Towards Patient-centered Diagnosis of Pediatric Obstructive Sleep Apnea—A Review of Biomedical Engineering Strategies

ABSTRACT

Introduction: Obstructive sleep apnea in children has a prevalence of 5%. Polysomnography is considered to be the gold standard for diagnosis and stratification of the condition. However, it is resource-intensive, expensive and uncomfortable for children and their families.

Areas covered: We focus this review on technical developments in sensor technology, materials and predictive analytics for translation to (i) patient comfort and compliance in the laboratory and (ii) validation of home sleep apnea testing in children. Key developments in adult polysomnography that could be considered for adoption in children are also highlighted. This review is organized by Sleep, Cardiovascular, Oximetry, Position, Effort, and Respiratory (SCOPER) parameters of interest.

Expert opinion: In the past decade, improvements in respiratory sensors and signal processing strategies have transitioned sleep apnea testing in adults from the laboratory to home, thus reducing costs and improving access. Unfortunately, such benefits have not been observed for children principally due to the lack of high-quality studies. The increasing cost of diagnosis of sleep apnea in children needs urgent attention. Recent technical developments as described in this review have the potential to support further evaluation of home sleep apnea testing while improving the current circumstances of in-lab polysomnography for children.

KEYWORDS:

• Pediatric obstructive sleep apnea
• airflow sensors
• acoustic monitoring
• signal processing
• wearable devices
• actigraphy
• heart rate variability
• polysomnography
• machine learning

Declaration of interest

A Isaiah receives patent-related royalties from University of Maryland, Baltimore for sleep apnea imaging. Technologies are not discussed in the manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One peer reviewer is an employee of a diagnostic company, Onera Health, and a consultant for Itamar Medical, a company providing home sleep testing for children and adults. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.