Accuracy and acceptability of home sleep apnea testing with electroencephalography compared to in-lab polysomnography for the diagnosis of obstructive sleep apnea in children.

Study objectives: In-laboratory polysomnography is recommended for the evaluation of obstructive sleep apnea (OSA) in children, but availability is limited. We hypothesized that home sleep apnea testing including electroencephalogram (HSAT with EEG) could accurately detect OSA in children and be an alternative to polysomnography.

Methods: Children clinically referred for polysomnography underwent testing with the HSAT with EEG device twice: once in their home as well as concurrently with in-lab polysomnography (portable lab testing). HSAT with EEG and portable lab testing were compared to reference polysomnography for OSA diagnosis using an obstructive apnea-hypopnea index (OAHI) > 2 events/h. OAHI cutoffs of 1 and 5 events/h were explored. The diagnostic accuracy was further analyzed using the area under the receiver operating characteristic curve.

Results: All 15 participants, median (range) age 8.1 (2.9-17.1) years, completed in-lab testing and HSAT with EEG. OSA was identified by polysomnography in 7 (47%) participants. HSAT with EEG correctly identified OSA status from polysomnography in 14 (93%) participants. OAHI was similar between polysomnography (1.7 [0-26] events/h) and portable lab testing (1.6 [0.3-24.4]) and HSAT with EEG (1.8 [0.3-23]), P = .98. HSAT with EEG OAHI showed strong correlation with polysomnography OAHI (Spearman's r = .8, P = .0001). Area under the receiver operating characteristic curve referenced with polysomnography was excellent using OAHI threshold values of 1, 2, and 5 compared with portable lab testing (area under the receiver operating characteristic curve = 0.96, 0.96, and 1, respectively) and HSAT with EEG (area under the receiver operating characteristic curve = 0.79, 0.95, and 0.98 respectively).

Conclusions: HSAT with EEG was accurate compared to polysomnography for the diagnosis of pediatric OSA. Electroencephalography may improve the diagnostic accuracy of HSAT in children, particularly for mild OSA and younger children.

Citation: Stefanovski D, Somayaji M, Ward M, et al. Accuracy and acceptability of home sleep apnea testing with electroencephalography compared to in-lab polysomnography for the diagnosis of obstructive sleep apnea in children. J Clin Sleep Med. 2025;21(8):1341-1348.