Home test can diagnose sleep apnea in children

Of course this is interesting, but consider the importance of sleep studies in kids is not just to find evidence of sleep apnea. We need to identify those who have severe apnea to know who is at medical risk of complications from surgery.  

This is why the AAP recommends a sleep study BEFORE tonsillectomy.

Note that the agreement was higher in the lab for the same device. So..can you trust the results at home?

I dont like "probably" as an answer.

So, if its positive, a child needs a psg ...and..if its negative, the child needs a psg. 

Bottom line: kids are different than adults....JR


A respiratory polygraphy test that can be administered at home accurately diagnoses children with sleep apnea.

The use of home respiratory polygraphy to diagnose children with sleep apnea was reliable and comparable to the results of polysomnography and an in-laboratory respiratory polygraphy, according to study results.

‘This study shows that [home respiratory polygraphy (HRP)] provides a reasonably valid alternative to [in-laboratory polysomnography (PSG)] for the diagnosis of [obstructive sleep apnea-hypopnea syndrome (OSAS)] in children clinically referred with a high index of clinical suspicion for the presence of OSAS,” María Luz Alonso-Álvarez, MD, of the Hospital Universitario de Burgos in Spain, and colleagues wrote. “This frequent and highly prevalent pediatric condition is associated with adverse consequences and excessive and costly use of health care services.”

The researchers conducted a prospective, blinded study on 50 randomly selected children (mean age, 5.3 years) being evaluated for clinical suspicion of OSAS. Participants were given an HRP and within 2 weeks a simultaneousPSG and in-laboratory respiratory polygraphy (LRP).

Sixty-six percent of the children were diagnosed with OSAS based on a PSG-defined obstructive respiratory disturbance index (ORDI) of at least three events per hour during sleep.

Using the interclass correlation coefficient, ORDI agreement between PSG and LRP (ORDI = 96.5; 95% CI, 92.3-98.2) as well as HRP (ORDI = 86.7; 95% CI, 76.5-92.5) was greater than 80% in all cases but higher for LRP than HRP.

The researchers emphasized the importance and validity of using HRP in the diagnoses of children suspected of having OSAS, namely reduced cost and the comfort of home testing.

“We should stress, however, that when inconclusive HRP findings occur, a conventional PSG should be performed, and we further recommend incremental research efforts, particularly for the mild diagnosis of OSA using HRP in children,” the researchers wrote.

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What should I know about sleep apnea?

This article gives information on the different types of sleep apnea and the available treatments.

Sleep apnea is a type of sleep disorder characterized by interruptions or pauses in breathing during sleep. These interruptions can be significant and can be potentially life threatening. Because of this, the disorder can have an important impact on quality of life as well as the health of a patient.

Kim LaJack, Director of the Sleep Disorders Center at Opelousas General Health System, says symptoms of sleep apnea might include loud snoring, excessive daytime sleepiness and feelings of exhaustion upon awakening, as if sleep had never taken place. Other symptoms include depression, irritability, morning headaches, loss of sex drive, lack of concentration and memory problems.

If untreated, sleep apnea can lead to accidents due to drowsy driving as well as health issues such as hypertension, heart attacks, diabetes and strokes, according to LaJack. 

The Three Types of Sleep Apnea 

1. Obstructive sleep apnea: OSA is essentially breathing that is interrupted by a physical block to airflow despite respiratory effort, causing complete or partial closure of the airway during sleep. The three causes for OSA are enlarged tonsils blocking the airway, an enlarged neck or a large tongue blocking the airway. 

2. Central sleep apnea: This type of sleep apnea occurs when the brain fails to send the appropriate signal to the muscles responsible for initiating breathing. “We see this with patients who have neuromuscular disorders or who are on a lot of pain medication,” LaJack explains. “Sometimes patients with heart failure also experience central sleep apnea.” 

3. Complex sleep apnea: This type of sleep apnea encompasses a combination of obstructive and central sleep apnea, with the airways closed off and breathing suspended. 

“While there are three different kinds of sleep apnea, the most frequently treated at Opelousas General is obstructive sleep apnea,” LaJack says. 

