Pulse Transit Time Improves Detection of Sleep Respiratory Events and Microarousals in Children

To evaluate the additional information provided by pulse transit time (PTT), a noninvasive tool, when using during polysomnography for the diagnosis of sleep breathing disorders in a pediatric population Respiratory and microarousals events were scored twice. The first scoring was performed using nasal pressure, thermistors, thoracic and abdominal movements, and oxygen saturation. The second scoring, blinded to the first scoring, was performed using PTT in combination with all the other signals. Microarousals were scored once visually on the EEG trace (cortical arousals [CAs]) and once using the PTT signal (autonomic arousals [AAs]) blinded to EEG. For the whole group of 16 children studied (mean age, 9.5 years), there was no significant difference between the respiratory disturbance index (RDI) with or without PTT analysis (22.4 ± 13.5/h vs 20.4 ± 14.3/h; not significant [mean ± SD]). Among the children exhibiting a “without PTT” RDI < 30/h, 5 of 12 children (41.66%) showed a clinically significant ≥ 5/h increase in RDI when using PTT. AAs detected by PTT were significantly more frequent than CAs during rapid eye movement (REM) sleep (7.4 ± 3.9/h vs 3.2 ± 2.3/h; p < 0.001) and slow wave sleep (SWS) [6.0 ± 4.3/h vs 0.6 ± 0.5/h; p < 0.0001] The quantification of respiratory effort using PTT improves the detection of respiratory events in children. The detection of microarousals is improved particularly in REM and SWS