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PubMed2004

Occult sleep apnea: the dilemma of negative polysomnography in symptomatic patients.

BACKGROUND AND PURPOSE: To determine the benefit of repeat polysomnography with/without esophageal pressure (PES) monitoring to diagnose sleep apnea syndrome (SAS) in patients with symptoms of sleep apnea who have had a 'negative', single-night polysomnogram (PSG). PATIENTS AND METHODS: This is a retrospective investigation of 1187 patients seen in our sleep lab from January to December 2001, of which 709 were adults suspected of having sleep apnea. Following a single PSG, 588 patients were diagnosed with sleep apnea and 121 had negative PSGs (an apnea-hypopnea index <5 events per hour). Of the 121 patients, 92 continued to complain of unexplained sleepiness, loud snoring, or apnea, symptoms which were also documented on their initial evaluation (PSG or multiple sleep latency testing). The remaining 29 patients had no further complaints, or another medical cause of their sleepiness was established (i.e. asthma) following the single-night PSG. Of the 92 patients, 28 underwent additional screening with both repeat PSG and PES monitoring within the following 6 months. RESULTS: With repeat PSG and PES monitoring, 18 of the 28 patients with previous, negative PSGs were diagnosed with sleep apnea. The sensitivity of a single-night PSG fell to 97%, with a false negative rate of 3%. Only 12 of the 28 would have been positive based on polysomnographic criteria alone, without the additional PES monitoring. On the other hand, 10 of the 28 remained negative and further evaluation revealed other, underlying medical problems (i.e. nocturnal asthma) that explained their symptoms. CONCLUSIONS: There is a clear benefit of repeat PSG, with or without PES monitoring, for patients with a prior negative PSG and continued symptoms suspected of having SAS.

Adult↗

PubMed2006

Periodic limb movement counting in polysomnography: effects of amplitude.

BACKGROUND AND PURPOSE: This study investigates the relationship between periodic limb movement (PLM) counts obtained with standard scoring criteria and PLM counts scored without amplitude criterion (AC). PATIENTS AND METHODS: Twenty-four sleep laboratory patients with a PLM index (PLMI) >5 per hour of sleep in a previous polysomnography (PSG) underwent a full night of digital PSG. PLM were twice scored manually: first, according to standard criteria, and second, without AC. RESULTS: The overall PLMI for time in bed was 34.4+/-30.7 with AC and 50.2+/-36.4 without AC. The PLMI in non-rapid eye movement (NREM) sleep was 45.3+/-40.1 versus 63.4+/-47.6 (P<0.001), in REM sleep 11.5+/-15.1 versus 25.7+/-35.4 (P=0.001) and in wakefulness 29.0+/-31.1 versus 46.0+/-36.1 (P<0.001) with and without AC (Wilcoxon tests). CONCLUSIONS: In comparison to PLM counts obtained with standard criteria, PLM counts obtained without consideration of amplitude are remarkably higher. Counting without AC increases the sensitivity to detect small PLM and probably allows for identification of PLM sequences which would not have fulfilled the periodicity criteria otherwise. PLM counts without AC might be more useful to investigate the periodicity of PLM and possible changes with treatment.

Drug Therapy↗

PubMed1998

Sleep abnormalities demonstrated by home polysomnography in teenagers with chronic fatigue syndrome.

To provide objective information about sleep physiology in young people with chronic fatigue syndrome (CFS), home polysomnography (PSG) was performed on 18 teenagers, aged 11-17 years, in whom CFS had been diagnosed according to internationally accepted criteria. The results were compared with those for healthy controls matched individually for gender and age. Compared with controls, CFS subjects showed significantly higher levels of sleep disruption by both brief and longer awakenings. Disruption of sleep in this way could at least contribute to the daytime symptoms of young people with CFS. The underlying cause of the disruption needs to be considered in each individual case. Further research is required to clarify the relative contribution of this neurobiological aspect of CFS in young people.

Adolescent↗

PubMed2001

Sleep detection with an accelerometer actigraph: comparisons with polysomnography.

