SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science XI. Pediatrics
0790
EVALUATION OF A SINGLE CHANNEL AIRFLOW DEVICE
FOR DIAGNOSIS OF OBSTRUCTIVE SLEEP APNEA
SYNDROME IN OBESE PEDIATRIC PATIENTS
Lesser DJ 1 , Pian MS 1 , Farrell MJ 2 , DeWitte J 3 , Haddad GG 1
1
Pediatric Respiratory Medicine, University of California, San Diego,
San Diego, CA, USA, 2 Pediatric Pharmacology Research Unit,
University of California, San Diego, San Diego, CA, USA, 3 Serenity
Sleep and Neurodiagnostics, INC, San Diego, CA, USA
Introduction: Obstructive sleep apnea syndrome (OSAS) is highly
prevalent in obese children. The ApneaLink is a portable single channel
airflow device that measures air flow, respiratory effort and pulse oximetry.
The device has proven useful in OSAS screening in adult patients. In
the current study, we asked whether this device could be used to screen
for OSAS in the pediatric population.
Methods: We performed simultaneous attended sleep-laboratory polysomnography
(PSG) and measurements using the portable device on
obese pediatric patients referred for snoring (age 9-18 years, BMI>95th
percentile for age/gender). We compared the obstructive apnea hypopnea
index (OAHI) obtained from PSG to the OAHI obtained from the
portable device scored both manually by the investigators and automatically
by the device.
Results: 15 subjects (10 males, mean age 12.6±2.8 years, BMI z score
2.42±0.37, OAHI on PSG 18.2±35.0 events/hour) were studied. The
OAHI of the PSG correlated with the OAHI of the device scored automatically
(r = 0.97, p < 0.001) and manually (r=0.94, p < 0.001). The
results demonstrate highest sensitivity and specificity of the OAHI from
the portable device auto score compared with the OAHI from the simultaneous
polysomnogram at an OAHI of > 10 events/hour (AHI > 1.5:
sensitivity 100%, specificity 40%; AHI > 5: sensitivity 83%, specificity
78%, AHI > 10: sensitivity 100%, specificity 91%).
Conclusion: The single channel device used in this study is a sensitive
screening tool for evaluation of suspected OSAS in obese pediatric
patients age 9 - 18 years. Our data suggest that the device may be most
effective in pediatric patients when a cut off OAHI of > 5 or > 10 events/
hour is applied to diagnose OSAS. We speculate that it can be used in
pediatric patients, for evaluation for referral to attended sleep-laboratory
PSG, clinical research, and inpatient sleep studies when an attended
PSG is not feasible.
Support (If Any): This work was supported by a research grant from
the ResMed Corporation.
0791
CYCLIC ALTERNATING PATTERN IN INFANTS WITH
CONGENITAL HYPOTHYROIDISM AND CENTRAL SLEEP
APNEA
Santana Miranda R 1,4 , Esqueda-León E 1 , Arana- Lechuga Y 1 ,
Rosa A 2 , Domínguez- Salazar E 1 , Murata C 4 , Terán- Pérez G 1 ,
Rojas-Zamorano J 1 , Bruni O 3 , Velázquez-Moctezuma J 1
1
Clinic Sleep Disorders, Universidad Autónoma Metropolitana,
México D. F., Mexico, 2 Laseeb, ISR-IST, Lisbon, Portugal, 3 Center for
pediatric sleep disorders, University of Rome “la sapienza”,, Rome,
Italy, 4 Neurodevelopment Laboratory, Pediatric National Institute,
Mexico City, Mexico
Introduction: Cyclic Alternating Pattern (CAP) is a neurophysiological
event during NREM sleep. This pattern has been found in pediatric
population and adults. Pioneer studies suggested a relationship between
CAP and instability during sleep. In some sleep disorders, as obstructive
apnea, changes on CAP distributions have been described. On the other
hand, infants with congenital hypothyroidism have a high index of central
sleep apnea. This experiment was designed to determine the presence
and distribution of CAP in infants with congenital hypothyroidism
and their relationship with central sleep apnea.
Methods: A two hours polysomnographic analysis was done in congenital
hypothyroidism (CH) infants with hormonal replacement therapy
(these infants belong to a development and early intervention program)
(n = 15), low risk (LR) infants (n = 15) and high risk (HR) infants by
high apnea central index with out congenital hypothyroidism (these infants
belong to a development and early intervention program) (n = 15).
Both sexes were represented in each group (age range: 24 days- 722
days old). After an early wake up, recordings were done in the morning
immediately after breakfast. Thus, at least two sleep cycles were
obtained. Sleep scoring was performed following Rechstschaffen and
Kales’ criteria with corrections for this age. CAP subtypes for phase A
were identified following the Terzano and cols’ criteria. Concerning the
phase B of the CAP, particular software especially designed for this task
(Somnium) was used. Statistical analysis was done using a linear correlation
analysis and ANOVA followed by Newman-Keuls test.
Results: Infants with CH have a similar sleep macro structure, however
by LR, the microstructure analyzed by subtypes of phase A of CAP is
different between groups and age. CH infants have more A3 subtype and
less A1 than LR infants.
Conclusion: The differences in subtypes A of CAP found between
groups could be an evidence to use CAP like a new tool for sleep analysis
on pediatric population. At the moment is not clear a relationship
between CAP, breathing disorder and congenital hypothyroidism.
0792
AN OBJECTIVE MEASURE OF SLEEPINESS IN EARLY
CHILDHOOD: FACIAL ANALYSIS OF CHILDREN’S
EXPRESSED SLEEPINESS (FACES)
Hartman VA 1 , LeBourgeois M 3,2
1
History, Brown University, Providence, RI, USA, 2 Department of
Psychiatry and Human Behavior, The Warren Alpert Medical School
of Brown University, Providence, RI, USA, 3 Department of Integrative
Physiology, University of Colorado at Boulder, Boulder, CO, USA
Introduction: Few measures for assessing sleepiness in early childhood
currently exist. This gap is likely due to young children’s inability to
self-report, regular and developmentally-appropriate napping, and no
normative data utilizing standard objective methods (e.g., MSLT, waking
theta activity). As sleepiness is linked to cognitive/mood disorders,
research on its prevalence/determinants in children is needed to inform
the prevention/treatment of sleep and behavioral problems. The purpose
of this study was to develop an objective measure of sleepiness in young
children.
Methods: Nine healthy children (3 M; 30-36 months) with no sleep/
emotion/behavioral problems followed a strict sleep schedule for 5
days before sleepiness assessments, which optimized sleep (12.5+ hrs
TIB/24hrs) and entrained the circadian system. Assessments (20min)
occurred on 2 afternoons in the home: one after an afternoon nap of
at least 60min (verified w/ actigraphy), the other after nap deprivation.
Children’s faces were videotaped while viewing a neutral seascapes video
for 4min followed by emotionally-eliciting pictures/movies. A review
of the literature related to behavioral manifestations of sleepiness led
to identifying facial features for coding: yawning, head-nodding, eyerubbing,
sleep-verbalizations, laying-head down, incomplete blinking,
and complete blinking. Reliable coders performed millisecond videobased
facial analysis of sleepiness behaviors. We hypothesized increased
sleepiness behaviors with acute sleep restriction in young children.
Results: A Wilcoxon test revealed a significant difference in both measures
of blinking across the assessment (ps