Home sleep apnea testing: an accuracy study.

AIM: There are no studies comparing tests performed at home with those carried out in the laboratory, using the same device. The only studies that have been performed have compared the device used at home with the standard polygraph used in the laboratory. The purpose of this study was therefore to verify the accuracy of the home diagnosis of obstructive sleep apnea syndrome (OSAS) via unassisted type 2 portable polysomnography, compared with polysomnography using the same equipment in a sleep laboratory. METHODS: To avoid any possible order effect on the apnea-hypopnea index (AHI), we randomly created two groups of 20-total 40 patients, according to the test sequence. One of the groups had the first test at home and the second test in the laboratory (H-L); the other group had the first test in the laboratory and the second at home (L-H). The second test always took place on the night immediately following the first test. All polysomnographic monitoring was undertaken with the same equipment, an Embletta X100 system (Embla, Natus Inc., Middleton, USA). The Embletta X100 is a portable polygraph that records eleven polygraph signs: (1) electroencephalogram C4/A; (2) electroencephalogram O2/M1; (3) submental EMG; (4) electrooculogram of the right side; (5) nasal cannula (air flow); (6) respiratory effort against a plethysmographic chest strap; (7) respiratory effort against an abdominal plethysmographic belt; (8) heart rate; (9) saturation of oxyhemoglobin; (10) snoring; and (11) body position. RESULTS: There was no difference in sleep efficiency between the group monitored in the laboratory and the group tested at home (p = 0.30). There was no difference in total sleep time (p = 0.11) or sleep latency (p = 0.52), or in the latency in phases N2 and N3 between the monitoring in the laboratory and at home (N2 p = 0.24; N3 p = 0.09). Some differences occurred regarding the PSG that took place at home, with longer duration of wake after sleep onset (WASO) and longer latency for REM sleep, due to failure of the patient to start the monitoring by pressing the "events" button on the device. In the distribution of sleep phases, there was no difference between the group monitored in the laboratory and the group tested at home. CONCLUSION: Results from home sleep monitoring correlate well with the laboratory "gold standard" and may be an option for diagnosing OSAS in selected patients.

TuCASA questionnaire for assessment of children with obstructive sleep apnea: validation.

OBJECTIVE: The aim of the present study was to validate The Tucson Children's Assessment of Sleep Apnea Study (TuCASA) questionnaire for use in the Brazilian population. METHODS: Of the total 62 children who participated in the present study (27 girls), aged 4 to 11 years, 45 (72.6%) had sleep-disordered breathing (SDB) diagnosed by polysomnography, while 17 (27.4%) had no sleep disorders. Translation, back-translation, and pretesting were previously performed. The final Portuguese-language version of TuCASA was administered to the participants from May 2012 to August 2013. The interviewer was blinded to presence or absence of SDB. Cronbach's alpha for the overall scale (with 95% CI) and the effect of excluding any items were evaluated. RESULTS: There was no difference among TuCASA items/score and the presence of SDB with either age or gender. The TuCASA had a Cronbach's alpha coefficient of 0.726 (95% CI 0.614 to 0.817), which denotes satisfactory internal consistency - a finding reinforced by evaluation of the effect of item exclusion on the questionnaire. Convergent validity was also satisfactory, in as much as most correlations were positive and significant. CONCLUSION: The translated version of the TuCASA questionnaire was validated for Brazilian populations and proved to be a reliable, validated instrument that can be used in clinical practice for evaluation of children with symptoms of SDB.

Effect of play activities on hospitalized children's stress: a randomized clinical trial.

OBJECTIVE: The use of unstructured play as an intervention to help children cope with the stress of a hospitalization period was tested in this randomized clinical trial. METHODS: Urinary cortisol (a stress marker) was examined in 53 pediatric patients hospitalized for respiratory diseases in a public hospital, divided into two groups that did or did not play. RESULTS: Boys and girls from the play group, 7-11 years old, showed a decrease in cortisol levels after participating in play activities. In younger participants (4-7 years old) the intervention did not seem as efficient, probably because in this group maturity levels may have influenced how children cognitively engaged in play as a coping strategy. CONCLUSIONS: The study showed the importance of using interventions that consider age ranges and gender in enhancing coping strategies, as well as the importance of such techniques that are employed by occupational therapists since they are professionals with expertise in the use of activities as therapeutic instruments.