0862 Is Portable Monitoring a Viable Alternative to In-Lab Evaluation of OSA in Medically Complex Children?

Abstract Introduction In-lab polysomnogram (PSG) remains the sole recommendation for evaluation of suspected obstructive sleep apnea (OSA) in children. While some studies have evaluated portable monitoring (PM) to diagnose OSA in children, few have evaluated PM in medically complex children for whom in-lab PSG may be a barrier to evaluation due to the increased family burden, as well as lack of in-lab resources and support for their advanced medical needs. This project sought to compare the results of in-lab PSG vs. PSG modified to mirror data obtained by PM for medically complex children to evaluate whether PM is a potential alternative in children for whom in-lab evaluation may be prohibitive. Methods In-lab PSGs from eight children with diagnoses of moderate to severe cerebral palsy who were referred to our academic Sleep Medicine Clinic from a multidisciplinary pediatric Complex Medical Care clinic, were scored using recommended pediatric PSG scoring criteria. The PSG montage was then modified to match a type III PM device (nasal pressure, respiratory effort, pulse oximetry, electrocardiogram, and body position). These modified records were then scored using pediatric AASM scoring criteria by a blinded board certified sleep medicine physician and compared to original in-lab results. Results Initial in-lab PSGs showed one patient without OSA, 3 with mild OSA, 2 with moderate OSA, one with severe OSA, and one with moderate central sleep apnea (CSA). When transitioned to PM montage, the absolute mean difference in AHI was 3.85/hr (SD=3.65), no diagnoses of OSA were missed, 50% (3/6) with OSA maintained the same severity, 50.0% (3/6) had increased severity, and one changed from no OSA to mild OSA. The patient with moderate CSA was changed to severe mixed sleep apnea. Conclusion Our results thus far indicate that PM may be an option for OSA diagnosis in some medically complex children with barriers to in-lab PSG. However, the limited montage of PMs cannot adequately classify arousals or time awake, and may therefore over-estimate the degree of sleep apnea in medically complex children who may have respiratory issues during both sleep and wake at night. Concern for seizures or CSA can limit overall utility of PM. Support (if any)