Two validation studies were conducted to optimize the sleep-detection algorithm of the Actillume. The first study used home recordings of postmenopausal women (age range: 51 to 77 years), which were analyzed to derive the optimal algorithm for detecting sleep and wakefulness from wrist activity data, both for nocturnal in-bed recordings and considering the entire 24 h. The second study explored the optimal algorithm to score in-bed recordings of healthy young adults (age range: 19 to 34 years) monitored in the laboratory. In Study I, the algorithm for in-bed recordings (n=39) showed a minute-by-minute agreement of 85% between Actillume and polysomnography (PSG), a correlation of.98, and a mean measurement error (ME) of 21 min for estimates of sleep duration. Using the same algorithm to score 24-h recordings with Webster's rules, an agreement of 89%, a correlation of.90, and 1 min ME were observed. A different algorithm proved optimal to score in-bed recordings (n=31) of young adults, yielding an agreement of 91%, a correlation of.92, and an ME of 5 min. The strong correlations and agreements between sleep estimates from Actillume and PSG in both studies suggest that the Actillume can reliably monitor sleep and wakefulness both in community-residing elderly and healthy young adults in the laboratory. However, different algorithms are optimal for individuals with different characteristics.

Adult↗

PubMedDate not supplied

The influence of polysomnography on the Multiple Sleep Latency Test and other measures of daytime sleepiness.

INTRODUCTION: According to its guidelines, the Multiple Sleep Latency Test (MSLT) should be performed following an all-night polysomnography (PSG). However, the sleep quality and consequently the MSLT results may be affected by PSG and by the fact that a subject sleeps under unfamiliar conditions. The aim of this study was to examine whether PSG performed in a sleep laboratory has any influence on the MSLT and other measures of daytime sleepiness. METHODS: Twenty healthy subjects with a mean age of 35.9+/-10.1 years underwent two MSLT examinations, and the 2 examination days were at least 4 weeks apart. In addition, on each occasion a monotonous vigilance task (VT) was performed and the subjects were asked to fill out the Epworth Sleepiness (ESS) and Visual Analogue Scales (VAS). In a cross-over design, a group of 10 subjects underwent a MSLT (MSLT-P) following a PSG and, on a second occasion, a MSLT (MSLT-N) was performed without a prior PSG. Vice versa, a second group of 10 subjects underwent first MSLT-N and then MSLT-P. RESULTS: None of the MSLT parameters differed significantly between MSLT-P and MSLT-N. The other measures of daytime sleepiness (VT, ESS, VAS) also showed no evidence of significant differences between days with and without a prior PSG. CONCLUSIONS: The results of MSLT and other measures of daytime sleepiness in healthy subjects are not influenced by the fact whether or not the subjects had a PSG the night prior to MSLT.

Adult↗

PubMed2002

Nasal resistances are useful in identifying children with severe obstructive sleep apnea before polysomnography.

OBJECTIVE: In this study, we would like to show that anterior rhinometry measurement of nasal resistance would be a simple and useful test to identify severe obstructive sleep apnea (OSA) in a population of children affected by adenotonsillar hypertrophy. METHODS: Seventy-three consecutive children (44 males; mean age 5.4+/-1.2 years) with adenotonsillar hypertrophy, who complained sleep-disordered breathing, were studied. All the parents completed a questionnaire concerning the children's sleeping habits and sleep complaints before consultation; each child underwent a general paediatric examination and an evaluation of craniofacial features and upper airway patency. In all 73 children polysomnography was performed and anterior rhinometry nasal patency was measured. RESULTS: The diagnosis of OSA was confirmed in 44/73 patients (60%). Total nasal resistance showed a significant direct correlation with apnea hypopnea index, arousal index, snoring time, percentage of sleep time spent at SaO(2)<90% and a significant inverse correlation with total sleep time, sleep efficiency and the mean of SaO(2)% during sleep. Total nasal resistance was significantly related to snoring, mouth breathing and daytime sleepiness. The receiver operator characteristics (ROC) curve indicates that in the range of age of our sample a nasal resistance value of 0.59 Pa/cm(3)/s has a sensitivity of 91% and specificity of 96% for identifying the children with adenotonsillar hypertrophy affected by OSA. CONCLUSIONS: Our study shows that in children with adenotonsillar hypertrophy nasal resistance seems to be risk factor for OSA. The anterior rhinometry appears as a useful tool in routine evaluation of sleep-disordered breathing in these patients.

Airway Resistance↗

PubMed2001

Equivalence versus pragmatic trials for the economic evaluation of information and communication technologies; the case of polysomnography under telesurveillance in the diagnosis of sleep apnea syndrome.

