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Medline ® Abstracts for References 84,85

of 'Evaluation of suspected obstructive sleep apnea in children'

Feasibility of using unattended polysomnography in children for research--report of the Tucson Children's Assessment of Sleep Apnea study (TuCASA).
Goodwin JL, Enright PL, Kaemingk KL, Rosen GM, Morgan WJ, Fregosi RF, Quan SF
Sleep. 2001;24(8):937.
STUDY OBJECTIVES: The Tucson Children's Assessment of Sleep Apnea study (TuCASA) is designed to investigate the prevalence and correlates of objectively measured sleep-disordered breathing in pre-adolescent children. This paper documents the methods and feasibility of attaining quality unattended polysomnograms in the first 162 TuCASA children recruited.
DESIGN: A prospective cohort study projected to enroll 500 children between 5 and 12 years of age who will undergo unattended polysomnography, neurocognitive evaluation, and physiological and anatomical measurements thought to be associated with sleep-disordered breathing.
SETTING: Children are recruited through the Tucson Unified School District. Polysomnograms and anthropometric measurements are completed in the child's home.
PARTICIPANTS: Of the 157 children enrolled in TuCASA, there were 100 children (64%) between 5-8 years old and 57children (36%) between the ages of 9 to 12. There were 74 (47%) Hispanic children, and 68 (43%) female participants.
MEASUREMENTS&RESULTS: Technically acceptable studies were obtained in 157 children (97%). The initial pass rate was 91%, which improved to 97% when 9 children who failed on the first night of recording completed a second study which was acceptable. In 152 studies (97%), greater than 5 hours of interpretable respiratory, electroencephalographic, and oximetry signals were obtained. The poorest signal quality was obtained from the chin electromyogram and from the combination thermister/nasal cannula. Parents reported that 54% of children slept as well as, or better than usual, while 40% reported that their child slept somewhat worse than usual. Only 6% were observed to sleep much worse than usual. Night-to-night variability in key polysomnographic parameters (n=10) showed a high degree of reproducibility on 2 different nights of study using identical protocols in the same child. In 5 children, polysomnograms done in the home were comparable to those recorded in a sleep laboratory.
CONCLUSIONS: The high quality of data collected in TuCASA demonstrates that multi-channel polysomnography data can be successfully obtained in children aged 5-12 years in an unattended setting under a research protocol.
Respiratory Center, Department of Medicine, University of Arizona College of Medicine, Tucson 85724, USA. jamieg@resp-sci.arizona.edu
Feasibility of comprehensive, unattended ambulatory polysomnography in school-aged children.
Marcus CL, Traylor J, Biggs SN, Roberts RS, Nixon GM, Narang I, Bhattacharjee R, Davey MJ, Horne RS, Cheshire M, Gibbons KJ, Dix J, Asztalos E, Doyle LW, Opie GF, D'ilario J, Costantini L, Bradford R, Schmidt B
J Clin Sleep Med. 2014;10(8):913. Epub 2014 Aug 15.
STUDY OBJECTIVES: Although unattended ambulatory polysomnography (PSG) is frequently performed in adults, few studies have been performed in children. The objective of this study was to evaluate the feasibility of comprehensive, ambulatory PSG, including electroencephalography, in school-aged children in the home environment.
METHODS: A total of 201 children, born premature with birth weights of 500-1,250 grams, currently aged 5-12 years and living in Canada and Australia, underwent unattended ambulatory PSG.
RESULTS: PSG was initially technically satisfactory in 183 (91%) cases. Fourteen studies were satisfactory when repeated, resulting in an overall satisfactory rate of 197 (98%). Artifact-free signals were obtained for≥75% of recording time in more than 92% of subjects, with the exception of nasal pressure, which was satisfactory for≥75% of recording time in only 67% of subjects. However, thermistry signals were satisfactory for≥75% of recording time in 92% of subjects, and some measure of airflow was present for≥75% of recording time in 96% of subjects. Children slept very well, with a long total sleep time (534±73 [mean±SD]minutes), high sleep efficiency (92%±5%), and low arousal index (9±3/h). Parents and children reported a high rate of satisfaction with the study.
CONCLUSIONS: This large, international study has shown that comprehensive, unattended, ambulatory PSG is feasible, technically adequate and well-tolerated in school-aged children when performed under research conditions. Further studies regarding the cost efficacy of this approach, and generalizability of the findings to a clinical population, are warranted.
Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA;