Sleep-disordered Breathing and Neurocognitive Assessment in Children and Young Adults (TRSPed)

One of main problems in the management of sleep-disordered breathing (SDB) in children and young adults is their screening, and the absence or the weak correlation between clinical symptoms and polysomnography (PSG). It may be useful to use additional measures together with PSG to improve the detection and characterization of respiratory events during sleep and/or correlation with clinical signs of SDB. The primary objective of the study is to determine whether psychological and neuropsychological test scores correlate with diagnostic PSG results.

One of main problems in the management of sleep-disordered breathing (SDB) in children and young adults is their screening, and the absence or the weak correlation between clinical symptoms and polysomnography (PSG). It may be useful to use additional measures together with PSG to improve the detection and characterization of respiratory events during sleep and/or correlation with clinical signs of SDB. In addition, the clinical impact of SDB and the benefit of treatment are still not clear in children and young adults, including neurocognitive and developmental perspective. Finally, the validation of simplified tools could optimize and simplify the detection of SDB in children and young adults. Patients scheduled to perform a diagnostic PSG for routine clinical care will have additional recordings and questionnaires as part of the study. The primary objective of the study is to determine whether psychological and neuropsychological test scores correlate with diagnostic PSG results.

Sleep-disordered breathing (SDB), Poly(somno)graphy (P(S)G), Cerebral oxygenation, Cyclic alternating pattern (CAP), Psychological and neuropsychological tests, Screening questionnaires, Treatment of SDB

Patients aged 1 to 20 years old with a suspicion of SDB or a high-risk of SDB due to their pathology and hospitalized at Necker Hospital for a sleep study for their clinical care.

Procedures added by research during PSG : SDB screening questionnaires Electromyography (EMG) of accessory and abdominal muscles Cerebral oxygenation Mandibular movements Sleep headband (pre-teens and teens) or other connected device Automatic PSG analyzes Psychological and neuropsychological assessment The recordings of the study will be repeated at one year if the patient needs a treatment (surgery or noninvasive ventilation) following the results of the PSG.

Anxiety questionnaire using the Revised Children's Manifest Anxiety Scale (RCMAS), with an anxiety being defined by a total T-score ≥60. Mean normal value of T-score is 50 ± 10.

Depression questionnaire using the Multiscore Depression Inventory for Children (MDI-C), with an abnormal score being defined by a T-score ≥70. Mean normal value of T-score is 50 ± 10.

Quality of life questionnaire using the Pediatric Quality of Life Inventory (PedsQL). The higher the score, the better the quality of life. Min value = 0. Max value = 100.

Sensoriality using the Sensory profile test. Atypical performance for a raw score <122. Min value = 38. Max value = 190.

Memory evaluation using the Children Memory Scale test. Mean normal score is 10 ± 3. Abnormal for a score <4.

Attention evaluation using the TAP test. Abnormal for a T-score <30. Mean normal value of T-score is 50 ± 10.

Executive function evaluation using the NEPSY-II. Mean normal score tests is 10 ± 3, abnormal for a score <4.

Executive function evaluation using the Trail Making test. Mean normal score is 10 ± 3, abnormal for a score <4.

Executive function evaluation using the KiTAP subtests. Abnormal T-score <30, with mean normal value of T-score is 50 ± 10.

Behavior evaluation using the Child Behaviour Checklist (CBCL). Abnormal T-score >65. Mean normal value of T-score is 50 ± 10.

Neurodevelopment evaluation using the Griffiths-III. Mean normal score is 100 ± 15. Abnormal for a score <70.

Neurodevelopment evaluation using the WPPSI-IV. Mean normal score is 100 ± 15. Abnormal for a score <70.

Neurodevelopment evaluation using the WISC-V. Mean normal score is 100 ± 15. Abnormal for a score <70.

Language evaluation using the Griffiths-III test. Mean normal score is 100 ± 15. Abnormal for a score <70.

Score of the sleep disturbance scale for children (SDSC) to detect the presence and severity of SDB Children < 4 years old: Min value 3, max value 15. Abnormal if score >4. Children > 4 years old: Min value 5, max value 25. Abnormal if score >12.

Geometric morphometric approach based on 3D facial surface analysis of linear distances between 25 pairs of craniofacial landmarks, defined as direct Euclidean distance (in mm) between the two points.

Geometric morphometric approach based on 3D facial surface analysis of geodesic distances between 25 pairs of craniofacial landmarks, defined as the shortest distance (in mm) between two points when following the contour of the face/skin.

Geometric morphometric approach based on 3D facial surface analysis of angular measurements between 25 pairs of craniofacial landmarks, defined as the angles (in degree) between sets of three landmarks.

Comparison between the apnea-hypopnea index (AHI) obtained from the P(S)G and the AHI calculated using respiratory muscle EMG

Comparison between the AHI obtained from the P(S)G and the AHI calculated taking into account hypoventilation and flow limitation

Comparison between the AHI obtained from the P(S)G and the AHI calculated taking into account autonomic arousals using the pulse wave amplitude

Comparison between the AHI obtained from the P(S)G and the AHI calculated using the pulse transit time

Comparison between the AHI obtained from the P(S)G and the AHI calculated using cerebral oxygenation desaturations

Correlation between clinical signs by questionnaire and hypoventilation and flow limitation scores by P(S)G.

Correlation between clinical signs by questionnaire and autonomic arousals using pulse wave amplitude by pulse oximetry.

Correlation between clinical signs by questionnaire and mandibular movement analysis by non-invasive magnetic distance sensors.

Correlation between clinical signs by questionnaire and cerebral oxygenation analysis by near-infrared spectroscopy.

Correlation between pulse oximetry and mandibular movement analysis by non-invasive magnetic distance sensors.

Correlation between sleep questionnaires and mandibular movement analysis by non-invasive magnetic distance sensors.

Correlation between the AHI obtained from P(S)G and the AHI obtained using respiratory inductance plethysmography.

Correlations between the sleep stages and AHI obtained from manual analysis of PSG and an automatic analysis.

Comparison of neurodevelopment evaluation using the Griffiths-III between baseline and 1 year following treatment for severe or moderate-to-severe (pubescent patient) obstructive sleep apnea. Mean normal score is 100 ± 15. Abnormal for a score <70.

Comparison of neurodevelopment evaluation using the WPPSI-IV between baseline and 1 year following treatment for severe or moderate-to-severe (pubescent patient) obstructive sleep apnea. Mean normal score is 100 ± 15. Abnormal for a score <70.

Comparison of neurodevelopment evaluation using the WISC-V between baseline and 1 year following treatment for severe or moderate-to-severe (pubescent patient) obstructive sleep apnea. Mean normal score is 100 ± 15. Abnormal for a score <70.

Comparison of PSQI scores between baseline and 1 year following treatment. PSQI max score = 21. Threshold values for the PSQI scale: 0-4: Good, 5-8: Moderate, >9: Bad sleep quality.

Comparison of ESS scores between baseline and 1 year following treatment. ESS max score = 33. Threshold values for the ESS scale: <8: No, 9-14: Moderate, >15: Severe sleepiness.

Inclusion Criteria: Patients aged 1 to 20 years with a suspicion of SDB or a high-risk of SDB due to their pathology and hospitalized at Necker Hospital for a sleep study Written informed consent Exclusion Criteria: No social insurance Significant psychomotor retardation Cooperation not possible Significant agitation Acute condition and/or temporary drug treatments that may interfere with the results of PSG (upper or lower airway infection) Patient under guardianship/curatorship