Ioan Iulia, Renard Emeline, Da Mota Sofia, Bonabel Claude, Tiotiu Angelica, Franco Patricia, Coutier Laurianne, Schweitzer Cyril
Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, France; EA3450-DevAH, Faculté de Médecine, Université de Lorraine, France.
Service de Médecine Infantile, Centre Hospitalier Universitaire de Nancy, France.
Sleep Med. 2023 Feb;102:117-122. doi: 10.1016/j.sleep.2023.01.001. Epub 2023 Jan 2.
Ambulatory exams were preferred in children during the COVID-19 pandemic. Polysomnography (PSG), the gold standard for obstructive sleep apnea (OSA) diagnosis, requires several leads and sensors to be attached to the child's body. Children are more comfortable with respiratory polygraphic (RP) recording, which needs fewer sensors.
To compare respiratory parameters obtained by home RP with those obtained by home PSG with the device installed at the child's home by a trained sleep nurse from a national health care provider.
Data from home PSGs performed in children aged 2-19 years were retrospectively included. The obstructive apnea-hypopnea index (OAHI) was computed in PSG and then in RP after removing the sleep signals. The two indexes were compared using non-parametric paired Wilcoxon rank test, Bland-Altman analysis and sensitivity-specificity analysis.
44 PSGs of 44 children were included with only 34 (77%) PSGs interpretable. Median (min-max) OAHI was significantly underestimated in RP than in PSG (2.2 (0-25) vs 4.0 (0.4-28), p < 0.0001), confirmed also by the Bland-Altman diagram, the magnitude of the difference being mean ± standard deviation -1.7 ± 1.7. The sensitivity and specificity of OAHI in RP to identify an OAHI ≥2/h in PSG was 0.91 for both.
Unattended ambulatory RP performed at child's house and installed under carefully controlled conditions is a useful exam for diagnosing OSA in children with or without comorbidities. However, RP must be installed in a supervised environment and interpreted with caution as it tends to underestimate OSA severity.
在新冠疫情期间，儿童更倾向于进行门诊检查。多导睡眠图（PSG）是阻塞性睡眠呼吸暂停（OSA）诊断的金标准，需要在儿童身体上连接多个导联和传感器。儿童对呼吸多导记录（RP）更舒适，因为它需要的传感器更少。
比较由国家医疗服务提供者的训练有素的睡眠护士在儿童家中安装设备进行的家庭RP与家庭PSG所获得的呼吸参数。
回顾性纳入2至19岁儿童的家庭PSG数据。在PSG中计算阻塞性呼吸暂停低通气指数（OAHI），然后在去除睡眠信号后在RP中计算。使用非参数配对Wilcoxon秩和检验、Bland-Altman分析和敏感性-特异性分析比较这两个指数。
纳入了44名儿童的44份PSG，只有34份（77%）PSG可解释。RP中的OAHI中位数（最小值-最大值）明显低于PSG（2.2（0-25）对4.0（0.4-28），p<0.0001），Bland-Altman图也证实了这一点，差异幅度为平均值±标准差-1.7±1.7。RP中OAHI识别PSG中OAHI≥2/h的敏感性和特异性均为0.91。
在儿童家中在严格控制条件下安装的无人值守动态RP是诊断有或无合并症儿童OSA的有用检查。然而，RP必须在监督环境中安装并谨慎解读，因为它往往会低估OSA的严重程度。
