SleepImage® as a tool for investigating sleep in children at high risk of comorbid sleep disorders.

OBJECTIVE

Children with neurodisability experience high rates of both respiratory and non-respiratory sleep disorders and greater challenges tolerating polysomnography (PSG). This study aimed to assess tolerability of a home sleep assessment device (SleepImage (SI), MyCardio, Denver, USA), compare SI respiratory and non-respiratory outcomes to PSG, assess the diagnostic accuracy of SI for OSA, and assess the correlation of the SI Sleep Quality Index (SQI) with PSG outcomes.

STUDY

DESIGN

Paired diagnostic accuracy study.

SETTING

Sleep laboratory in a specialist children's hospital.

PATIENTS: Children with neurodisability aged 3-18 years undergoing diagnostic PSG between April and August 2025.

INTERVENTIONS: SI was worn concurrently with attended PSG. Total sleep time ≥4 h on SI and PSG and SI signal quality >80% defined acceptable recordings for comparative analysis.

MAIN OUTCOME MEASURES: Tolerability and diagnostic yield of SI, severity of obstructive sleep apnoea, sleep quality.

RESULTS

48 children were recruited, and 20 had acceptable recordings for comparison (median (IQR) age 11.8 (7.0-13.1) years, 45% female). Not including SI recordings affected by technical factors, SI tolerance was 70%. SI diagnostic yield was 49%. The median (IQR) Obstructive Apnoea Hypopnoea Index on PSG was 1.8 (0.8-6.6)/h compared to the comparable SI index (sAHIOBS) of 4.3 (2.8-6.4)/h (p = 0.31), with SI overestimating OSA severity at milder severities but under-estimating it in severe OSA. SI had a negative predictive value for moderate-severe OSA of 100% (95% CI 71.5% - 100%). SQI correlated negatively with arousal index (r = -0.45, p = 0.046).

CONCLUSION

SI is tolerated in most children with neurodisability but diagnostic yield is limited by poor signal quality. It is useful for ruling out moderate-severe OSA, and can quantify non-OSA causes of impaired sleep quality.