSAS in children with SDB- related symptoms.
Topics: Child; Humans; Female; Adolescent; Male; Polysomnography; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep; Psychological Tests
PubMed: 37014151
DOI: 10.1002/ppul.26404 -
Sleep Medicine May 2021Obstructive sleep apnea syndrome in children is associated with significant morbidity. Polysomnography is the main diagnostic tool but is time consuming and requires...
OBJECTIVE
Obstructive sleep apnea syndrome in children is associated with significant morbidity. Polysomnography is the main diagnostic tool but is time consuming and requires skilled manpower to supervise the patient overnight and hence long referral to diagnosis time. However, there are limitations and underestimation of the apnoea hyponea index (AHI) with alternative home sleep apnoea testing (HSAT), such as type 3 respiratory polygraphy (RP). Prior studies have demonstrated pulse transit time (PTT) to be a reliable indicator of cortical arousals. In this study, the use of PTT together with RP will be studied to determine whether the derived AHI is comparable to that of PSG.
METHOD
Forty-five patients with suspected OSA met the inclusion criteria underwent PSG in the sleep laboratory for analysis. The raw data for either PSG or RP analysis were allocated separately to two different accredited sleep technicians. The primary outcome AHI derived from PTT with RP was compared to the AHI derived from PSG. Secondary outcomes compared were obstructive apnoea index (OAI), total hypopnoea index (THI) and arousal index (AI). Bland Altman analysis was used to compare the agreement of AHI derived from the 2 modalities and demonstrate whether RP is non inferior or equivalent to the gold standard for diagnosing OSAS.
RESULTS
The patients studied had a median age of 8.8 years (range 3-17 years). The patients were not limited to certain spectrum of severity OSA and had AHI results spread from mild to severe OSA (AHI 0.4/hr to 72.2/hr). The RP with PTT-derived AHI was strongly correlated to the PSG derived AHI as seen on the Spearman plot (r = 0.98). The Bland Altman plot showed no evidence of underestimation of the AHI due to missed arousal related hypopneas. The difference of AHI derived from RP and PSG results were clinically insignificant. The differences between the PSG and RP total hypopnoea index (THI) and arousal index (AI) were also statistically insignificant.
CONCLUSION
The study shows that RP with PTT can be considered a reliable diagnostic alternative compared with PSG. The role of PTT incorporated with RP was to minimize underestimation of AHI due to missed arousal associated hypopnea events. The results were apparent across mild to severe severity of OSA. There are advantages of RPs particularly in paediatrics. Overall this study offers promising preliminary insights that RP incorporated with PTT can be further explored as an acceptable home diagnostic tool for diagnosing OSA in children.
Topics: Adolescent; Arousal; Child; Child, Preschool; Humans; Polysomnography; Pulse Wave Analysis; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 33865076
DOI: 10.1016/j.sleep.2021.02.048 -
Sleep Medicine Clinics Jun 2021Sleep disorders in Parkinson disease have attracted the attention of clinicians and researchers for decades. Recently, major advances in their clinical characterization,... (Review)
Review
Sleep disorders in Parkinson disease have attracted the attention of clinicians and researchers for decades. Recently, major advances in their clinical characterization, polysomnographic description, pathophysiologic understanding, and treatment took place. Parkinson disease encompasses the whole spectrum of sleep medicine: every category of sleep disorder can be observed in these patients. Video polysomnography frequently is indicated, sometimes followed by multiple sleep latency/maintenance of wakefulness tests. Additional studies may include actigraphy, cardiorespiratory polygraphy, and dim light melatonin assessment. Treatment needs to be specific to the underlying sleep disorder and can include medications and nondrug treatments, for example, behavioral therapy and light therapy.
Topics: Humans; Parkinson Disease; Sleep Wake Disorders
PubMed: 33985657
DOI: 10.1016/j.jsmc.2021.03.001 -
Indian Pediatrics Nov 2021Sleep-related breathing disorders (SRBD), also referred to as sleep-disordered breathing (SDB), are common sleep disorders in children. They can be broadly divided... (Review)
Review
Sleep-related breathing disorders (SRBD), also referred to as sleep-disordered breathing (SDB), are common sleep disorders in children. They can be broadly divided between central and obstructive sleep-disordered breathing with or without associated hypoventilation. In most cases, SRBD are associated with adenotonsillar hypertrophy (obstructive SDB) which are classified as simple. SRBD can co-exist with an underlying condition like obesity, genetic syndromes or neuromuscular disorders which are classified as complex. Polysomnography (PSG) is the gold standard for diagnosing sleep disorders. However, it is time-consuming and requires trained technician to acquire and interpret signals. Attended in-lab respiratory polygraphies are easier to conduct and provide respiratory data equivalent to a PSG. Similar to adult sleep services, overnight unattended home respiratory polygraphies are becoming more widely used. These require careful patient selection and good parental education programs to be most successful in children. Overnight oximetry has limitations but can be a useful tool for screening children with obstructive sleep apnea and prioritizing treatment. This review aims to discuss these various diagnostic methods to assess sleep disorders in children.
