Detecting pediatric sleep apnea: consistency on cardiopulmonary coupling and oximetry measurement

Abstract

Introduction Cardiopulmonary coupling (CPC) analysis is an approach of data extracted from a single channel of ECG, and is highly correlated with the actual respiration. There have been an increasing number of papers evaluating CPC or using CPC as a clinical measurement. It has been recommended, based on several studies, to be a screening tool for sleep disorders, especially sleep related breathing disorders (SDB). Previous studies have suggested that adding oximetry would improve the reliability of clinical evaluation. This study was designed to investigate the consistency rate between CPC sleep spectrogram and Oximetry results on detecting sleep apneas. Materials and methods Target subjects are children with OSA, 2–8 yr, who have full-night oximetry and ECG-recorded data with at least 80% qualified data for analysis. All data was time synchronized with ECG data. Value of SpO2 and pulse rate was collected from full night oximetry, and sensors were placed on the fingertips. Based on the sleep physiology and mechanism of CPC, High frequency coupling (HFC) and low-frequency coupling (LFC) are the marker of stable sleep and unstable sleep respectively. Fragmented sleep is characterized by coupled low-frequency behaviors across numerous sleep based physiological stream. Results 37 children (14 girls and 23 boys, 5.0 ± 1.7 yr, BMI:16.10 ± 2.25) were included with recorded SPO2 min (77.94 ± 7.69)% and the total consistency rate between CPC sleep spectrogram and Oximetry result was (78.17 ± 11.46)%. With mild OSA, 5 children (3 girls and 2 boys, 5.6 ± 2.2 yr, BMI:15.47 ± 1.20) showed SPO2 min with (91.64 ± 2.04)% and consistency rate (87.05 ± 6.43)%. With moderate OSA, 9 children (5 girls and 4 boys, 5.6 ± 1.6 yr, BMI:15.65 ± 2.00) were recorded with SPO2min (84.12 ± 2.1)% and consistency rate was (79.07 ± 14.80)%. With sever OSA, 23 children (5 girls and 17 boys, 4.7 ± 1.6 yr, BMI:16.77 ± 2.44) showed SPO2min (72.81 ± 2.48)% and consistency rate (77.93 ± 10.44)%. Conclusion CPC can be used for clinical evaluation, such as detecting sleep apneas. It has advantage for screening sleep on pediatric populations. In addition to its simplicity and cost- effectiveness, the reliable results and acceptability can make it practical. Adding actigraphy and/or oximetry will improve its clinical applications. More and better designed clinical studies are worth expecting in the future. Acknowledgements First, I appreciate the participation of all children and their parents, as well as the efforts of all the people involved in the research. I would like to thank Professor C.K. Peng and Dr. Robert Thomas at Beth Israel Deaconess Medical Center, affiliated Hospital of Harvard Medical School for their help in organizing a project and mentoring me with the Cardiopulmonary Coupling techniques and sleep clinic observation.