Usefulness of Spectral Analysis of Respiratory Rate Variability to Help in Pediatric Sleep Apnea-Hypopnea Syndrome Diagnosis

Abstract

The sleep apnea-hypopnea syndrome (SAHS) is a chronic respiratory disorder of high prevalence among children (up to 4%). Nocturnal polysomnography (PSG) is the gold standard method to diagnose SAHS, which is a complex, expensive, and time-consuming test. Consequently, alternative simplified methods are demanded. We propose the analysis of the respiratory rate variability (RRV) signal, directly obtained from the airflow (AF) signals. The aim of our study is to evaluate the usefulness of the spectral information obtained from RRV in the diagnosis of pediatric SAHS. A database composed of 946 AF and blood oxygen saturation (SpO2) recordings from children between 0 and 13 years old was used. Our database was divided into four severity groups according to the apnea-hipopnea index (AHI): no-SAHS (AHI < 1 events/h), mild (1 events/h ≤ AHI < 5 events/h), moderate (5 events/h ≤ AHI < 10 events/h), and severe SAHS (AHI ≥ 10 events/h). RRV and 3% oxygen desaturation index (ODI3) were obtained from AF and SpO2 recordings, respectively. A spectral band of interest was determined (0.09–0.20 Hz.) and a total of 12 spectral features were extracted. Nine of these features showed statistically significant differences (p-value < 0.05) among the four severity groups. The spectral features from RRV along with ODI3 were used as inputs to binary logistic regression (LR) classifiers. The diagnostic performance of LR models were evaluated for the AHI cut-off points of 1, 5, and 10 e/h, achieving 66.5%, 84.0%, and 88.5% accuracy, respectively. These results outperformed those obtained by single ODI3. The joint use of the spectral information from RRV and ODI3 achieved a high diagnostic capability in the most severely-affected children, thus showing their complementarity. These results suggest that the information contained in RRV spectrum together with ODI3 is useful to help identify moderate-to-severe SAHS.