Peut-on se passer de la polygraphie pour l'évaluation de l'obstruction ventilatoire chez les enfants de moins de 6 mois présentant une séquence de Pierre Robin ? Étude comparative des résultats de polygraphie et de gazométrie transcutanée
Bibliographic record
Abstract
Introduction. Obstructive sleep apnea syndrome (OSAS) in patients with Pierre Robin sequence (RPS) predominates in the first weeks of life. This underlines the importance of early diagnosis and therapeutic management to limit the short and long term deleterious effects on growth and psychomotor development. Polysomnography is the gold standard for the diagnosis of OSAS, but its limited access restricts its use. It is therefore important to evaluate other simplified explorations such as ventilatory polygraphy (PV) or SenTec type gasometry. The aim of our study was to compare, for the same patient, the severity classes of OSAS based on the indexes of obstructive apnea of PV and the results of SenTec based on the McGill score. Methods. We compared the results of 53 polygraphy (IAH, IAHOM, ID3%) and gasometric (McGill score) recordings during sleep, carried out in 48 patients aged less than 6 months with SPR, followed at the Reference Center of Necker-Enfants Malade Hospital. Results. 19 recordings had severe OSAS on the AHI (36%) and only 3 presented McGill scores of 3 or 4. The correlation between the two tests was low and not significant (Spearman 0.22, p-value 0.14). Similarly, the concordance between IAHOM and McGill score was weak and non-significant (Spearman 0.18, p-value 0.23). On the other hand, the concordance between IAH and ID3% was good (Spearman 0.72), as well as between IAHOM and ID3% (Spearman 0.59). The comparative analysis between theorical support on the different indexes studied (AHI, IAHOM, ID3% and McGill score) and the actual ventilatory management of patients showed significantly correct kappa concordance coefficients (respectively 0.52 for the AHI and 0.55 for AHIOM). There were no significant differences in the severity of retrognathism or glossoptosis between ventilated and non-ventilated patients. There was no significant difference between patients ventilated or not, and the diagnostic form of the SPR. Conclusion. Our study shows that, for our patients with SPR, we currently cannot do without polygraphy. We believe it is necessary to establish a composite criterion based on the clinical state of the patient, coupled with several polygraphic indexes and the McGill score, in order to objectively and reliably establish thresholds for therapeutic management.
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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 | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 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".