High Night-to-Night Variability in Childhood Obstructive Sleep Apnea Severity
Bibliographic record
Abstract
Abstract Rationale: Overnight, attended, in-laboratory polysomnography (PSG) is the gold standard test for diagnosing childhood obstructive sleep apnea (OSA) and is heavily relied upon for treatment decision-making. The obstructive apnea-hypopnea index (OAHI) measured on the PSG is a common outcome measure in pediatric sleep research and is often utilized to determine research study eligibility. We sought to evaluate the test-retest reliability of the OAHI in children with moderate to severe OSA. Methods: This is a secondary analysis of two pediatric trials conducted at the Hospital for Sick Children (Toronto, Canada) evaluating alternative OSA therapies for children aged 4-18 years old with moderate to severe OSA on a baseline diagnostic PSG. Mild, moderate, and severe OSA were classified as OAHI 1.5 to <5 events/hour, 5 to <10 events/hour, and ≥10 events/hour, respectively. The baseline diagnostic PSG data was compared to the PSG data from the inactive control arms of the trials. The intraclass correlation coefficients were calculated and Bland-Altman analyses were completed. Results: Twenty-seven children were included (mean age 8 years, 41% females, median body mass index 24 kg/m2). The inter-test interval was 48 days (range: 14–78 days). The median (interquartile range) OAHIs on the first and second PSGs were 9.4 (7.4, 14.0) events/hour and 14.2 (5.4, 21.6) events/hour, respectively, with weak correlation (intraclass correlation coefficient 0.303; 95% CI -0.064, 0.604; p=0.0518). The change in OAHI from night-to-night was ≥5 events/hour in 16/27 children (59%) and ≥10 events/hour in 8/27 children (30%). Amongst children with moderate OSA on the first night PSG, 5/15 (33%) had mild or no OSA on the second PSG. Amongst children with severe OSA on the first night PSG, 2/12 (17%) had mild or no OSA on the second PSG. Comparing the first and second night PSGs, the median (interquartile range) total sleep time was 401.0 (363.0, 448.8) minutes and 414.0 (362.5, 450.5) minutes, the percentage of rapid eye movement sleep time was 18.7% (14.7%, 22.4%) and 19.6% (16.3%, 24.0%), and the percentage of supine sleep time was 41.7% (25.1%, 57.0%) and 47.4% (32.1%, 67.5%), respectively. Conclusions: The OAHI measured on a PSG demonstrates poor test-retest reliability in children with moderate to severe OSA. The diagnosis of OSA in children should not rely solely on the OAHI from a single night PSG. Further evaluation of night-to-night variability in children with OSA is required to better understand factors associated with high night-to-night variability and associated health consequences.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".