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Published on: December 6, 2016
Clinical assessment of pediatric obstructive sleep apnea: a systematic review and meta-analysis
Victor Certal1, Emanuel Catumbela, João C Winck
1Department of Otorhinolaryngology, Hospital Sao Sebastiao, Santa Maria da Feira, Portugal. victorcertal@gmail.com
Insights
Clinical symptoms and signs are not reliable for diagnosing pediatric obstructive sleep apnea (OSA). Current methods show poor accuracy, necessitating new diagnostic approaches for better detection of this common childhood condition.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Diagnostic Accuracy Studies
Background:
- Clinical assessment of symptoms and signs is standard for investigating pediatric obstructive sleep apnea (OSA).
- The diagnostic accuracy of these clinical indicators for pediatric OSA requires systematic evaluation.
Purpose of the Study:
- To systematically assess the diagnostic accuracy of individual and combined clinical symptoms and signs in predicting pediatric OSA.
- To evaluate the evidence base for current clinical diagnostic methods in pediatric OSA.
Main Methods:
- A systematic literature review and diagnostic meta-analysis were conducted.
- Ten studies involving 1,525 children were included, comparing clinical assessment to polysomnography.
- Diagnostic accuracy metrics including sensitivity, specificity, and HSROC models were analyzed.
Main Results:
- Significant variability in sensitivity and specificity was observed for individual symptoms and signs.
- High sensitivity but low specificity was noted for tonsillar size and snoring.
- High specificity but low sensitivity was found for excessive daytime somnolence, observed apnea, and breathing difficulties.
- Combined symptom/sign models showed moderate accuracy, with HSROC indicating poor overall diagnostic performance.
Conclusions:
- Neither isolated nor combined clinical symptoms and signs provide satisfactory diagnostic performance for pediatric OSA.
- Current clinical assessment methods are insufficient for accurate pediatric OSA prediction.
- Development of alternative diagnostic models is crucial to enhance accuracy.
Objectives/Hypothesis:
Clinical symptoms and signs are routinely used to investigate pediatric obstructive sleep apnea (OSA). This study aimed to systematically assess the evidence for the diagnostic accuracy of individual or combined clinical symptoms and signs in predicting pediatric OSA.
Study Design:
A systematic review of the literature and diagnostic meta-analysis.
Methods:
Four medical databases were searched (from inception to August 2011). Studies were included that compared the clinical assessment with the current gold standard (full polysomnography). The study quality was assessed using the quality assessment tool for diagnostic accuracy studies. Summary estimates of diagnostic accuracy were determined using the sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and hierarchical summary receiver operating characteristic (HSROC) model for meta-analyses.
Results:
Ten diagnostic studies with 1,525 patients were included in the review. There was substantial variation in the sensitivity and specificity among different symptoms and signs, as well as across studies. Tonsillar size and snoring reported by parents or caregivers had high sensitivity but low specificity. In contrast, excessive daytime somnolence, observed apnea, and difficulty in breathing during sleep had high specificity but low sensitivity. Seven models of a combination of symptoms and signs presented moderate sensitivity (range, 0.04-0.94) and specificity (range, 0.28-0.99). The HSROC indicates poor diagnostic performance of the symptoms and signs in predicting pediatric OSA.
Conclusions:
Neither single nor combined symptoms and signs have satisfactory performance in predicting pediatric OSA. Alternative diagnostic models are necessary to improve the accuracy.
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