Topics: Adult; Child; Humans; Oximetry; Polysomnography; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 33941709
DOI: No ID Found -
The Journal of Clinical Psychiatry Oct 2016Intentional deception is a common act that often has detrimental social, legal, and clinical implications. In the last decade, brain activation patterns associated with...
OBJECTIVE
Intentional deception is a common act that often has detrimental social, legal, and clinical implications. In the last decade, brain activation patterns associated with deception have been mapped with functional magnetic resonance imaging (fMRI), significantly expanding our theoretical understanding of the phenomenon. However, despite substantial criticism, polygraphy remains the only biological method of lie detection in practical use today. We conducted a blind, prospective, and controlled within-subjects study to compare the accuracy of fMRI and polygraphy in the detection of concealed information. Data were collected between July 2008 and August 2009.
METHOD
Participants (N = 28) secretly wrote down a number between 3 and 8 on a slip of paper and were questioned about what number they wrote during consecutive and counterbalanced fMRI and polygraphy sessions. The Concealed Information Test (CIT) paradigm was used to evoke deceptive responses about the concealed number. Each participant's preprocessed fMRI images and 5-channel polygraph data were independently evaluated by 3 fMRI and 3 polygraph experts, who made an independent determination of the number the participant wrote down and concealed.
RESULTS
Using a logistic regression, we found that fMRI experts were 24% more likely (relative risk = 1.24, P < .001) to detect the concealed number than the polygraphy experts. Incidentally, when 2 out of 3 raters in each modality agreed on a number (N = 17), the combined accuracy was 100%.
CONCLUSIONS
These data justify further evaluation of fMRI as a potential alternative to polygraphy. The sequential or concurrent use of psychophysiology and neuroimaging in lie detection also deserves new consideration.
Topics: Adult; Arousal; Brain; Deception; Executive Function; Female; Humans; Image Interpretation, Computer-Assisted; Lie Detection; Logistic Models; Magnetic Resonance Imaging; Male; Observer Variation; Prospective Studies; Reference Values; Sensitivity and Specificity; Young Adult
PubMed: 26794034
DOI: 10.4088/JCP.15m09785 -
Journal of Clinical Medicine Jul 2020The utility of home respiratory polygraphy (HRP) was assessed as an alternative to polysomnography (PSG) in the diagnosis of childhood obstructive sleep apnea syndrome...
The utility of home respiratory polygraphy (HRP) was assessed as an alternative to polysomnography (PSG) in the diagnosis of childhood obstructive sleep apnea syndrome (OSAS). PSG was indicated only in patients with concomitant disease or where HRP results were questionable. The follow-up period was 1 year. We recorded clinical and anthropometric data, physical examination findings, respiratory variables, severity level and choice of therapy. We assessed 121 children, 70 boys and 51 girls, with mean age 7 ± 4 years, mean body mass index (BMI) 19 ± 5 kg/m, and mean BMI percentile 62 ± 38%. We included 104 HRP and 24 PSG recordings. Of the latter, 7 were preceded by HRP (false negatives) and 17 were indicated as the first-choice method owing to concomitant disease. Of the initial HRP recordings, 93% were technically valid. All technically valid HRPs and 96% of PSGs resulted in a diagnosis of OSAS (apnea-hypopnea index 9.5 ± 9.1/h). Thirty-three percent of cases were moderate and 22% severe. Apnea-hypopnea index showed no correlation with BMI or BMI percentile. Adenotonsillectomy was indicated in 93 patients (77%), conservative treatment in 17 (14%), and conservative treatment combined with CPAP/BiPAP in 11 (9%). There were no significant differences between children diagnosed by HRP and by PSG in terms of treatment choice. The prevalence of OSAS in our sample was 96.7%. In conclusion, when the probability of OSAS is high, HRP is usually sufficient for diagnosing the syndrome and establishing therapy in children. PSG is advisable in complex or questionable cases.
PubMed: 32630238
DOI: 10.3390/jcm9072067 -
Medicina Clinica Jul 2016Sleep apnea-hypopnea syndrome is an underdiagnosed medical condition which is gainingin importance. It is associated with cardiovascular disease, stroke, hypertension,... (Review)
Review
Sleep apnea-hypopnea syndrome is an underdiagnosed medical condition which is gainingin importance. It is associated with cardiovascular disease, stroke, hypertension, insulin resistance and traffic accidents, resulting in deterioration of quality of life and increased mortality in these patients. The most characteristic symptoms of the disease are snoring, documented apnoeas and excessive daytime sleepiness. Polysomnography is the gold standard for diagnosis, but in patients with high pre-test probability, we should opt for respiratory polygraphy, a more accessible and less expensive test. Besides making lifestyle changes, the treatment of choice is continuous positive airway pressure. Some surgical techniques may be useful in the treatment of sleep apnoea-hypopnoea syndrome. In patients who cannot tolerate continuous positive airway pressure, are not candidates for surgery or have a high surgical risk intraoral devices might be used.
Topics: Combined Modality Therapy; Continuous Positive Airway Pressure; Diet Therapy; Health Behavior; Health Promotion; Humans; Physical Examination; Polysomnography; Sleep Apnea, Obstructive
PubMed: 26971989
DOI: 10.1016/j.medcli.2016.01.030