Related Experiment Video
Updated: Apr 21, 2026
Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults
Published on: February 9, 2022
The impact of recent changes to the respiratory scoring rules in pediatrics
Gillian M Nixon1, Melissa Hyde2, Sarah N Biggs3
1The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Victoria, Australia and Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
Insights
The 2007 American Academy of Sleep Medicine (AASM) scoring rules underestimate obstructive sleep apnea (OSA) severity in children compared to older guidelines. Including respiratory event related arousals (RERAs) with AASM 2007 rules aligns with previous findings.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Clinical Diagnostics
Background:
- The American Academy of Sleep Medicine (AASM) updated its polysomnography (PSG) scoring guidelines in 2007 and 2012.
- A significant change involved the definition of hypopnea, altering the airflow reduction threshold from 50% to 30% for pediatric obstructive sleep apnea (OSA).
Purpose of the Study:
- To evaluate the impact of different polysomnography (PSG) scoring rules on the assessment of obstructive sleep apnea (OSA) severity in children.
- To compare the obstructive apnea-hypopnea index (OAHI) derived from modified ATS 1996, AASM 2007, and AASM 2007 with respiratory event related arousals (RERA) scoring criteria.
Main Methods:
- Polysomnography (PSG) was performed on 42 children (mean age 4.3 years).
- Obstructive apnea-hypopnea index (OAHI) was calculated using three distinct scoring rule sets: modified ATS 1996, AASM 2007, and AASM 2007 including RERAs (AASM+RERA).
Main Results:
- The AASM 2007 OAHI was significantly lower than the modified ATS 1996 OAHI (median 0.4 vs. 0.8 events/h), underestimating OSA severity in 24% of cases.
- The AASM+RERA OAHI was also lower than the modified ATS 1996 OAHI but the difference was not clinically significant except at very high OAHI values.
Conclusions:
- The AASM 2007 scoring rules result in a lower OAHI and underestimate OSA severity in children compared to previous standards.
- Incorporating RERAs into the AASM 2007 OAHI calculation yields results comparable to older scoring methods.
- These findings support the 2012 AASM guideline update, which includes events with less than 50% airflow reduction, acknowledging that morbidity exists even in mild OSA.
Study Objectives:
In 2007 the American Academy of Sleep Medicine (AASM) published polysomnography (PSG) scoring guidelines, which were updated in 2012. A key change in terms of scoring respiratory events in children was the threshold for reduction in airflow (50% vs 30%) for the definition of hypopnea. This study aimed to determine the impact of different scoring rules on the assessment of severity of obstructive sleep apnea (OSA) in children.
Methods:
Forty-two children (mean age 4.3 y, 16 F) underwent PSG. An obstructive apnea-hypopnea index (OAHI) was determined using three scoring rules: (1) ATS 1996 rules with minor modifications (modified ATS 1996); (2) AASM 2007 rules (AASM 2007); and (3) AASM 2007 rules with respiratory event related arousals included in the OAHI (AASM+RERA).
Results:
The AASM 2007 OAHI (median 0.4 events/h, range 0, 14) was lower than the modified ATS 1996 OAHI (median 0.8 range 0, 26.1, p < 0.001), underestimating severity of disease in 24% of cases. The AASM+RERA OAHI (median 0.8, range 0, 19.1) was also lower than the modified ATS 1996 OAHI (p = 0.02), but the difference was not clinically significant except at very high OAHIs.
Conclusion:
The AASM 2007 rules lead to a lower OAHI and lesser OSA severity when compared to the previous standard. Inclusion of RERAs in the AASM 2007 OAHI leads to a comparable OAHI to the previous rules. Given that morbidity has been demonstrated even in mild OSA, these results support the inclusion of events with a reduction in airflow of less than 50% as included in the updated AASM rules in 2012.
More Related Videos
Related Concept Videos
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:30Respiratory System Abnormal Finding I: Inspection and Percussion
Inspection Findings
During an inspection, several findings may suggest the presence of respiratory distress or disease. Pursed-lip breathing, where exhalation is slowed by...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:27Physical Assessment of the Respiratory Tract II: Inspection
Chest Configuration
The chest configuration...
01:31Respiratory System Abnormal Finding II: Palpation and Auscultation
Palpation Findings
During a respiratory assessment, palpation can reveal several vital abnormalities: