Obstructive sleep apnea (OSA) in children is a prevalent, albeit largely undiagnosed disease associated with a large spectrum of morbidities. Overnight in-lab polysomnography remains the gold standard diagnostic approach, but is time-consuming, inconvenient, and expensive, and not readily available in many places. Simplified Home Respiratory Polygraphy (HRP) approaches have been proposed to reduce costs and facilitate the diagnostic process. However, evidence supporting the validity of HRP is still scarce, hampering its implementation in routine clinical use. The objectives were: Primary; to establish the diagnostic and therapeutic decision validity of a simplified HRP approach compared to PSG among children at risk of OSA. Secondary: (a) Analyze the cost-effectiveness of the HRP versus in-lab PSG in evaluation and treatment of pediatric OSA; (b) Evaluate the impact of therapeutic interventions based on HRP versus PSG findings six months after treatment using sleep and health parameters and quality of life instruments; (c) Discovery and validity of the urine biomarkers to establish the diagnosis of OSA and changes after treatment.

Introduction: Diagnosis method of sleep apnea is polysomnography (PSG) and respiratory polygraphy (RP). Both systems are costly, time consuming and uncomfortable. The objective of our study was to validate an infrared thermographic camera with an artificial intelligence system, in order to identify apneic respiratory events in adults with clinical suspicion of OSA. Methods: Total number of respiratory events (apneas and hypopneas) detected by facial temperature micro-changes were analyzed and compared with events detected by nasal flow quantified by the PSG nasal cannula and thermistor. The result of both methods was classified by binary form as normal study if it presented an AHI≤10 or pathological if the AHI was>10. Results: 30 records were full valuable (age 48±11 years, 83% men, body mass index 27± 3.7 kg/m2, and Epworth of 9±4 points). 16 studies were normal on PSG and 14 were pathological. Thermographic camera was able to detect all normal studies (100% specificity) and 12 of the 14 pathological studies, classifying only 2 pathological studies as normal. Table I presents the validity results. Conclusions: Use of this system is highly valid, especially for diagnosing the presence of OSA (AHI >10). If these results are confirmed with a greater number of patients, the potential implantation of thermography treated with artificial intelligence could result in a new “no contact” diagnostic system for patients with suspected OSA.

Introduction: OSA children gold standar diagnosis method is polysomnography (PSG), wich is expensive and not available across centers. HRP has been proposed as diagnostic method but its validity evidence is still scarce. Objetive was to assess the diagnostic validity of HRP compared with the PSG. Material and Methods: Randomized, single blind and crossover trial in children aged 2 to 14 years with clinical suspicion of OSA. They performed HRP (Apnea link Air®) and PSG were carried out in different order according to randomization. Data from HRP and from full PSG will be compared according to the different apnea-hypopnea index (AHI) and the concordance of the diagnosis when using clinical findings and data from PSG or HRP. Results: 493 children were randomized; 248 began with HRP continuing with PSG (group I) and 245 started with PSG followed by a HRP (Group II). It was necessary to repeat 4 of 208 PSG (1,9%) and 90 of 211 HRP (42,7%) in group I, being valid after repetition 3 of 4 PSG (75%) and 31 of 90 HRP (34%). In group II, 7 of 201 PSG (3%) and 89 of 215 HRP (41%) were repeated, being valid after repetition 5 of 7 PSG (71%) and 43 of 89 HRP (48%).Difference was found between PSG AHI (3.9;IR 2.3–7.3) and HRP AHI (3.3;IR 1.8–5.7), p=0.001.Correlation between both AHI values was 0.455 (p<0.001) and intraclass correlation coefficient was 0.491(0.277-0.632). Area under AHI HRP curve of the diagnosis of OSA with AHI PSG higher than 3, was 0.753 (0,694-0,811). Conclusion: Results of validity of this HRP is only modest and not allow a generalized use for diagnosis of OSA in children. It forces to repeat almost half of test, and then only half of these are valid.

Introduction: Lung cancer screening using low dose CT (LDCT) reduces mortality in a population at risk. The number of subjects needed to screen may pose a significant challenge to a national health service. We sought to investigate the feasibility a lung cancer screening program using LDCT in a restricted population of very high risk individuals. Patients and Methods: Prospective data on the first 94 subjects enrolled in the LDCT screening program at our hospital were included in this pilot study. Among patients meeting NLST criteria, only those with emphysema, COPD, and/or nodules will undergo annual screening. Screening was performed according to the consensus International Early Lung Cancer Action Program (IELCAP) protocol. Results: Of the 94 subjects included in the program thus far, 5 (5.3%) failed to undergo baseline testing. Mean age of those undergoing baseline LDCT was 63.17 SD(6.5) with a median tobacco exposure of 50 (IQR: 40-80) pack-years. 60% were current smokers, 58 patients had COPD and 75 had emphysema (84%). Mean FEV1 was 2.06 L (DS 0.63) which was 76% of predicted and 39 subjects (43.8%) had a diffusing capacity of carbon monoxide below 80% of predicted. One patient required bronchoscopy for cryptogenic organizing pneumonia (COP). Ten patients (11%) had nodules ≥ 6mm. Four of them had a follow up LDTC at 3 months. The remaining 6 patients are awaiting follow up LDCT. Conclusions: Lung cancer screening is feasible in patients with COPD and/or emphysema meeting NLST criteria. Despite concerns regarding excess positive screening findings in this population, nodules 6 mm or greater are relatively rare in this population of very high risk individuals.