This article deals with the choice of the appropriate protocols for the early economic evaluation of information and communication technologies, equivalence trial versus pragmatic trial. The reasoning put forward here is based on a concrete interrogation relative to polysomnography (PSG), a key diagnostic test for sleep apnoea syndrome (SAS). Is PSG under tele-surveillance more efficient than ambulatory PSG to diagnose SAS? After analyzing and discussing both advantages and limits of these two kinds of trial, we showed that one or the other can be used to obtain appropriate results. But in this particular example, we concluded that a pragmatic trial should be preferred, knowing that it requires a smaller sample of patients along with a narrower range of uncertainty concerning the evaluation of costs.

Clinical Trials as Topic↗

PubMed1999

Economic studies and 'technical' evaluation of telemedicine: the case of telemonitored polysomnography.

Information and communication technology (ICT) is not yet integrated into current medical practice and frequently, organizational patterns of health care production are held responsible for this situation. However, and quite paradoxically, measures recently taken in France indicate that a preferential role is granted to ICT in order to promote the development of healthcare networks. In this context, one should carefully examine which factors, other than organizational ones, can explain the very slow diffusion of telemedicine. Actually, medical assessment of telemedicine is very seldom and the medical community is unable to appreciate the extent that this technology would modify the quality of care provided. Furthermore, and as a consequence of the former, there is no economic evaluation of telemedicine applications and its effects, in terms of productivity, remain virtual. In this article, based on an early evaluation of telemonitored polysomnography to diagnose sleep apnea syndrome, we show that it is possible, even at an experimental stage, to produce appropriate and convincing clinical results stating the true technological effectiveness (choice of an adequate clinical trial, selection of appropriate endpoints). Specific attention is given to the technical conditions in which the technology is assessed, we also provide most of the data that should be taken into account to foresee the major organizational transformations of the production processes. Our results show that early clinical ad hoc evaluations of telemedicine applications can be conducted promptly, providing strong clinical results and useful data for any forthcoming economic evaluation.

Adult↗

PubMed2001

[Nap polysomnography: sufficient grounds for initiating CPAP treatment?].

UNLABELLED: Nap polysomnography (NPSG) is a technique for rapid diagnosis of sleep apnea-hypopnea syndrome (SAHS). Although an apnea-hypopnea index (AHI) over 10 indicates a diagnosis of SAHS, treatment with nasal continuous positive airway pressure (CPAP) starts when the AHI exceeds 30. OBJECTIVE: To determine the diagnostic yield of NPSG for initiating CPAP and to evaluate the different types of polysomnographic findings. METHODS: Two hundred ninety-six patients suspected of having SAHS underwent NPSG lasting three hours. NPSG findings were considered positive at AHI > 30; normal at AHI < 10 with non-REM and REM sleep (more than 10%); invalid if the patient slept less than 60 minutes; and inconclusive if AHI was between 10 and 30 with REM, if AHI was < 30 without REM, or if upper airway resistance syndrome (UAS) was suspected. Positive and normal polysomnographic findings were considered diagnostic and the invalid and inconclusive findings were considered non-diagnostic. We also observed whether SAHS was predominantly obstructive, predominantly hypopneic, central-mixed, central-obstructive or miscellaneous, based on the type of event detected mot often during NPSG. RESULTS: Seventy percent of the NPSG were diagnostic (55% positive and 15% normal) and 30% were not (12% invalid and 18% inconclusive). Fifty-five percent of the positive NPSGs were predominantly obstructive, 29% were predominantly hypopneic, 8% were central-mixed, 4% were central-obstructive and 4% were miscellaneous. CONCLUSIONS: The diagnostic value of NPSG for initiating CPAP treatment is high. Predominantly hypopneic forms are particularly common.

Data Interpretation, Statistical↗

PubMed1998

[Follow-up of the premature infant: prevention of severe diseases and sudden death. Role of polysomnography].

Incidence and severity of apnea and bradycardia in preterm infants may be related to the immaturity of the respiratory control mechanisms. In addition, there is a steadily increasing risk for sudden death with decreasing birth weight or gestational age during the first year of age, justifying the search for a specific preventing strategy for very low birth weight (VLBW) infants. The purpose of this paper is to define practical preventive guidelines for VLBW infants at the time of discharge from the neonatal intensive care units. Polysomnography appears as a useful method to detect those among the VLBW infants who are at risk of life threatening events and may need home monitoring.

Apnea↗

PubMed1998

[Measurement of respiratory effort (esophageal pressure) and estimation of resistance of the upper airway in polysomnography: indications, limitations and results].

