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Published on: December 6, 2016
Accuracy of clinical assessment of paediatric obstructive sleep apnoea in two English centres
E L Sproson1, A M Hogan, C M Hill
1Department of ENT, Queen Alexandra Hospital, Portsmouth, UK. e.sproson@doctors.org.uk
Insights
Clinical diagnosis of obstructive sleep apnoea in children is insensitive and lacks specificity. A tested algorithm also failed to identify children at high risk for post-adenotonsillectomy complications.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
Background:
- Obstructive sleep apnoea (OSA) is a common condition in children.
- Accurate diagnosis is crucial for timely intervention and management.
Purpose of the Study:
- To evaluate the sensitivity and specificity of clinical diagnosis for paediatric obstructive sleep apnoea.
- To assess a clinical algorithm's effectiveness in identifying children at high risk for post-adenotonsillectomy complications.
Main Methods:
- Sixty-seven children (aged 3-8 years) underwent clinical assessment.
- Overnight polysomnography was used as the gold standard for OSA diagnosis.
Main Results:
- Clinical diagnosis showed 68.4% sensitivity and 59.5% specificity for OSA.
- The algorithm failed to identify high-risk children, despite polysomnography confirming severe OSA in seven cases.
Conclusions:
- Clinical assessment for paediatric OSA is unreliable.
- The studied algorithm is ineffective for risk stratification.
- Improved diagnostic guidelines for paediatric OSA are needed, especially in regions with limited polysomnography access.
Objectives:
To ascertain the sensitivity and specificity of clinical diagnosis of obstructive sleep apnoea in children, and to determine if a published clinical algorithm identifies those at high risk of post-adenotonsillectomy complications.
Method:
Sixty-seven children aged three to eight years underwent clinical assessment and overnight polysomnography.
Results:
Polysomnography detected a significant apnoea-hypopnoea index (i.e. > or =5, indicating significant obstructive sleep apnoea) in 13 (43 per cent) children with a clinical diagnosis of obstructive sleep apnoea and in six (19 per cent) children with no such diagnosis. The sensitivity of clinical assessment was 68.4 per cent and the specificity 59.5 per cent. The post-operative risk algorithm failed to identify any high risk children, although in actuality seven had severe obstructive sleep apnoea confirmed by polysomnography.
Conclusions:
This study of two English centres confirms that the clinical diagnostic process for obstructive sleep apnoea is reasonably insensitive and has low specificity. The studied algorithm discriminated poorly between children with and without severe obstructive sleep apnoea. Realistic diagnostic screening guidelines for paediatric sleep apnoea are overdue in the UK, where access to polysomnography is limited.
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