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VOLUME 37, ISSUE 12

NEW MEASURE OF SLEEP FRAGMENTATION IN CHILDREN
Movement Distribution: A New Measure of Sleep Fragmentation in Children with Upper Airway Obstruction

http://dx.doi.org/10.5665/sleep.4264

Scott Coussens, BSc(Hons)1,2; Mathias Baumert, PhD3,4; Mark Kohler, PhD4; James Martin, MD2; Declan Kennedy, MD2,4; Kurt Lushington, PhD5; David Saint, PhD1; Yvonne Pamula, PhD2

1School of Medical Sciences, University of Adelaide, Adelaide, Australia; 2Department of Respiratory and Sleep Medicine, Children, Youth and Women's Health Service, North Adelaide, Australia; 3Cardiovascular Research Centre, Royal Adelaide Hospital and School of Medicine, University of Adelaide, Adelaide, Australia; 4Children's Research Centre, University of Adelaide, Adelaide, Australia; 5School of Psychology, University of South Australia, Adelaide, Australia



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Study Objectives:

To develop a measure of sleep fragmentation in children with upper airway obstruction based on survival curve analysis of sleep continuity.

Design:

Prospective repeated measures.

Setting:

Hospital sleep laboratory.

Participants:

92 children aged 3.0 to 12.9 years undergoing 2 overnight polysomnographic (PSG) sleep studies, 6 months apart. Subjects were divided into 3 groups based on their obstructive apnea and hypopnea index (OAHI) and other upper airway obstruction (UAO) symptoms: primary snorers (PS; n = 24, OAHI < 1), those with obstructive sleep apnea syndrome (OSAS; n = 20, OAHI ≥ 1) and non-snoring controls (C; n = 48, OAHI < 1).

Interventions:

Subjects in the PS and OSAS groups underwent tonsillectomy and adenoidectomy between PSG assessments.

Measurements and Results:

Post hoc measures of movement and contiguous sleep epochs were exported and analyzed using Kaplan-Meier estimates of survival to generate survival curves for the 3 groups. Statistically significant differences were found between these group curves for sleep continuity (P < 0.05) when using movement events as the sleep fragmenting event, but not if stage 1 NREM sleep or awakenings were used.

Conclusion:

Using conventional indices of sleep fragmentation in survival curve analysis of sleep continuity does not provide a useful measure of sleep fragmentation in children with upper airway obstruction. However, when sleep continuity is defined as the time between gross body movements, a potentially useful clinical measure is produced.

Citation:

Coussens S, Baumert M, Kohler M, Martin J, Kennedy D, Lushington K, Saint D, Pamula Y. Movement distribution: a new measure of sleep fragmentation in children with upper airway obstruction. SLEEP 2014;37(12):2025-2034.

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