Abstract Introduction Nasal pressure airflow (NPAF), an integral signal in pediatric polysomnography, is the gold standard to identify hypopneas during a polysomnogram (PSG). Acquiring reliable NPAF signals requires technical skill for accurate PSG interpretation. At our center, prior to intervention, only 48% of studies had optimal NPAF signals. Our lab developed a unique approach for Data Reliability Enhancement and Analysis in Monitoring Quality, “DREAM-Q,” with goal to increase the percentage of PSGs with optimal NPAF signals to 75% by June 30, 2026, regardless of technologist’s level of experience. Methods A DREAM-Q survey was developed in REDCap and completed by daytime scorer after scoring each PSG, without stratification of clinical context, age, patient complexity or other factors. DREAM-Q included assessment of 1) accuracy of overnight technician documentation, 2) quality of 11 signals on a 4-point objective scale (1=poor, 2=fair, 3=good, 4=excellent), 3) appropriate troubleshooting of signals and 4) description of troubleshooting efforts. After analysis of baseline data, the initial intervention included creation and distribution of two job aids detailing goals of the project in video format and a troubleshooting document. A subsequent intervention included a policy change that night technologists include documentation of NPAF signal integrity every 30 minutes (e.g. cannula position, patency, quality, troubleshooting, patient tolerance, and respiratory status). DREAM-Q results were reviewed with our scoring team and shared weekly with night technicians in the form of an SPC chart as an ongoing motivator to continue progress. Results Collection of baseline data ramped up over 5-months (5/20/25-10/26/25) with scorer sampling rate improving from 31% to 75% (n=1,387 PSGs sampled). DREAM-Q surveys demonstrated 48% with optimal NPAF quality (score 4). Following implementation of initial intervention on 10/26/25, data through 11/22/25 showed an improvement in optimal NPAF quality to 55% (n=345 PSGs). Conclusion DREAM-Q is a unique, useful method for data reliability enhancement and analysis in monitoring quality of acquisition signals during pediatric PSG. Our ongoing quality improvement initiative has demonstrated that targeted strategies of education, feedback, and focused support for overnight technicians resulted in improvement in NPAF quality. We plan to continue improvement cycles to further optimize signal quality with potential expansion to other polysomnogram signals. Support (if any)
Gersz et al. (Fri,) studied this question.