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Should children with suspected obstructive sleep apnea syndrome and normal nap sleep studies have overnight sleep
M M Saeed1, T G Keens, M W Stabile
1Division of Pediatric Pulmonology, Mattel Children's Hospital, University of California at Los Angeles School of Medicine, USA.
Insights
Daytime nap studies for sleep apnea in children are not highly sensitive for predicting abnormal overnight polysomnography (ONP) results. However, abnormal nap study findings suggest a high likelihood of obstructive sleep apnea syndrome.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
Background:
- Overnight polysomnography (ONP) is the gold standard for diagnosing sleep-disordered breathing but is costly and time-consuming.
- Daytime nap studies are utilized as a screening tool for sleep-disordered breathing in children.
Purpose of the Study:
- To evaluate if normal or mildly abnormal daytime nap studies can rule out the need for ONP in children.
- To determine if specific nap study abnormalities predict abnormal ONP findings in children with suspected obstructive sleep apnea syndrome.
Main Methods:
- Retrospective chart review of 143 children with suspected obstructive sleep apnea syndrome.
- Comparison of daytime nap study findings with overnight polysomnography (ONP) results.
- Analysis of individual nap study parameters for predictive value of abnormal ONP.
Main Results:
- 66% of overnight polysomnograms (ONP) were abnormal, while 59% of nap studies were mildly abnormal.
- No single nap study parameter demonstrated high sensitivity in predicting abnormal ONP.
- Most nap study parameters exhibited good specificity and positive predictive value for abnormal ONP.
Conclusions:
- Individual nap study parameters have low sensitivity for predicting abnormal ONP findings in children.
- Abnormal findings on a daytime nap study indicate a high probability of obstructive sleep apnea syndrome, warranting further investigation or treatment.
Study Objectives:
Overnight polysomnography (ONP) is the "gold standard" for the diagnosis of sleep-disordered breathing, but it is expensive and time-consuming. Thus, daytime nap studies have been used as screening tests. If the findings of a nap study are normal or mildly abnormal, should ONP be performed? Do specific abnormalities in nap studies predict abnormal findings in ONP? To answer these questions, we conducted this study.
Design:
Retrospective chart review.
Setting:
Children's hospital.
Participants:
One hundred forty-three children with suspected obstructive sleep apnea syndrome secondary to isolated adenotonsillar hypertrophy, who had normal or mildly abnormal nap studies, and underwent ONP.
Measurements And Results:
We compared daytime nap and overnight polysomnograms in 143 children (52 girls; mean [+/- SD] age, 5.6 +/- 3.1 years). Total sleep time was 1 h in daytime nap, and 5.1 +/- 1.3 h in ONP. The interval between the two studies was 5.9 +/- 4.8 months. The findings of 59% of the nap studies were mildly abnormal, while 66% of overnight studies were abnormal. No individual nap study parameter (including short obstructive apneas, hypopneas, hypoxemia, hypoventilation, snoring, paradoxical breathing, gasping, retractions) had good sensitivity at predicting abnormal overnight polysomnograms, but most had good specificity and positive predictive value.
Conclusions:
We conclude that individual nap study parameters are not very sensitive in predicting abnormal ONP findings. However, when nap study parameters are abnormal, the chance of obstructive sleep apnea syndrome is high.