Feasibility and parental perception of home sleep studies during COVID-19: a tertiary sleep centre experience

ObjectiveRapid implementation of home sleep studies during the first UK COVID-19 ‘lockdown’—completion rates, family feedback and factors that predict success.DesignWe included all patients who had a sleep study conducted at home instead of as inpatient from 30 March 2020 to 30 June 2020. Studies with less than 4 hours of data for analysis were defined ‘unsuccessful’.Results137 patients were included. 96 underwent home respiratory polygraphy (HRP), median age 5.5 years. 41 had oxycapnography (O2/CO2), median age 5 years. 56% HRP and 83% O2/CO2 were successful. A diagnosis of autism predicted a lower success rate (29%) as did age under 5 years.ConclusionSwitching studies rapidly from an inpatient to a home environment is possible, but there are several challenges that include a higher failure rate in younger children and those with neurodevelopmental disorders.

OSA: Special suspected in spontaneous cerebrospinal fluid leakage

Objectives: Loss of Cerebrospinal Fluid (CSF-L) results from a rupture of the skull base and overlying meninges, and pathological communication between the subarachnoid space and the nasal or middle ear cavity. Recently, the pathogenesis has been linked with Intracranial Hypertension (IIH), elevated Body Mass Index (BMI) and Obstructive Sleep Apnea (OSA). Methods: A single institution retrospective study was conducted on 14 patients from our spontaneous CSFL series, which included 167 patients over a 15-year period from 2004 to 2019. All patients underwent to home respiratory polygraphy. Epidemiological and clinical data were reviewed. For the statistical analysis, the confidence interval for a proportion was defined, according to the methods described by RG Newcombe. Results: 14 patients, previously operated on duraplasty in our ENT department, were enrolled. They underwent to polygraphy. The data were compared with those derived from the literature and the results are neither in the range of the general population nor in the non-spontaneous CSFL Conclusion: OSA can increase Intracranial Pressure (ICP) and thus spontaneous CSF losses. However, OSA and BMI may not be independent. Therefore, further studies are needed to analyze the data in detail.

Effects of Transcatheter Mitral Valve Repair Using MitraClip® Device on Sleep Disordered Breathing in Patients with Mitral Valve Regurgitation

Sleep disordered breathing (SDB) is common among patients with valvular heart disease, and successful valve surgery could reduce SDB severity. However, data about the effects of transcatheter mitral valve repair on SDB are scarce. Therefore, mitral regurgitation (MR) patients undergoing MitraClip-placement were prospectively enrolled. Before MitraClip-placement, daytime sleepiness and sleep quality were assessed using the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), respectively; and all patients underwent SDB screening using five-channel respiratory polygraphy. After 3–6 months, patients had a similar reassessment including: ESS, PSQI, and respiratory polygraphy. 67 patients were included (77 ± 8years). Despite normal sleepiness scores, 41 patients (61%) had SDB with apnea-hypopnea-index (AHI) ≥ 15 h before MitraClip-placement, of whom only three patients had known SDB previously. Compared to patients without SDB, patients with SDB had similar sleepiness scores but higher NT-proBNP values at baseline (4325 vs. 1520 pg/mL, p < 0.001). At follow-up, there were significant AHI improvements among patients with SDB (p = 0.013). However, there were no significant sleepiness score changes. In conclusion, the prevalence of SDB among MitraClip candidates is very high even in those without daytime sleepiness. MR patients with SDB have higher NT-proBNP values, which may reflect a worse prognosis. MitraClip-placement may improve the underlying SDB, which could be an additional benefit of the procedure.

Screening diagnosis of sleep apnea syndrome in patients with ischemic stroke

Objective: to evaluate the effectiveness of the STOP-BANG questionnaire, Berlin questionnaire, and the Epworth sleepiness scale in the screening diagnosis of sleep apnea syndrome in patients with ischemic stroke.Materials and methods. We examined 107 patients (45 women and 62 men; the median age was 64 (56; 74) (aged 36–88). The study involved questioning using the STOP-BANG questionnaire, Berlin questionnaire, Epworth sleepiness scale, and nocturnal respiratory polygraphy.Results. Among 75 patients with sleep apnea syndrome, the STOP-BANG questionnaire, Berlin questionnaire, and the Epworth sleepiness scale showed sensitivity — 91 %, 72 %, 51 %, respectively, specificity — 53 %, 78 %, 84 %, respectively, diagnostic accuracy — 72 %, 75 %, 68 % respectively, positive predictive value — 82 %, 89 %, 88 %, respectively, and negative predictive value — 71 %, 54 %, 42 %, respectively.Conclusion. The STOP-BANG questionnaire and the Berlin questionnaire are convenient and informative for the screening assessment of the risk of sleep apnea syndrome in patients with ischemic stroke, but their use should be complemented by instrumental diagnostic methods for reliable exclusion of sleep-disordered breathing.

Validity and Cost-Effectiveness of Pediatric Home Respiratory Polygraphy for the Diagnosis of Obstructive Sleep Apnea in Children: Rationale, Study Design, and Methodology

Obstructive sleep apnea (OSA) in children is a prevalent, albeit largely undiagnosed disease associated with a large spectrum of morbidities. Overnight in-lab polysomnography remains the gold standard diagnostic approach, but is time-consuming, inconvenient, and expensive, and not readily available in many places. Simplified Home Respiratory Polygraphy (HRP) approaches have been proposed to reduce costs and facilitate the diagnostic process. However, evidence supporting the validity of HRP is still scarce, hampering its implementation in routine clinical use. The objectives were: Primary; to establish the diagnostic and therapeutic decision validity of a simplified HRP approach compared to PSG among children at risk of OSA. Secondary: (a) Analyze the cost-effectiveness of the HRP versus in-lab PSG in evaluation and treatment of pediatric OSA; (b) Evaluate the impact of therapeutic interventions based on HRP versus PSG findings six months after treatment using sleep and health parameters and quality of life instruments; (c) Discovery and validity of the urine biomarkers to establish the diagnosis of OSA and changes after treatment.

Evaluación preliminar de la Variabilidad de la Frecuencia Cardiaca de Pacientes con Fibrilación Auricular Paroxística y Apnea Obstructiva Barra lateral del artículo

This paper describes the processing of electrocardiographic (ECG) signals from 16 patients diagnosed with paroxysmal atrial fibrillation and sleep apnea-hypopnea syndrome (SAHS) classified as either moderate or severe by respiratory polygraphy. Processing goes from acquisition up to the analysis of their heart rate variability (HRV), where original computer scripts written in MATLAB R2020b are used within scripts adapted from other research groups. Computer processing included linear resampling, noise suppression, R-wave detection, misidentified peaks correction, tachogram resampling at a constant period and trend removal. Regular sampling is mandatory for Fourier analysis through Welch’s periodogram. Once the spectral power was estimated, the HRV was evaluated before, during and after an apnea episode. The behavior of the HRV was compared to the group of patients with moderate SAHS against those with severe SAHS. When comparing the groups at post-apnea stage, significant differences were found in the normalized low-frequency band (LF: 0.04–0.15Hz, p=0.0183), and also in the normalized high frequency band (HF: 0.15–0.4 Hz, p=0.0182), which suggests that in patients with severe SAHS the sympathetic activity is higher (power in LF band), which in turn presupposes that the autonomic nervous system is in frequent alertness, which has been associated with high cardiovascular risk.