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Trial registered on ANZCTR
Registration number
ACTRN12624000465550p
Ethics application status
Not yet submitted
Date submitted
23/03/2024
Date registered
16/04/2024
Date last updated
16/04/2024
Date data sharing statement initially provided
16/04/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
The Paediatric Obstructive Sleep Apnoea (OSA) Screening Triple Test (POSTT) Study: Validation of a novel home delivered paediatric OSA screening test.
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Scientific title
The Paediatric Obstructive Sleep Apnoea (OSA) Screening Triple Test (POSTT) Study: Validation of a novel home delivered paediatric OSA screening test.
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Secondary ID [1]
311616
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
POSTT Study
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Paediatric Obstructive Sleep Apnoea
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Paediatric sleep disordered breathing
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Condition category
Condition code
Respiratory
330016
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0
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Sleep apnoea
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Intervention: The proposed intervention is a home-based POSTT consisting of nocturnal pulse oximetry, a validated PSQ, and video-assessment of tonsillar size. This is available as a standalone kit that can be mailed to study participants.
Participants will receive POSTT kits (already built and ready for testing) containing a sleep diary, pulse oximetry unit, disposable accessories, and instruction manual for parents to set up and perform PO and record significant events in the sleep diary. This instruction video and manual has been specifically designed and developed for this research trial.
a. Home Nocturnal Pulse Oximetry (PO): PO will be performed over one night in participants’ homes: This involves a small finger oximetry sensor and oximetry device (TGA Approved for paediatric use) which is worn over the course of one night's sleep. Parents/carers will also be required to complete a sleep diary notating the child's sleep symptoms and other night-time events. The Oximetry will be reported by a researcher sleep physician according to McGill scoring system for the presence and severity of obstructive sleep apnoea, namely Normal/inconclusive, Mild Obstructive Sleep Apnoea, moderate Obstructive Sleep Apnoea, severe Obstructive Sleep Apnoea.
b. Paediatric Sleep Questionnaire (PSQ): The PSQ consists of 22 symptom items encompassing 4 domains: sleep-related breathing, snoring, daytime somnolence, and behaviour. The overall score is calculated as a proportion of positive answers with a score greater or equal to 0.33 considered predictive for OSA. In this study, participants will receive a PSQ as part of the POSTT kit.
c. Video Study: In this study, participants will receive a smart-phone attached, single-use LED-lluminated (commercially available) tongue depressor which attaches to a smartphone video device (TGA approved) plus instructions for parents on how to record a brief video of their child’s oral cavity (as little as 5 seconds will be adequate). This recording will be remotely reviewed by a doctor to grade tonsil size from 0 to IV according to the Brodsky grading scale. With a positive result being a score of III or IV, and a negative result being I or II.
Whilst the kit is in the possession of the participant and family, they may directly contact the study research assistance via mobile phone call or text, for technical support - one 5 minute call per evening of study.
If once the kit is returned, any component of the triple test is deemed inadequate for reporting/scoring, it will be returned to the family for repeat testing within 1 week, and prior to the family undertaking the Gold standard Polysomnography test. A maximum of 1 repeat test will be offered/performed.
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Intervention code [1]
328256
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Diagnosis / Prognosis
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Comparator / control treatment
Comparator/Control Treatment: The Gold Standard test or 'control' treatment is the Polysomnography. It will be conducted over one night in a sleep laboratory in the presence of trained technical staff and under the supervision of a sleep physician. This involves continuous recording of multiple physiological variables (e.g., EEG, ECG, PO, digital video recording, etc.). If a single night study is deemed to have inadequate data or poor quality, then a second night’s study will be offered/performed. It will be reported according to standard reporting criteria and the presence and severity of any obstructive sleep apnoea will be reported. This study will be performed within 4 weeks of the POSTT which is the comparator, with no minimum time between the two studies.
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Control group
Active
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Outcomes
Primary outcome [1]
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Sensitivity and Specificity of POSTT for the prediction of moderate or severe Obstructive Sleep Apnoea will be determined.
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Assessment method [1]
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Sensitivity of OSA diagnoses will be determined by comparing POSTT results to the gold standard in-lab Polysomnography. The individual results from the McGill Oximetry Grade, Paediatric Sleep Questionnaire (PSQ) and Brodsky Tonsil grade will be combined to produce an Obstructive Sleep Apnoea score (normal/mild vs Moderate /severe), and compared to the Polysomnography Report (normal/mild vs Moderate/severe).
Apnoea Hypopnea Index (AHI), McGill Oximetry Grade, Paediatric Sleep Questionnaire (PSQ), Brodsky tonsil grade.
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Timepoint [1]
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POSTT completed on Day 1, and overnight Polysomnography completed within the next 4 weeks.