During polysomnography, measurement of airflow and respiratory effort are essential for classifying the type of respiratory event and for evaluating the efficacy of treatment. There are various ways to measure respiratory effort, the reference technique being oesophageal manometry. This measures fluctuations in intrathoracic pressure which correspond to variations in upper airway resistance and therefore allows differentiation between central and obstructive respiratory events. Thus the simple snorer can be distinguished from an individual with the upper airway resistance syndrome (UARS). In the UARS abnormally high resistance develops in the upper airway in the absence of identifiable apnoeas and hypopnoeas. The characteristic cresendo-decresendo pattern of the oesophageal pressure signal, when associated with the micro-arousals which are responsible for the hypersomnolence, is pathognomonic of this condition. The clinical application of oesophageal manometry is limited by its poor tolerance in certain individuals and by the potential deleterious effect the catheter itself has on sleep quality and on the dynamics of the upper airway. Other less invasive techniques, such as nasal pressure and pulse transit time, are currently under evaluation.

Airway Resistance↗

PubMed2002

A new design of a polysomnography-based multi-center treatment study for the restless legs syndrome.

Periodic limb movements (PLM) cause sleep disorders and daytime symptoms and are frequently associated with restless legs syndrome (RLS). Treatment of RLS with increased PLM during sleep (PLMS) has been evaluated in studies limited in size, methodology and study length. This long-term, placebo-controlled, multi-center, study with polysomnography (PSG) recordings has been designed in order to assess efficacy and safety parameters of pergolide treatment in RLS. This novel approach for a study was created to assure consistently high quality of sleep recording and analysis. Using defined criteria, 21 sleep centers were approved for the study after a pilot phase. Seventeen centers with 16 different PSG systems randomized 100 patients. Digital sleep recordings from 4 visits (baseline, 6 weeks, 6 months, 1 year) were submitted to one central evaluation center following previously defined standardized operating procedures. Visual scoring of all recordings was performed by one independent scorer. Reliability of scoring was evaluated for 20 randomly selected baseline recordings. The mean epoch by epoch agreement for sleep stages was 88% (range 81-96%), mean arousal re-scoring differed by 0.5 (range: -16 to 20), and mean PLM index re-scoring differed by 0.1 (range: -1.5 to 2.1). Using one scorer with a demonstrated high reliability in PSG scoring for all sleep recordings was very effective in terms of study cost, study duration, and data quality.

Dopamine Agonists↗

PubMed2002

Sleep/wake cycles in the dark: sleep recorded by polysomnography in 26 totally blind subjects compared to controls.

OBJECTIVES: To evaluate subjective sleep difficulties and nocturnal sleep with polysomnography in 26 completely blind subjects, living in normal social environments and to compare the findings with those of matched controls. METHODS: Twenty-six blind individuals with no light perception and free-running melatonin rhythms, as assessed by measurements of urinary and salivary 6-sulfatoxymelatonin, were polygraphically monitored. Actigraphy and Braille sleep logs were obtained from the individuals for 14 days. Their sleep was compared to that of matched controls. RESULTS: Blind individuals were 'free-running' despite normal and regular social interaction. Each had ordinary working conditions and/or a family life with seeing spouse and children. Actigraphy obtained on 14 successive days showed the presence of small amount of daytime 'sleep' - 24.7+/-25.1 min per day. Total sleep time, sleep latency, sleep efficiency, and total REM sleep were significantly lower than in matched controls. Working blind subjects had a slightly higher total sleep time than those retired and unemployed. Congenital blindness, acquired blindness, presence of bilateral prosthetic eyes or presence of normal human eyes did not produce different nocturnal sleep and 'free-running' pattern results. CONCLUSIONS: Reduced total sleep time and other sleep abnormalities were associated with the complaint of daytime sleepiness and poor sleep in blind subjects. The abnormalities of sleep, which may be related to the free-running condition, present an additional challenge for these subjects, who are already severely impaired by their complete lack of vision.

Adult↗

PubMed2003

First night effect in children and adolescents undergoing polysomnography for sleep-disordered breathing.

