15 research outputs found
A Novel, Contactless, Portable “Spot-Check” Device Accurately Measures Respiratory Rate
Respiratory rate (RR) is an important vital sign used in the assessment of acutely ill patients. It is also used as to predict serious deterioration in a patient's clinical condition. Convenient electronic devices exist for measurement of pulse, blood pressure, oxygen saturation and temperature. Although devices which measure RR exist, none has entered everyday clinical practice.
We developed a contactless portable respiratory rate monitor (CPRM) and evaluated the agreement in respiratory rate measurements between existing methods and our new device. The CPRM uses thermal anemometry to measure breath signals during inspiration and expiration.
RR data were collected from 52 healthy adult volunteers using respiratory inductance plethysmography (RIP) bands (established contact method), visual counting of chest movements (established non-contact method) and the CPRM (new method), simultaneously. Two differently shaped funnel attachments were evaluated for each volunteer.
Data showed good agreement between measurements from the CPRM and the gold standard RIP, with intra-class correlation coefficient (ICC): 0.836, mean difference 0.46 and 95% limits of agreement of -5.90 to 6.83. When separate air inlet funnels of the CPRM were analysed, stronger agreement was seen with an elliptical air inlet; ICC 0.908, mean difference 0.37 with 95% limits of agreement -4.35 to 5.08.
A contactless device for accurately and quickly measuring respiratory rate will be an important triage tool in the clinical assessment of patients. More testing is needed to explore the reasons for outlying measurements and to evaluate in the clinical setting
STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma
Background Suboptimal adherence to inhaled steroids
is common in children with asthma and is associated
with poor disease control, reduced quality of life and
even death. Previous studies using feedback of
electronically monitored adherence data have
demonstrated improved adherence, but have not
demonstrated a significant impact on clinical outcomes.
The aim of this study was to determine whether
introduction of this approach into routine practice would
result in improved clinical outcomes.
Methods Children with asthma aged 6–16 years were
randomised to the active intervention consisting of
electronic adherence monitoring with daily reminder
alarms together with feedback in the clinic regarding
their inhaled corticosteroid (ICS) use or to the usual care
arm with adherence monitoring alone. All children had
poorly controlled asthma at baseline, taking ICS and
long-acting β-agonists. Subjects were seen in routine
clinics every 3 months for 1 year. The primary outcome
was the Asthma Control Questionnaire (ACQ) score.
Secondary outcomes included adherence and markers of
asthma morbidity.
Results 77 of 90 children completed the study
(39 interventions, 38 controls). Adherence in the
intervention group was 70% vs 49% in the control
group (p≤0.001). There was no significant difference in
the change in ACQ, but children in the intervention
group required significantly fewer courses of oral
steroids (p=0.008) and fewer hospital admissions
(p≤0.001).
Conclusions The results indicate that electronic
adherence monitoring with feedback is likely to be of
significant benefit in the routine management of poorly
controlled asthmatic subjects
Home oximetry to screen for obstructive sleep apnoea in Down syndrome
Objective Children with Down
syndrome are at high risk of obstructive sleep apnoea (OSA) and screening is
recommended. Diagnosis of OSA should be confirmed with multichannel sleep
studies. We aimed to determine whether home pulse oximetry (HPO) discriminates
children at high risk of OSA, who need further diagnostic multichannel sleep
studies.Design Cross-sectional prospective study
in a training sample recruited through three UK centres. Validation sample used
single-centre retrospective analysis of clinical data.Patients Children with Down
syndrome aged 0.5–6 years.Intervention Diagnostic multichannel
sleep study and HPO.Main outcome measures Sensitivity and
specificity of HPO to predict moderate-to-severe OSA.Results 161/202 children with Down syndrome
met quality criteria for inclusion and 25 had OSA. In this training sample, the
best HPO parameter predictors of OSA were the delta 12 s index >0.555
(sensitivity 92%, specificity 65%) and 3% oxyhaemoglobin (SpO2) desaturation index (3% ODI)>6.15 dips/hour
(sensitivity 92%, specificity 63%). Combining variables (delta 12 s index, 3%
ODI, mean and minimum SpO2) achieved
sensitivity of 96% but reduced specificity to 52%. All predictors retained or
improved sensitivity in a clinical validation sample of 50 children with
variable loss of specificity, best overall was the delta 12 s index, a measure
of baseline SpO2Â variability (sensitivity 92%;
specificity 63%).
Conclusions HPO screening could
halve the number of children with Down syndrome needing multichannel sleep
studies and reduce the burden on children, families and health services alike.
This approach offers a practical universal screening approach for OSA in Down
syndrome that is accessible to the non-specialist paediatrician.</p
Home oximetry to screen for obstructive sleep apnoea in Down syndrome
ObjectiveChildren with Down syndrome are at high risk of obstructive sleep apnoea (OSA) and screening is recommended. Diagnosis of OSA should be confirmed with multichannel sleep studies. We aimed to determine whether home pulse oximetry (HPO) discriminates children at high risk of OSA, who need further diagnostic multichannel sleep studies.DesignCross-sectional prospective study in a training sample recruited through three UK centres. Validation sample used single-centre retrospective analysis of clinical data.PatientsChildren with Down syndrome aged 0.5–6 years.InterventionDiagnostic multichannel sleep study and HPO.Main outcome measuresSensitivity and specificity of HPO to predict moderate-to-severe OSA.Results161/202 children with Down syndrome met quality criteria for inclusion and 25 had OSA. In this training sample, the best HPO parameter predictors of OSA were the delta 12 s index >0.555 (sensitivity 92%, specificity 65%) and 3% oxyhaemoglobin (SpO2) desaturation index (3% ODI)>6.15 dips/hour (sensitivity 92%, specificity 63%). Combining variables (delta 12 s index, 3% ODI, mean and minimum SpO2) achieved sensitivity of 96% but reduced specificity to 52%. All predictors retained or improved sensitivity in a clinical validation sample of 50 children with variable loss of specificity, best overall was the delta 12 s index, a measure of baseline SpO2variability (sensitivity 92%; specificity 63%).ConclusionsHPO screening could halve the number of children with Down syndrome needing multichannel sleep studies and reduce the burden on children, families and health services alike. This approach offers a practical universal screening approach for OSA in Down syndrome that is accessible to the non-specialist paediatrician.</jats:sec
Sleep in infants and toddlers with Down syndrome compared to typically developing peers:looking beyond snoring
Aims To compare sleep in infants and toddlers with Down syndrome (DS) to typically developing controls, including differences in snoring and sleep ecology (sleep setting and parent behaviors).MethodsParents of 104 children with DS and 489 controls aged 6-36 months completed the Brief Infant Sleep Questionnaire. We explored group differences, controlling for demographic variables.Results Parents of children with DS reported more sleep problems (45% v 19%), snoring (19% vs 2%), room-sharing (37% vs 17%), and less night-time sleep (55 mins) and total sleep over 24 hours (38 mins). They were more likely to be present when their child fell asleep (OR 4.40). Snoring increased night waking but did not limit night-time/24-hour sleep. However, parental presence was associated with 55 minutes less night-time and 64 minutes less 24-hour sleep. After controlling for snoring and parental presence, children with DS slept less at night (38 mins) but more in the day (21 mins) with no significant difference in 24-hour sleep. ConclusionsOverall, significant differences in sleep patterns, problems, and ecology were found between children with DS and controls. Parental presence at settling, not snoring, explained most differences, including over an hour’s less 24-hour sleep. Early intervention programmes that promote self-soothing skills could prevent the burden of sleep loss in young children with DS. <br/