Evaluating the added-value of video recording in respiratory polygraphy for the diagnosis of obstructive sleep apnea in children

Polysomnography (PSG) is the gold standard for diagnosing obstructive sleep apnea (OSA) in children but not always available. Abbreviated exams exist, such as respiratory polygraphy (RP), but are less accurate for OSA diagnosis. Video recording (video-RP) may provide a more precise estimation of the total sleep time (TST) compared to RP alone. The aim of this study was to evaluate the diagnostic power of video-RP compared to RP and PSG. Overall, 68 PSG from 68 children (median [1st; 3rd quartile] age of 9 [7; 12]years) were included. After the interpretation of the initial PSG, the analysis was deleted, and the recording was analyzed by taking into account only the respiratory signals and video recording (video-RP). Finally, a third interpretation, after deleting the previous, was performed by considering only the respiratory signals (RP). The median [1st; 3rd percentile] obstructive apnea-hypopnea index (OAHI) was underestimated in video-RP (4.1 [2.7; 6.5]/h) as well as RP (4.0 [2.7; 6.2]/h) compared to PSG (4.8 [2.9; 6.7]/h, p = 0.02 and p = 0.01, respectively). Bland-Altman analysis confirmed the underestimation of OAHI by video-RP and RP compared to PSG, the magnitude of the difference being -0.69 ± 2.16 and -0.78 ± 2.12, respectively. OSA severity grading was different when scored by video-RP and RP compared to PSG in 14 (21 %) children. Video-RP underestimated the OAHI compared to PSG, similar to RP. Adding the video recording did not improve the diagnostic power of RP for the diagnosis of OSA. The use of video-RP at home should be investigated in future studies.