Abstract
PurposePolysomnography is not recommended for children at home and does not adequately capture partial upper airway obstruction (snoring and stertor), the dominant pathology in pediatric sleep-disordered breathing. New methods are required for assessment. Aims were to assess sleep disruption linked to partial upper airway obstruction and to evaluate unattended Sonomat use in a large group of children at home.MethodsChildren with suspected obstructive sleep apnea (OSA) had a single home-based Sonomat recording (n = 231). Quantification of breath sound recordings allowed identification of snoring, stertor, and apneas/hypopneas. Movement signals were used to measure quiescent (sleep) time and sleep disruption.ResultsSuccessful recordings occurred in 213 (92%) and 113 (53%) had no OSA whereas only 11 (5%) had no partial obstruction. Snore/stertor occurred more frequently (15.3 [5.4, 30.1] events/h) and for a longer total duration (69.9 min [15.7, 140.9]) than obstructive/mixed apneas and hypopneas (0.8 [0.0, 4.7] events/h, 1.2 min [0.0, 8.5]); both p < 0.0001. Many non-OSA children had more partial obstruction than those with OSA. Most intervals between snore and stertor runs were < 60 s (79% and 61% respectively), indicating that they occur in clusters. Of 14,145 respiratory-induced movement arousals, 70% were preceded by runs of snore/stertor with the remainder associated with apneas/hypopneas.ConclusionsRuns of snoring and stertor occur much more frequently than obstructive apneas/hypopneas and are associated with a greater degree of sleep disruption. Children with and without OSA are frequently indistinguishable regarding the amount, frequency, and the degree of sleep disturbance caused by snoring and stertor.
Highlights
Sleep-disordered breathing (SDB) in children typically presents as a history of snoring, disturbed sleep, and enlarged adenoids/tonsils
Purpose Polysomnography is not recommended for children at home and does not adequately capture partial upper airway obstruction, the dominant pathology in pediatric sleep-disordered breathing
Of 14,145 respiratory-induced movement arousals, 70% were preceded by runs of snore/stertor with the remainder associated with apneas/hypopneas
Summary
Sleep-disordered breathing (SDB) in children typically presents as a history of snoring, disturbed sleep, and enlarged adenoids/tonsils. While standard PSG metrics report apneas and hypopneas, they do not measure periods of partial upper airway obstruction (UAO) such as snoring that are characteristic of pediatric SDB. Many PSG systems do use snore sensors but the recommended recording parameters [4] only permit capture of a small bandwidth of snore sounds [5,6,7]. Flow limitation is another sign of UAO seen on PSG but it is not routinely quantified as it is difficult to do so. Body movements, a robust indicator of sleep disruption intrinsic to actigraphy, are not scored as arousal events in PSG unless there is a concurrent EEG activation [4]
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