Abstract
Introduction Many children have residual obstructive sleep apnea (OSA) following adenotonsillectomy (AT). While in-lab polysomnography (PSG) remains the gold standard for re-evaluation, its limitations include cost, limited availability of pediatric sleep laboratories, and inconvenience to families due to disruptions in routine. Home sleep apnea testing (HSAT), used clinically in adults, presents an alternative to evaluate the effect of OSA treatment in children and improve access to care. Specifically, type II HSAT, may surpass limited-channel tests in accuracy. This study aims to evaluate the feasibility, acceptability, and preference of type II HSAT compared to PSG to evaluate treatment effect following AT in children with OSA. Methods This comparative effectiveness trial included children aged 5-12 years scheduled for a PSG to evaluate residual OSA following AT. Participants underwent type II HSAT in their home within one week of their clinical PSG. Children and parents completed questionnaires regarding preference and acceptability of type II HSAT versus PSG. The relationship between obstructive apnea-hypopnea index (OAHI) by HSAT and PSG was analyzed using Spearman correlation and Bland-Altman plots. Results In this preliminary analysis, 20 participants (10 female; mean age=9.5; Black/African American 70%; White 25%; Hispanic 10%) who attempted HSAT completed all study procedures. Thirteen (65%) parents reported HSAT was closer to a normal night’s sleep compared to PSG, and 11 (55%) preferred PSG. Using an OAHI cutoff of 2 events/hour, OSA status by HSAT was the same as PSG for 16/20 (80%) participants. Spearman’s correlation was 0.8 (p-value < 0.001). The Bland-Altman analysis revealed the average difference (-1.025), falling within the 95% limits of agreement (-4.694, 2.644). Conclusion Based on preliminary analysis, parents reported type II HSAT was feasible and closer to a normal night’s sleep compared to PSG. Type II HSAT was accurate in detecting mild OSA and importantly, HSAT-derived OAHI correlated well with PSG. To further validate these initial findings, we aim to enroll 40 more patients in this ongoing trial. Type II HSAT appears to be acceptable and have comparable accuracy to be considered an alternative to PSG to re-evaluate OSA following AT in school-age children. Support (if any) This research is supported by the AASM Foundation.