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Secondary outcome [1]
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POSTT test repeat proportion
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Assessment method [1]
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The number of POSTT tests that needed repeating due to inadequacy in one or more of the test components as a proportion of total POSTTs.
i) Adequacy of the overnight oximetry will be determined by the sleep physician (study researcher) and will be based on criteria such as: duration (> 6 hours sleep), and consistent signal quality,
ii) Adequacy of the tonsil video will be determined by the ENT surgeon (study researcher)
iii) Adequacy of the PSQ will be determined by the study researchers if all questions are answered (yes, no, don't know).
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Timepoint [1]
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Once patient has completed POSTT kit
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Secondary outcome [2]
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Test completion proportion
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Assessment method [2]
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Number of POSTT tests that remained incomplete despite repeat testing and technician support, as a proportion of total POSTTs.
Lack of POSTT kit completion will be determined if any of the 3 components of the POSTT remains incomplete despite 1 repeat test offered/completed, and adequate (5 min phone-call) technician support on each night of the study.
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Timepoint [2]
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Once all patients have completed POSTT kits.
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Secondary outcome [3]
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Patient Satisfaction
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Assessment method [3]
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Parent satisfaction with the POSTT and other feedback will be assessed with a Likert scale satisfaction survey, sent to the parents of study participants within 1 week of completing both the POSTT and PSG. Net promoter score (NPS): for the POSTT and PSG will be calculated.
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Timepoint [3]
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Within 1 week of completing the POSTT and Polysomnography, the Net Promoter score (NPS); for the POSTT and Polysomnography will be calculated
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Eligibility
Key inclusion criteria
a) Target Population: Australian children aged 2-16 years and at least one parent/guardian
b) Sample Populations:
- Patients, who have already been referred for PSG and fit inclusion criteria, will be recruited from each participating sleep centre.
c) Study participants will be considered eligible for inclusion if they are aged between 2-16 years at the time of recruitment, and able to complete the POSTT within 4 weeks of PSG.
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Minimum age
2
Years
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Maximum age
70
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Exclusion Criteria 1: Based on studies showing reduced accuracy of pulse oximetry testing in these populations, children with the following conditions will be excluded from the study:
a. Neuromuscular disease,
b. Congenital syndromes (e.g. Trisomy 21),
c. Congenital heart diseases,
d. Chronic lung disease requiring oxygen therapy,
e. Previous trauma/burns to airway/face/neck,
f. Weight <3rd or >95th centile for age
Exclusion Criteria 2: Previous adenotonsillectomy (this renders tonsillar size component of index test non-contributory).
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Study design
Purpose of the study
Diagnosis
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/06/2024
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Actual
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Date of last participant enrolment
Anticipated
30/09/2025
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Actual
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Date of last data collection
Anticipated
1/06/2026
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Actual
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Sample size
Target
129
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NT,QLD,VIC
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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The Passe and Williams Foundation
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Address [1]
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Country [1]
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Australia
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Primary sponsor type
University
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Name
Monash University
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Address
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
318323
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Country [1]
318323
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
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Monash University Human Research Ethics Committee
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Ethics committee address [1]
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https://www.monash.edu/researchoffice/ethics
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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06/05/2024
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Approval date [1]
314772
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Ethics approval number [1]
314772
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Summary
Brief summary
Obstructive sleep apnoea (OSA) has serious negative impacts to the physical health, mental health, and cognitive function and development of children. Unfortunately, OSA is quite common and is reported to occur between 1-6% of children. However, currently, the gold standard for OSA assessment (a sleep study or polysomnography (PSG)) is expensive and difficult to access. The limited access to PSG testing leads to unnecessary risk for these children, as it often delays in treatment, and/or results in an incomplete assessment prior to surgeries like adenotonsillectomy. However, a novel postage delivered and home conducted kit may be able to reduce these issues. The Paediatric OSA Screening Triple Test (POSTT) is TGA approved and includes an overnight oximetry device, a validated sleep questionnaire, and video tonsil assessment tool. This proposed research will compare the novel POSTT kit to PSG and determine the diagnostic accuracy, real-world feasibility, and patient satisfaction and preference. We hypothesise that the POSTT kit will demonstrate to be as accurate and more feasible than PSG. If the hypothesise is correct, the novel kit will allow for an increase in access to care, especially for regional and rural patients.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Paul Paddle
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Address
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Monash Health, Department of Otolaryngology, Head and Neck Surgery: 823-865 Centre Road, Bentleigh East, Victoria 3165
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Country
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Australia
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Phone
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+61 447558499
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Paul Paddle
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Address
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Monash Health, Department of Otolaryngology, Head and Neck Surgery: 823-865 Centre Road, Bentleigh East, Victoria 3165
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Country
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Australia
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Phone
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+61 447558499
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Paul Paddle
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Address
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Monash Health, Department of Otolaryngology, Head and Neck Surgery: 823-865 Centre Road, Bentleigh East, Victoria 3165
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Country
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Australia
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Phone
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+61 447558499
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Fax
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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