Portable pediatric sleep diagnostics: 2 measures closer to reliable home sleep apnea tests for all ages

Citation:

Start J. Portable pediatric sleep diagnostics: 2 measures closer to reliable home sleep apnea tests for all ages. J Clin Sleep Med. 2021;17(4):617–618.

Pediatric obstructive sleep apnea (OSA) is a serious health problem with estimation of 1% to 5% of children having sleep-disordered breathing and these patients have historically remained unrecognized by many practitioners.^1–3 In attempting to address the meager availability of reliable diagnostic resources, research has shown an increasing need to utilize technologies that have reduced a similar gap that existed in adult medicine approximately 2 decades ago with the advent of home sleep apnea tests (HSAT).⁴ Although they are not equivalent to the gold standard of polysomnography (PSG), they offer a relatively affordable, diagnostic option for detecting OSA in specific populations of adult patients who are suspected of having moderate to severe OSA.⁵ The impracticality of HSAT use in heterogeneous groups (ie age, comorbidities and home conditions) of pediatric patients continues to confirm significant issues regarding the reliability of various commonly used components and is covered well in several excellent studies.^6–8

In this issue of the Journal of Clinical Sleep Medicine, Burkart et al⁹ report on the validity of two wrist-based devices: a dual-channel device (Fitbit Charge 3, Fitbit Inc., San Francisco, CA) and a single-channel device (Actigraph GT9X, ActiGraph, LLC, Pensacola, FL), both worn on the nondominant wrist of 56 test patients ranging in age from 3 to 17 years while they underwent standard diagnostic PSG at a local children’s hospital. The goal of this comparison was to look at the sleep parameters measured by both devices compared with simultaneous diagnostic PSG and see if the dual-channel device made a substantial difference over the data provided by the single-channel device. One of the key points to this study was that the dual-channel device not only matched the quality of the data from the single-channel device but also outperformed the data in most instances. The parameters that were compared included total sleep time, sleep efficiency, wake after sleep onset, sleep onset, and sleep offset. Reviewing the data showed that the parametric measurements for the Fitbit more closely matched those recorded by PSG than did the data detected and recorded by the Actigraph.

Another important aspect of Burkart et al⁹ is the paucity of laboratory information on this technology, with only 3 previous studies looking at dual-channel recording devices.^10–12 These 3 studies used different single-channel and dual-channel devices, did not include the entire spectrum of pediatric ages as this study did, and used PSG in different settings. In Burkart et al,⁹ all of the patients had their sleep study at the same laboratory with the same technologists and wore both devices on their nondominant wrist from the start to the finish of their PSG. The value of these conditions lends increased reliability to the conclusions as established in this trial.

In addition to validating that a dual-channel device is superior to a lone accelerometer, Burkart et al⁹ also potentially serves to illuminate the path for further studies leading to the development of a device that can dependably provide information on this wide range of pediatric patients and do so reliably in their individual home environment. Masoud and colleagues⁸ studied a consecutive series of pediatric patients between ages of 7 and 17 years using a HSAT that used the usual array of peripheral transduction devices while simultaneously administering PSG. Their results show excellent concurrence overall with PSG regarding the diagnosis of OSA. The authors observed increasingly accurate results as the patients’ ages increased. Masoud et al⁸ acknowledged failed studies secondary to signal loss from displaced pulse oximetry probes because the younger patients had smaller fingers and they tended to move around more. These observations may suggest potential benefits in moving away from HSAT devices toward wrist-based technology as seen in Burkart et al.⁹ As one example, Tanphaichitr et al¹³ looked at peripheral arterial tonometry, which has shown good potential in identifying moderate and severe OSA in pediatric patients aged 8–15 years. So far, bounding the intimidating gap of pediatric ages 3–17 years continues to challenge this field. However, through studies such as Burkart et al,⁹ that gap is gradually narrowing.

DISCLOSURE STATEMENT

The author reports no conflicts of interest.