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Am J Respir Crit Care Med. 2017 Dec 15;196(12):1591-1598. doi: 10.1164/rccm.201705-0930OC.

Nocturnal Oximetry-based Evaluation of Habitually Snoring Children.

Author information

1
1 Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.
2
2 Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois.
3
3 Unidad Multidisciplinar del Sueño, Centro de Investigación Biomédica en Red Respiratorio, Hospital Universitario de Burgos, Burgos, Spain.
4
4 Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.
5
5 Division of Child Neurology, Department of Pediatrics, LeBonheur Children's Hospital, University of Tennessee Health Science Center, School of Medicine, Memphis, Tennessee.
6
6 Sleep Unit, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China.
7
7 Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
8
8 Spectrum Health, Michigan State University, Grand Rapids, Michigan.
9
9 Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
10
10 Laboratory of Experimental Medicine and Pediatrics and.
11
11 Department of Pediatrics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.
12
12 Sleep Medicine Center, Department of Pediatric Cardiology and Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
13
13 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio.
14
14 Pediatric Pulmonology Unit, Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece.
15
15 Sleep Unit, Department of Neurology, Sant Joan de Deu, Barcelona Children's Hospital, Barcelona, Spain.
16
16 Department of Neonatology and Sleep Unit, University of Tubingen, Tubingen, Germany; and.
17
17 Pediatric Respiratory Unit, Department of Pediatrics, Hospital de Santa Maria, Academic Medical Center of Lisbon, Lisbon, Portugal.

Abstract

RATIONALE:

The vast majority of children around the world undergoing adenotonsillectomy for obstructive sleep apnea-hypopnea syndrome (OSA) are not objectively diagnosed by nocturnal polysomnography because of access availability and cost issues. Automated analysis of nocturnal oximetry (nSpO2), which is readily and globally available, could potentially provide a reliable and convenient diagnostic approach for pediatric OSA.

METHODS:

Deidentified nSpO2 recordings from a total of 4,191 children originating from 13 pediatric sleep laboratories around the world were prospectively evaluated after developing and validating an automated neural network algorithm using an initial set of single-channel nSpO2 recordings from 589 patients referred for suspected OSA.

MEASUREMENTS AND MAIN RESULTS:

The automatically estimated apnea-hypopnea index (AHI) showed high agreement with AHI from conventional polysomnography (intraclass correlation coefficient, 0.785) when tested in 3,602 additional subjects. Further assessment on the widely used AHI cutoff points of 1, 5, and 10 events/h revealed an incremental diagnostic ability (75.2, 81.7, and 90.2% accuracy; 0.788, 0.854, and 0.913 area under the receiver operating characteristic curve, respectively).

CONCLUSIONS:

Neural network-based automated analyses of nSpO2 recordings provide accurate identification of OSA severity among habitually snoring children with a high pretest probability of OSA. Thus, nocturnal oximetry may enable a simple and effective diagnostic alternative to nocturnal polysomnography, leading to more timely interventions and potentially improved outcomes.

KEYWORDS:

automated pattern recognition; blood oxygen saturation; childhood obstructive sleep apnea–hypopnea syndrome; neural network; nocturnal oximetry

PMID:
28759260
PMCID:
PMC5754445
DOI:
10.1164/rccm.201705-0930OC
[Indexed for MEDLINE]
Free PMC Article

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