OBJECTIVE: To establish whether there is a first night effect (FNE) in children and adolescents with suspected obstructive sleep apnoea undergoing polysomnography (PSG) and whether this affects sleep and breathing, furthermore, to determine the extent to which age may influence the sleep and cardiorespiratory parameters. METHODS: One hundred and thirty-one children and adolescents (age classes-A: 2-6 years n=37; B: 7-12 years n=60; C: 13-17 years n=34) underwent PSG on 2 consecutive nights (I and II) under identical conditions for suspected sleep-related respiratory disorders. One hundred and five patients including 3 patients with obstructive sleep apnoea syndrome (OSAS) treated by adenotonsillectomy and 18 OSAS patients receiving nCPAP-therapy had no PSG-abnormalities (Group 1-A: n=28; B: n=53; C: n=24). A further 26 patients (Group 2) had clinically and polysomnographically confirmed untreated OSAS (A: n=9; B: n=12; C: n=5). RESULTS: There were no statistically significant differences between children with no PSG-abnormalities (Group 1) and those with OSAS (Group 2) in terms of sleep parameters (arousal indices excluded), oxygen saturation (SaO(2)) and heart rate (HR), and these parameters have, therefore, been pooled for the entire group (n=131) in the 3 age classes A, B and C. In the second and third age classes, sleep efficiency on the first night was reduced. In all age classes, there was significantly more wakefulness during the first night. In the second and third age ranges, the proportion of NREM 1 in the first night was significantly higher, with a correspondingly reduced proportion of NREM 4 in the third age group. In all age classes, REM sleep was significantly less during the first night, but REM latency was comparable on both nights. On the first night, the mean HR was higher. There were significant differences in apnoea/hypopnoea-index (AHI), electroencephalogram (EEG)-arousal-index (AI) and motoric arousal index (jerk index, JI) between Groups 1 and 2. In neither group, were there any significant differences in AHI, mean SaO(2) or number of EEG-arousals between nights 1 and 2. Only in the age class A, in Group 2 (n=9) was the number of motoric arousals significantly higher on the first night. Comparison of the age classes A, B, and C revealed that most polysomnographic parameters were age-dependent. Increasing age was found to correlate with a higher proportion of NREM 1, especially on the first night. Also, there was an age-dependent increase in NREM 2 on both nights, a decrease in NREM 3 on the first night, and a decrease in NREM 4 on both nights. In older children, we also found a lower proportion of REM sleep on the first night and a lower HR on both nights. In Group 1, we found a lowered AHI, AI and JI (for JI significant only on the first night) in older patients. No such age dependence of AHI, AI and JI was seen in OSAS patients (Group 2). CONCLUSIONS: In children and adolescents, there is an FNE comparable with that described in adults. In OSAS children and also in children with no PSG-abnormalities, there is night-to-night-variability in sleep parameters, but not in respiratory parameters. An adaptation night is, therefore, necessary when sleep architecture is to be studied, but not when only the nocturnal respiratory pattern is investigated. Sleep parameters, HR and arousal indices are all age-dependent.

Adolescent↗

PubMed2003

Comparison of the NovaSom QSG, a new sleep apnea home-diagnostic system, and polysomnography.

BACKGROUND: Obstructive sleep apnea (OSA) is a serious, common, and underdiagnosed disorder that challenges health care resources. While polysomnography (PSG) represents the standard diagnostic test for OSA, portable devices provide an alternative diagnostic tool when issues of cost, time, geographic availability, or other constraints pose impediments to in-lab testing. This study compares the NovaSom QSG, a new sleep apnea home diagnostic system, to PSG both in the laboratory and in the home. METHODS: Fifty-one consecutive adults referred to the sleep lab for suspicion of OSA underwent one night of in-lab, simultaneous recording of PSG and NovaSom QSG in addition to using the NovaSom QSG at home for three nights. Two separate comparisons were made using the apnea-hypopnea index (AHI): in-lab PSG to in-lab NovaSom QSG and in-lab PSG to home NovaSom QSG. RESULTS: Using a clinical cut-off of AHI=15, the sensitivity and specificity of the in-lab NovaSom QSG vs. PSG were 95% and 91%, respectively. For home NovaSom QSG vs. in-lab PSG, the sensitivity was 91% and specificity was 83%. The intra-class correlation coefficient for the agreement between three separate nights of NovaSom QSG home data was 0.88. CONCLUSIONS: In a patient population suspected of having OSA, the NovaSom QSG demonstrated acceptable sensitivity and specificity both in the lab and self-administered in the home, when compared to PSG.

Adult↗

PubMed2003

Scoring polysomnography respiratory events: the utility of nasal pressure and oro-nasal thermal sensor recordings.