Diagnosis and Treatment

Giving the history of symptoms to a qualified physician is the only way to determine if a patient's experience requires a sleep study, says LaJack. Patients who have undergone initial evaluation spend an evening at the Sleep Disorders Center at Opelousas General Health System, where their sleep is closely monitored. 

“Monitoring involves obtaining information about sleep stages, including heart rate, respiratory effort and oxygen and carbon dioxide levels,” LaJack says. 

The treatment for sleep apnea varies depending on the cause. OSA in adults involves initiation of continuous positive airway pressure (CPAP) therapy. The CPAP machine delivers a pressure into the patient's airway by way of a mask and tubing, acting as a splint to hold the airway open. LaJack says OSA in children is generally treated with tonsillectomy. On occasion, children will need to be treated with CPAP, and with family support, it often is successful. In regards to central sleep apnea, PAP therapy involves an added element of delivering a breath during pauses in breathing. 

Dr. Joseph Y. Bordelon, Medical Director of the Sleep Disorders Center, emphasizes, “No matter the cause of the sleep apnea, the goal of therapy is to maintain an open airway so that the patient can have a more restful night of sleep, experience improved quality of life, and to prevent complications associated with untreated sleep disordered breathing. If we can delay someone's premature trip to the funeral home or nursing home, then we have been successful.”

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Easy Peezy

This article discusses a new product called Easy Peezy, a urine tests to diagnose obstructive sleep apnea in children.

What does good sleep have to do with peeing in a cup? For millions of kids, it could mean better, healthier sleep and possibly avoiding a mistaken diagnosis of ADHD. Meet the Easy Peezy Pee Test, an innovative new diagnostic test in development at NuSomnea that has been found to be 96.5% accurate in determining if a child has pediatric Obstructive Sleep Apnea, or OSA. This condition is associated with symptoms often mistaken for Attention Deficit/Hyperactivity Disorder, or ADHD.

On September 16, 2014, NuSomnea launches an Indiegogo fundraising campaign to help complete the development of the urinalysis test and to conduct another validation study in children, to confirm the results found in initial studies.

The Indiegogo campaign will offer contributors a variety of perks including fun t-shirts and backpacks featuring "The Peezies," the adorable characters from the Easy Peezy video, as well as the Easy Peezy Pee Test when it becomes available.

The aptly named Easy Peezy Pee Test identifies the urinary concentrations of four proteins that are predictive of pediatric OSA, representing a remarkable improvement over traditional, and costly, diagnostic methods. "Diagnosing OSA usually requires an expensive stay at a sleep lab. It's inconvenient for parents and uncomfortable for kids," said Michael Thomas, co-founder of NuSomnea. "We're changing that with a simple urine test that's more accessible, more accurate and costs about seventy-five percent less."

Obstructive Sleep Apnea is a common sleep disorder resulting from the collapse of the pharyngeal airway during sleep, often hundreds of times per night, depleting blood oxygen saturation and contributing to a host of serious health problems. Pediatric OSA is linked to a greater incidence of childhood obesity, asthma, nervous conditions and bed-wetting. Left untreated, pediatric OSA can lead to hypertension, cardiovascular disease and diabetes as children grow older. While OSA is usually associated with adults, research shows that 2-5% of children have pediatric OSA, and it is a growing problem in the US.

Snoring is one of the indicators that a child may have OSA. Studies have reported that 27% of children snore and it can be difficult for doctors to determine from a medical exam alone which patients should be tested for OSA.

In children, other common indicators of OSA are behavioral problems, learning disabilities, hyperactivity and attention problems, which may frequently be diagnosed as ADHD or ADD. Nearly 7 million children between 4 and 17 years old are currently diagnosed with ADHD, but research has reported that up to 50% might actually have pediatric OSA. Further, a large percentage of kids with ADHD respond to the standard treatment for OSA -- tonsil and adenoid surgery -- reinforcing the conclusion that many have OSA in addition to or instead of ADHD. If a child has OSA, treating only for ADHD with stimulant drugs may not resolve the issue.

Because the Easy Peezy Pee Test is so convenient to administer, it has the potential to be used as both a diagnostic tool and a disease management tool to more closely monitor therapy effectiveness and improve patient outcomes.

The Easy Peezy Pee Test by NuSomnea is still in clinical development and should be available to doctors in 2016.

