A photoplethysmography-based home sleep apnea test compared with polysomnography in children 2 to 6 years of age.

PURPOSE: This study aimed to determine the accuracy and feasibility of utilizing a photoplethysmography-based home sleep apnea test (PPG-HSAT) in children ages 2 to 6 years. METHODS: Fifty children aged 2 to 6 years referred for polysomnography (PSG) for evaluation of obstructive sleep apnea (OSA) were prospectively enrolled to wear the SleepImage PPG-HSAT concurrently during in-lab PSG. This is a ring-worn PPG-HSAT scored using proprietary SleepImage software. Thirty-nine participants completed testing. A "limited PSG" dataset was created by trimming PSG data to match periods when PPG-HSAT data were available. The apnea-hypopnea index (AHI) and presence of OSA were compared between methods. RESULTS: Device-related issues (e.g., detachment, intolerance, user setup error) that precluded successful data collection occurred in 11% of studies; an additional 25% had less than 2 h of total sleep time recorded on PPG-HSAT. Using automated SleepImage scoring, the mean difference in total sleep time between PPG-HSAT and PSG was - 220 min (95% CI - 278 to - 62; p < .001). When PPG-HSAT was compared with limited PSG, the mean difference was - 11 min (95% CI - 38 to 16; p = .83). Sensitivity for diagnosing OSA was 94.1%, specificity 22.7%, positive predictive value 0.48, and negative predictive value 0.83. The obstructive AHI was higher with PPG-HSAT than with both PSG and limited PSG (p < 0.001). PPG-HSAT detected no central events. Caregivers reported good ease of use and tolerance of the device. CONCLUSION: This PPG-HSAT was technically inadequate and diagnostically inaccurate in diagnosing OSA in children 2 to 6 years of age. CURRENT KNOWLEDGE/STUDY RATIONALE: An accurate and reliable home sleep apnea test would significantly impact pediatric OSA diagnosis. This study aimed to determine the accuracy and feasibility of utilizing the home sleep apnea test Sleep Image in 50 children ages 2 to 6 years. STUDY IMPACT: The PPG-HSAT was technically inadequate and diagnostically inaccurate in diagnosing OSA in children 2 to 6 years of age. The need for continued rigorous evaluation of pediatric HSAT devices is illustrated. Future research is needed to determine the best technology and age of use prior to recommending the widespread use of any HSAT device in children.