OBJECTIVE: To evaluate the clinical utility of nasal cannula/pressure (NP) and oro-nasal thermal sensor (Th) recordings, alone and in combination for scoring respiratory events during routine diagnostic polysomnography (PSG). BACKGROUND: The use of Th devices to measure airflow during PSG is not recommended because Th are insensitive to airflow changes other then complete airflow cessation. It has been suggested that NP recording is a better measure of airflow and can also detect increased upper airway resistance during PSG. METHODS: Thirty consecutive PSG's were examined using 13 standard channels including Th and NP recordings. Respiratory events were scored separately utilizing NP+Th, Th alone and NP alone in a blinded fashion using modified AASM criteria. Respiratory events were time matched to within 5 s for each of the recording methods. RESULTS: NP+Th detected more events than Th alone (P<0.0001); NP+Th detected more events than NP alone (P<0.0001) and NP alone detected more events than Th alone (P<0.0001). For AHI >50, NP alone and Th alone each detected 90% of matched NP+Th events. However, for AHI <50, NP alone detects 54% and Th alone detects 42% (P<0.005) of matched NP+Th events. For AHI >50, NP alone scored 97% of matched Th alone scored respiratory events, and Th alone scored 94% of NP alone scored respiratory events (P>0.05). However, for AHI<50, NP alone scored 90% of matched Th alone scored respiratory events, whereas Th alone scored 62% of matched NP alone scored events (P<0.0001). CONCLUSIONS: In severe sleep disordered breathing (AHI >50), NP+Th, NP alone and Th alone have similar ability to detect respiratory events. When AHI <50, NP+Th appears better for detecting respiratory events than NP or Th alone. If only one measure of airflow is used, NP detects more events than Th.

Adult↗

PubMed2005

[Comparison between the 1993 and 2002 Guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) for identifying respiratory events in polysomnography tests].

OBJECTIVE: To compare the results of applying both the 1993 and 2002 guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) to identify respiratory events during nighttime polysomnography tests. PATIENTS AND METHODS: One hundred twenty consecutive patients with medium to high suspicion of sleep apnea-hypopnea syndrome (SAHS) were included in the study. The 1993 guidelines recommended the use of a thermistor and the evaluation of only apneas and hypopneas. The 2002 guidelines, on the other hand, recommended the use of a thermistor, nasal pressure cannula, and thoracoabdominal bands so that respiratory effort related to arousals could be studied along with apneas and hypopneas. In our study we did not use an esophageal pressure catheter. We calculated the apnea index, hypopnea index, and apnea-hypopnea index (AHI) and determined the number of patients who would be diagnosed with SAHS (AH I > or =10) and the number for whom initiation of continuous positive airway pressure treatment would be recommended (AHI > or =30) according to the 2 sets of guidelines. RESULTS: Polysomnographic tests were valid for 118 of the 120 patients (80% men). The mean (SD) age was 51 (11.6) years and the mean body mass index 31.2 (4.3). Using the 1993 guidelines, the AHI was less than 10 in 25 patients, between 20 and 29 in 38, and 30 or more in 50. In the group overall, mean apnea and hypopnea indices and AHI were all significantly higher with the 2002 guidelines than with the 1993 criteria. With the 1993 criteria, the mean AHI was 33.16 and with 2002 criteria, 45.02 (P<.05). Sixty-four percent of the studies considered normal according to the 1993 SEPAR guidelines were considered apneic according to the 2002 guidelines. Of the patients considered not to need continuous positive airway pressure according to the 1993 SEPAR guidelines, 47.61% did need therapy according to the 2002 guidelines. CONCLUSIONS: There are significant differences in AHI, and in both apnea and hypopnea indices depending on whether the 1993 or the 2002 SEPAR guidelines are applied.

Female↗

PubMed1999

Role of polysomnography in tracheostomy decannulation in the paediatric patient.

Tracheostomy in infants and children has been the subject of controversy in the medical literature, but decannulation in the paediatric patient is even more controversial. Various approaches and techniques have been used for decannulation, however in spite of all efforts it continues to be a problem. The objective of our study was to assess the role of polysomnography (PSG) in predicting readiness for decannulation. All subjects (n = 31) of the study were less than 12 years of age, and tracheostomized for periods of at least six months to ensure a minimum period of dependence on the tube. All had clinical, radiological and endoscopic clearance before PSG was performed. Twenty-one out of 22 patients with favourable PSG data were successfully decannulated. Attempts to decannulate all the nine patients with unfavourable PSG failed. The conclusion of the study was that PSG is a useful adjunct to the many methods of evaluating readiness for decannulation in children with long-term tracheostomy tubes.

Child↗