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New recommendations for diagnosing sleep apnea in adults

This article explains new recommendations for diagnosing obstructive sleep apnea in adults.

Doctors should assess the risk factors for and the symptoms of obstructive sleep apnea (OSA) in patients with unexplained daytime sleepiness, according to a new evidence-based clinical practice guideline from the American College of Physicians (ACP) published in Annals of Internal Medicine, ACP's flagship journal.

"Obstructive sleep apnea is a serious health condition that is associated with cardiovascular disease, hypertension, cognitive impairment, and type 2 diabetes," said Dr. David Fleming, president, ACP. "It is important to diagnose individuals with unexplained daytime sleepiness so that they can get the proper treatment."

ACP recommends a full-night, attended, in-laboratory polysomnography (PSG) for diagnostic testing in patients suspected of having OSA. When PSG is not available, ACP recommends using a home-based portable monitor.

Obesity is the best documented risk factor for OSA. Symptoms of OSA include unintentional sleep episodes during wakefulness, daytime sleepiness, unrefreshing sleep, fatigue, insomnia, and snoring.

OSA is caused by repetitive obstruction of the upper airway during sleep, resulting in reduced airflow (hypopnea) or complete airflow cessation (apnea). According to the National Heart, Lung, and Blood Institute, 12 to 18 million adults in the United States have sleep apnea. The incidence of OSA is rising, likely because of the increasing rates of obesity. The incidence of OSA increases with age, particularly in adults over the age of 60.

ACP's guideline, "Diagnosis of Obstructive Sleep Apnea in Adults," includes High Value Care advice to help doctors and patients understand the benefits, harms, and costs of tests and treatment options so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices.

"Diagnosing obstructive sleep apnea is high value care," Dr. Fleming said. "Prior to diagnosis, patients with obstructive sleep apnea have higher rates of health care use, more frequent and longer hospital stays, and greater health care costs than after diagnosis."

Assessing patients for OSA in the absence of daytime sleepiness or treating individuals with low apnea-hypopnea index (AHI) scores is low value care because the evidence indicates that it does not improve clinical outcomes, ACP states in the guideline.

ACP developed the guideline based on a systematic review of the published literature on human subjects in the English language.

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All about sleep apnea

This article provides much information on sleep apnea, including signs you may have it, and what you should do to get checked if you think you might have sleep apnea.

Think you might have sleep apnea? Not sure what the symptoms are? It's a growing sleep disorder that people are more and more being affected by.

Sleep apnea affects some 18 million Americans and around 850,000 Canadians. The etymology of the word apnea translates into the suspension of breathing or the absence of respiration. Pauses can last anywhere from a few seconds to a few minutes, this can occur up to 30 times per hour in some cases.

Obstructive sleep apnea can be mild, moderate or severe. The severe form of this ailment can progressively degenerate, leading in some cases to death in patients. Sleep apnea often goes undiagnosed as extreme snoring. Both sexes experience sleep apnea but it is more common in males than females. Certain racial groups are also more prone to this condition, Hispanics have higher rates of sleep apnea than Caucasians.

Common Sleep Apnea Statistics

The Sleep Disorders Guide has provided the following research information.

- 1 in every 15 Americans has sleep apnea

- University of California’s San Diego campus discovered 17 percent of the 54 African Americans had obstructive sleep apnea. The 346 Caucasians tested only had an 8 percent indicator

- 1 in 50 Americans are undiagnosed

- obstructive sleep apnea patients are at an increased rate for traffic incidents

- People driving drowsy is responsible for 100,000 car accidents, 40,000 injuries and up to 1,550 deaths per year if your bed partner has this condition you are unlikely to get any sleep

- stroke, hypertension and heart disease are all linked to sufferers of sleep apnea

A lack of proper sleep has been linked to cognitive problems in the workforce and decreases in educational achievement. Memory and complex decision making skills are also affected at an increased rate leading to occupational accidents and fatalities.

