Night to night variability of pulse oximetry features in children at home and at the hospital

Xenia L R Hoppenbrouwer,Dustin Dunsmuir,J Mark Ansermino,Wendy Oude Nijeweme-D’Hollosy,Ainara Garde,Peter Veltink,Aryannah U Rollinson,Guy Dumont

doi:10.1088/1361-6579/ac278e

Abstract

Objective. Investigation of the night-to-night (NtN) variability of pulse oximetry features in children with suspicion of Sleep Apnea. Approach. Following ethics approval and informed consent, 75 children referred to British Columbia Children's Hospital for overnight PSG were recorded on three consecutive nights, including one at the hospital simultaneously with polysomnography and 2 nights at home. During all three nights, a smartphone-based pulse oximeter sensor was used to record overnight pulse oximetry (SpO2 and photoplethysmogram). Features characterizing SpO2 dynamics and heart rate were derived. The NtN variability of these features over the three different nights was investigated using linear mixed models. Main results. Overall most pulse oximetry features (e.g. the oxygen desaturation index) showed no NtN variability. One of the exceptions is for the signal quality, which was significantly lower during at home measurements compared to measurements in the hospital. Significance. At home pulse oximetry screening shows an increasing predictive value to investigate obstructive sleep apnea (OSA) severity. Hospital recordings affect subjects normal sleep and OSA severity and recordings may vary between nights at home. Before establishing the role of home monitoring as a diagnostic test for OSA, we must first determine their NtN variability. Most pulse oximetry features showed no significant NtN variability and could therefore be used in future at-home testing to create a reliable and consistent OSA screening tool. A single night recording at home should be able to characterize pulse oximetry features in children.

Highlights

Obstructive sleep apnea (OSA), a common health problem, is characterized by repeated upper airway obstructions resulting in cessations of breathing
We reported on the use of a portable pulse oximeter called the phone oximeter (PO) in children with suspicion of OSA, the variability in measurements over different nights
We hypothesized at least a difference between both hospital and home, possibly from an adaptation response to a new location, the so called first night effect (FNE) (Agnew et al 1966, Sharpley et al 1988)

Summary

Introduction

Obstructive sleep apnea (OSA), a common health problem, is characterized by repeated upper airway obstructions resulting in cessations of breathing. OSA currently affects up to 3% of children (Ali et al 1993, Redline et al 1999, Anuntaseree et al 2001, Rosen et al 2003, Wildhaber and Moeller 2007), up to 22% of adolescents (Johnson and Roth 2006) and from 9% to 38% of the general adult population (Punjabi 2008, Franklin and Lindberg 2015, Senaratna et al 2017). These cessations can result in arousals, frequent sleep fragmentations and oxyhemoglobin desaturations, leading to daytime sleepiness. OSA can result in other serious consequences including cognitive impairment, failure to thrive and cardio-respiratory problems (Pediatrics 2002, Huang et al 2014)

Methods

Results

Conclusion