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Simple, affordable test may help identify sleep apnea in children

Automated analysis of nighttime oximetry could lead to more timely interventions and possibly enhanced outcomes in children with obstructive sleep apnea, according to findings recently published in the American Journal of Respiratory and Clinical Care Medicine.

According to researchers, 3 to 5% of all children have sleep apnea.

“The vast majority of children around the world undergoing adenotonsillectomy for obstructive sleep apnea-hypopnea syndrome are not objectively diagnosed with nocturnal polysomnography due to access availability and cost issues,” Roberto Hornero, PhD, of the Biomedical Engineering Group at the University of Valladolid in Spain and colleagues wrote.

To try and find a more cost-effective way to diagnose the condition, Hornero and colleagues created, then validated, a self-operating neural network algorithm using an initial set of single-channel nocturnal oximetry recordings from 589 patients around the world who were suspected to have obstructive sleep apnea. Data came from a pulse oximeter that was attached to the participant’s fingertip overnight. This automated system was compared with polysomnography.

Researchers found that the automatically estimated apnea-hypopnea index showed high agreement with the index from traditional polysomnography (intra-class correlation coefficient, 0.785) when tested in 3,602 additional subjects. Further assessment on the apnea-hypopnea cut-off points revealed an incremental diagnostic ability of 75.2% accuracy at one event per hour, 81.7% accuracy at five events per hour and 90.2% accuracy at 10 events per hour.

“This study provides extensive validation on the satisfactory diagnostic performance of automated analysis of nocturnal single-channel oximetry as a low-cost alternative to standard [nocturnal polysomnography] in the context of childhood [obstructive sleep apnea]. Therefore, the current findings indicate that automated processing of the [nocturnal oximetry] signal provides an accurate and widely implementable diagnostic tool for childhood [obstructive sleep apnea], particularly in resource constrained environments,” Hornero and colleagues wrote.

“By simplifying the procedure and dramatically reducing the cost, we believe we can evaluate more children who are at significantly at risk, especially in areas where there is limited access to a pediatric sleep laboratory facility,” David Gozal, MD, MBA, of the department of pediatrics at the University of Chicago, said in a press release.

Researchers also noted that their system allows for children who did not seem to need treatment, but had continuous symptoms, to be retested within a few weeks. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.