Fatalities Caused By Sleep Disorders

The impact of getting a lack of sleep can not be underestimated. Medical resident students work longer hours than most hospital staff. During the first year residency med students usually work a 24 hour shift every third night they can work up to 96 hours in some cases. Columbia University’s College of Physicians and Surgeons states that medical student hours can not exceed 80 hours per week with at least 24 consecutive hours free from duty in a week. These guidelines are often not adhered to with priority shifts and hours going to senior staff. The Accreditation Council for Graduate Medical Education found that residents who worked more than 80 hours per week were at risk for making significant medical errors that led to negatively impacting patients. Sleep related fatigue is a leading cause of medical errors facing hospitals and patients.

The Three Mile Island incident of 1979 resulted in a cooling malfunction in reactor #2, radioactive gas was released, fortunately there were no fatalities. Cooling to the reactor was eventually restored, this incident was thought to have been caused by lack of sleep of the plant employees. The occupational damage from lack of sleep ended up costing $975 million back in March 28th of 1979.

The Exxon Valdez Oil Spill was one of the worst environmental disasters in U.S. history. The 987 foot long oil tanker ran aground a reef in Prince William Sound, Alaska releasing 10.8 million gallons of crude oil into the Pacific ocean. The oil spill ended costing $3.8 billion to clean up. This incident again was related to the ships crew suffering from lack of sleep.

Who Is At Risk For Sleep Apnea?

The Centers for Disease Control and Prevention (CDC) states that one-third of U.S. adults or 34.9 percent are obese. The medical costs for treating obese people amounted to $147 billion in 2008 U.S. dollars. The male gender and certain racial groups are more at risk for sleep apnea than other demographics. Blacks are at a 47.8% increased risk of obesity compared to 42.5% for Hispanics. Whites have a 32.6% obesity rate compared to 10.8% for Asians.

Obesity and socioeconomic status go hand in hand when it comes to obesity. Blacks and Mexican Americans are prime candidates for the battle of the bulge. Among women obesity levels rise with education levels. Women with a college degree had a 23.4% obesity rate compared to 42.1% of women without a high school diploma. Men and women with college degrees have significantly lower rates of obesity. The common denominator is the more education people have the more income they earn and the healthier food they can purchase.

Simply put people with higher incomes are able to afford organic or natural foods. GM staple crops like GM corn are modified to produce higher yields. A Norway research study fed rats GM corn for 90 days, the end result was the rats feeding on the GM corn grew obese, in contrast to the rats fed on the non-GM diet. The physiology of rats is similar to humans, if rats grow obese from a GM diet than humans eating the same type of food will also become obese. Nutrient levels in today’s crops have decreased significantly since WWII, modern day food simply does not have the nutritional density it once did. A lack of nutrient dense crops results in people eating large quantities of food, the more food a person consumes to make up for the lack of nutrients the more weight they put on. Mexican Americans and Blacks from lower economic levels live in areas with an abundance of fast food outlets and grocery stores that do not have access to the organic food market because of the higher prices, this makes this demographic prime candidates for sleep apnea.

Diagnosing Sleep Apnea

The most direct method to diagnose sleep apnea is at a sleep clinic managed by qualified sleep technicians. The clinical name for the study of sleep is called polysomnography, this test measures brain wave activity, heart rate, breathing and eye and leg movements. Patients undergoing this study check in during the evening into a private room that has a video camera, the sleep room is adjacent to the monitoring room where the sleep technician monitors the patient. Sensors are placed on the legs of the individual to monitor restlessness at night. A sensor belt is placed around the abdomen and waist to monitor breathing, additional sensors are placed near the mouth and nose to measure the respiratory rate.

The final step in polysomnography is the attachment of a Continuous positive airway pressure (CPAP) device that attaches to the mouth of the patient. The CPAP machine supplies light air pressure through the mouth or nose, this pressure is enough to keep the airway open so the patient can breathe properly while sleeping. If the presence of obstructive sleep apnea is documented during the night the sleep technician will re-enter the room and apply a CPAP mask that is attached to a CPAP machine. The sleep technician will wait for the patient to enter a deep sleep before gradually determining the minimum airflow to keep the airway open. The technician will also monitor the patients other vitals for symptoms of sleep apnea. A definitive diagnosis can be made later by a physician sleep specialist that is dedicated to the study of sleep medicine.

CPAP is the most widely accepted and effective machine to treat sleep apnea today. If you think you may be a sufferer of sleep apnea consult your physician regarding making an appointment at a sleep clinic.

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