Conducting unattended home sleep studies in children with narcolepsy and healthy matched controls: a feasibility study

Introduction: We investigated the technical feasibility and acceptability of conducting unattended home sleep studies for research purposes in children with and without narcolepsy. Methods: 23 children with narcolepsy (age: 8-15 years) and 23 healthy gender and age-matched controls were recruited. As part of a larger descriptive study called ‘The Paediatric Narcolepsy Project’, we aimed to investigate the differences in sleep architecture between children with and without narcolepsy. Children underwent home polysomnography (PSG) using a portable PSG system (Embla® Systems). A standard montage was used to measure sleep architecture with nine EEG channels (F3, F4, C3, Cz, C4, O1, O2, M1, M2), two electro-oculography (EOG) and two electromyography (EMG) channels. All children were set up in their own homes by the researcher. Study failure was defined as sleep recordings with less than four hours of interpretable sleep data. Four hours of sleep was deemed acceptable to capture two sleep cycles. Failed home studies were classified into three main areas of sensor removal, equipment failure or battery failure. Results: 22/23 children with narcolepsy (male=15, female=8) underwent home PSG. One child declined due to a previous negative PSG experience in hospital. Similarly, 22/23 matched controls underwent the sleep recording. One child became unwell during the set up, so did not proceed.16/22 (73%) of the children with narcolepsy were successfully studied and all of the control children were successfully studied. Discussion: This research has shown that conducting unattended home sleep studies to measure sleep architecture in children with narcolepsy and healthy controls for research purposes is feasible and is tolerated by the majority of children. However, our data show that unattended home sleep studies carry a risk of data loss, even when set up in the home by a trained researcher

Paediatric Narcolepsy: A Review of Diagnosis and Management

Narcolepsy is a chronic disabling neurological sleep disorder that requires lifelong treatment. We have outlined the clinical features of narcolepsy, the assessment and diagnosis process and have summarised the existing treatment options for children and adolescents with narcolepsy. In the future, the approach to management of paediatric narcolepsy should ideally be in a multidisciplinary setting, involving specialists in sleep medicine, sleep physiology, neurologists and psychologists/psychiatrists. A multidisciplinary approach will help to manage the potential impact of narcolepsy on children and adolescents who are in a stage of their life that is critical to their physical, emotional and social development and their academic attainment

Initial demonstration of in vivo tracing of axonal projections in the macaque brain and comparison with the human brain using diffusion tensor imaging and fast marching tractography.

Diffusion tensor imaging (DTI), a magnetic resonance imaging technique, is used to infer major axonal projections in the macaque and human brain. This study investigates the feasibility of using known macaque anatomical connectivity as a "gold-standard" for the evaluation of DTI tractography methods. Connectivity information is determined from the DTI data using fast marching tractography (FMT), a novel tract-tracing (tractography) method. We show for the first time that it is possible to determine, in an entirely noninvasive manner, anatomical connection pathways and maps of an anatomical connectivity metric in the macaque brain using a standard clinical scanner and that these pathways are consistent with known anatomy. Analogous human anatomical connectivity is also presented for the first time using the FMT method, and the results are compared. The current limitations of the methodology and possibilities available for further studies are discussed