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Published on: December 6, 2016
Current hypopnea scoring criteria underscore pediatric sleep disordered breathing
Cheng-Hui Lin1, Christian Guilleminault
1Stanford University Sleep Medicine Division, Stanford, CA, USA.
Insights
The American Academy of Sleep Medicine (AASM) criteria significantly underdiagnosed obstructive sleep apnea (OSA) in children compared to Stanford criteria. This highlights potential issues with AASM hypopnea scoring in pediatric sleep disordered breathing (SDB) diagnosis.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Diagnostic Criteria Evaluation
Background:
- Accurate diagnosis of pediatric sleep disordered breathing (SDB) is crucial for child health.
- Different scoring criteria for polysomnograms (PSGs) may lead to variations in SDB diagnosis.
- The 2007 American Academy of Sleep Medicine (AASM) pediatric scoring criteria and Stanford scoring criteria are commonly used.
Purpose of the Study:
- To compare the 2007 AASM pediatric scoring criteria with Stanford scoring criteria for pediatric polysomnograms.
- To evaluate the impact of different scoring systems on the diagnosis of sleep disordered breathing (SDB) in children.
- To characterize the differences in obstructive sleep apnea (OSA) diagnosis rates between the two scoring systems.
Main Methods:
- Retrospective analysis of diagnostic and post-treatment nocturnal polysomnograms (PSGs) from children (age 2-18 years) with suspected SDB.
- Independent, blinded analysis of PSGs using both AASM and Stanford scoring criteria by a single researcher.
- Comparison of diagnostic yield and apnea-hypopnea index (AHI) between the two scoring systems.
Main Results:
- The Stanford criteria identified 207 abnormal PSGs, while the AASM criteria identified only 39 abnormal PSGs out of 209 total.
- Stanford criteria diagnosed OSA in 99% of referred children, whereas AASM criteria diagnosed OSA in only 19%.
- AASM AHI was significantly lower and skewed compared to Stanford AHI; all 99 treated children showed improvement with Stanford criteria.
Conclusions:
- The AASM scoring criteria significantly underdiagnosed OSA in children compared to the Stanford criteria.
- The scoring of hypopneas is a primary factor differentiating the two criteria.
- The current AASM definition of hypopnea may hinder the accurate recognition of SDB in pediatric populations.
Objective:
This is a retrospective study comparing 2007 American Academy of Sleep Medicine (AASM) pediatric scoring criteria and Stanford scoring criteria of pediatric polysomnograms to characterize the impact different scoring systems have upon the diagnosis of sleep disordered breathing in children.
Methods:
The diagnostic and post-treatment nocturnal polysomnograms (PSGs) of children (age 2-18 years) consecutively referred to an academic sleep clinic for evaluation of suspected sleep disordered breathing (SDB) for 1 year were independently analyzed by a single researcher using AASM and Stanford scoring criteria in a blinded fashion.
Results:
A total of 209 (83 girls) children with suspected SDB underwent clinical evaluation and diagnostic PSG. Analysis of the diagnostic PSGs using the Stanford and AASM criteria classified 207 and 39 studies as abnormal, respectively. The AASM scoring criteria classified 19% of subjects as having obstructive sleep apnea (OSA) while the Stanford criteria diagnosed 99% of the subjects with OSA who were referred for evaluation of suspected sleep disordered breathing. There was a positive correlation between SDB-related clinical symptoms and anatomic risk factors for SDB. Scatter-plot analyses showed that the AASM apnea hypopnea index (AHI) was not only significantly lower compared to the Stanford AHI but also skewed in distribution. Ninety-nine children were restudied with PSG (9 were initially diagnosed with SDB with AASM criteria, whereas all 99 were diagnosed with SDB with Stanford criteria). All 99 children had been treated and had a post-treatment clinical evaluation and post-treatment PSG during the study period. All 99 children evaluated after treatment showed improvement in clinical presentation, Stanford AHI, and oxygen saturation during sleep.
Conclusion:
The AASM scoring criteria classified 19% of subjects as having OSA while the Stanford criteria diagnosed 99% of the subjects with OSA who were referred for evaluation of suspected sleep disordered breathing. The primary factor differentiating the AASM and Stanford criteria was the scoring of hypopneas. The AASM definition of hypopnea may be detrimental to the recognition of SDB in children.
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