New research shows that a thorough analysis of blood oxygen levels during sleep in children with habitual snoring could help providers find easier, more inexpensive, and reliable ways to determine if these children would benefit from a diagnosis and treatment plan for obstructive sleep apnea. They found this analysis was most accurate in children with severe sleep apnea.
The majority of children with sleep apnea are underdiagnosed, which is largely due to the scarcity of certified pediatric sleep specialists and sleep labs. Other factors include high cost, the need for overnight specialists, and inconvenience to the parent and child. These factors are even more problematic in less developed regions.
Senior author of the study, David Gozal, MD, MBA, and professor of pediatrics at the University of Chicago notes that this type of analysis could significantly simplify the procedure. The process dramatically reduces the cost of treating this condition and helps providers thoroughly evaluate high-risk children, focusing especially on areas where there is little to no access to a pediatric sleep lab.
Researchers from many backgrounds developed and described a diagnostic neural-network algorithm using 23 analytic features. This algorithm was published early in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.
Scientists gathered data from a pulse oximeter, a device that is loosely attached to the patient’s fingertip to measure blood oxygen levels and heart rate throughout the night.
The study, Nocturnal Oximetry-Based Evaluation of Habitually Snoring Children, proved that the simplified process compared well to a regular sleep study, and this could cut health care costs by 90-95%.
Polysomnography is the standard diagnostic criteria for sleep apnea. It is considered a definitive approach. The study is performed using an oximeter for blood oxygen levels and other components that look at brain activity, eye movement, muscle tension, and cardiac signals. In addition to the electronic measurements, the patient is videotaped during the study. This approach is highly expensive and requires several specialists.
Researchers wanted to find a way to determine if those additional diagnostic measures were necessary. They compared their analyzed results with polysomnography, reviewing over 4000 studies on children between 2 and 18 years of age. All patients had habitual snoring or other signs of severe obstructive sleep apnea, so they were all referred to one of the 13 pediatric sleep labs around the world. Researchers found that measures other than oximetry had limited additional value.
Dr. Gozal notes that the efforts medical science has made to cut back on resources have led to an advancement in sleep medicine. A convenient and accurate diagnostic tool could significantly improve evaluations, diagnosis, and treatment of obstructive sleep apnea in children. An overnight oximetry device for OSA offers a simple way to identify at-risk children and get them adequate treatment.
The greatest accuracy was seen in children who had severe obstructive sleep apnea. Analysis of pulse oximetry found 75% of mild apnea cases, most of whom did not need treatment. Researchers could identify 82% of moderate sleep apnea cases and 90% of severe sleep apnea cases.
The authors note that mild cases can be monitored over several weeks to make sure the symptoms do not worsen.
Approximately 3-5% of children have sleep apnea. Chronic sleep deprivation can lead to significant behavioral, cognitive, and physical development issues. These children are also at higher risk of developing chronic conditions later in life, such as heart disease and diabetes.
An analytical approach using only pulse oximetry offers early, regular, and inexpensive ways to screen and treat children with obstructive sleep apnea.
© 2020 American Sleep Association.