Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children.

Abstract

STUDY OBJECTIVES\nTo compare type 2 polysomnography (T2PSG) to the gold standard type 1 in-laboratory polysomnography (T1PSG) for diagnosing obstructive sleep apnea (OSA) in children; validate home T2PSG in children with suspected OSA.\n\n\nMETHODS\n81 participants (ages 6-18) with suspected OSA had simultaneous T1PSG and T2PSG in the sleep laboratory, 47 participants (ages 5-16) had T1PSG in the sleep laboratory and T2PSG performed at home. Sleep scientists staged and scored PSG data, pediatric sleep physicians assigned a diagnosis of normal or OSA. Participant demographics, PSG variables and diagnoses were compared using Chi-Squared and Fischer s exact tests for nominal variables, t-test for continuous variables and Cohen s kappa to assess concordance.\n\n\nRESULTS\nAcceptable recordings were obtained for every home T2PSG. When T1PSG and T2PSG were simultaneous, correlation between the number of arousals, respiratory disturbance index and sleep stages was excellent. T2PSG at home demonstrated less stage 2 sleep, more rapid eye movement (REM) sleep and higher sleep efficiency. Comparison of home T2PSG to T1PSG for diagnosing OSA showed a false positive rate of 6.6% and false negative rate of 3% for those performed at home.\n\n\nCONCLUSIONS\nT2PSG in the home is feasible with excellent concordance with T1PSG for the purposes of diagnosing OSA in children aged 5-18 years. Home T2PSG may be more representative of a normal night for children and could benefit those suspected of having OSA by reducing waiting times for laboratory PSG, improving access to PSG and possibly reducing costs of investigating and treating OSA.