Use of ambulatory polysomnography in children with syndromic craniosynostosis.

Children with syndromic or complex craniosynostosis are at risk of developing obstructive sleep apnea (OSA) because of midface hypoplasia and collapse of the pharynx. The criterion standard in diagnosing OSA is polysomnography. The aims of this study were to analyze the feasibility of a home cardiorespiratory monitor in children with syndromic or complex craniosynostosis and to analyze whether oximetry alone or the sum of the amplitudes of the thoracic and abdominal movements (X flow) are valuable alternative assessments to diagnose OSA at home, when complete recording was not achieved. We performed a prospective study of 129 children and analyzed 200 different ambulatory polysomnographies. In 41% of the measurements, a complete analysis of the obstructive apnea-hypopnea index was possible based on the adequate recording of all sensors. Oximetry in comparison with polysomnography had a positive predictive value of 82% and a negative predictive value of 79% for diagnosing OSA. Moderate OSA could be excluded with a negative oximetry. Comparing the X flow and the nasal flow signals that the hypopneas were adequately recorded in 86% and the obstructive apneas in 55%, resulting in an underestimation of the severity of OSA in 10%. In conclusion, in children with syndromic or complex craniosynostosis, diagnosing OSA using home cardiorespiratory monitoring is feasible. Oximetry alone can be used as a rough estimate screening, and with a negative test result, moderate OSA can be excluded. X flow can be helpful in diagnosing OSA in the absence of nasal flow.