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Published on: December 6, 2016
Diagnosis of Pediatric Obstructive Sleep Apnea Syndrome in Settings With Limited Resources
Maria Pia Villa1, Nicoletta Pietropaoli1, Maria Chiara Supino1
1Pediatric Sleep Disease Center, Child Neurology, Department of Neuroscience, Mental Health, and Sense Organs, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.
Insights
The combined use of sleep clinical record scores and nocturnal oximetry shows moderate success in predicting obstructive sleep apnea syndrome (OSAS) severity in children when polysomnography (PSG) is unavailable.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Diagnostic Tools
Background:
- Polysomnography (PSG) is the gold standard for diagnosing pediatric obstructive sleep apnea syndrome (OSAS).
- Limited availability of pediatric sleep laboratories necessitates development of alternative screening methods.
- Early identification of OSAS in children is crucial for timely intervention and management.
Purpose of the Study:
- To evaluate the combined utility of the sleep clinical record (SCR) and nocturnal oximetry (MOS) in predicting PSG results for pediatric OSAS.
- To assess the diagnostic accuracy of SCR and MOS, individually and in combination, for identifying different severities of OSAS.
- To determine if SCR and MOS can serve as effective screening tools in resource-limited settings.
Main Methods:
- A prospective study involving 268 children with suspected OSAS.
- Children underwent evaluation using SCR, followed by nocturnal oximetry (MOS) and PSG.
- SCR scores ≥6.5 and MOS >1 were considered positive indicators for OSAS.
Main Results:
- A positive SCR score was associated with a significantly increased risk of OSAS (AHI ≥1).
- An MOS >1 strongly predicted moderate-to-severe OSAS (AHI >5).
- The combination of SCR and MOS achieved moderate success in predicting primary snoring, mild OSAS, or moderate-to-severe OSAS.
Conclusions:
- Combined SCR and nocturnal oximetry offer a viable screening approach for pediatric OSAS when PSG is not feasible.
- While SCR shows high sensitivity, MOS provides excellent specificity for moderate-to-severe OSAS.
- This combined method aids in stratifying children's risk for sleep-disordered breathing, guiding further diagnostic steps.
Importance:
Although polysomnographic (PSG) testing is the gold standard for the diagnosis of obstructive sleep apnea syndrome (OSAS) in children, the number of pediatric sleep laboratories is limited. Developing new screening methods for identifying OSAS may reduce the need for PSG testing.
Objective:
To evaluate the combined use of the sleep clinical record (SCR) and nocturnal oximetry testing for predicting PSG results in children with clinically suspected OSAS.
Design, Setting, And Participants:
Prospective study over 10 months. A cohort of 268 consecutive children (mean [SD], age 6 [3] years) referred for clinically suspected OSAS was studied at a pediatric sleep center at a university hospital. Children with disorders other than adenotonsillar hypertrophy or obesity were excluded.
Main Outcomes And Measures:
Mild OSAS (obstructive apnea-hypopnea index [AHI], 1-5 episodes/h) and moderate-to-severe OSAS (AHI, >5 episodes/h) were the main outcome measures. Sleep clinical record scores greater than or equal to6.5 were considered positive, as were McGill oximetry scores (MOS) greater than 1, and these positive scores were the main explanatory variables in our study. Each participant was evaluated by the SCR, followed by pulse oximetry test the first night and PSG test in the sleep laboratory the second night.
Results:
Of the total participants, 236 (88.1%) were diagnosed with OSAS, 236 (88.1%) had a positive SCR score, and 50 (18.7%) had a positive MOS. Participants with positive SCR scores had significantly increased risk of an AHI greater than or equal to 1 (adjusted odds ratio [AOR], 9.3; 95% CI, 3.7-23.2; P < .001). Children with an MOS greater than 1 were significantly more likely to have an AHI greater than 5 episodes/h than children with an MOS equal to 1 (AOR, 26.5; 95% CI, 7.8-89.2; P < .001). A positive SCR score had satisfactory sensitivity (91.9%) and positive predictive value (91.9%) but limited specificity (40.6%) and negative predictive value (40.6%) for OSAS. An MOS greater than 1 had excellent specificity (97.4%) and positive predictive value (94%) but low sensitivity (39.2%) and fair negative predictive value (60.8%) for moderate-to-severe OSAS among children with a positive SCR score. The combination of SCR scores and MOS correctly predicted primary snoring, mild OSAS, or moderate-to-severe OSAS in 154 of 268 (57.4%) participants.
Conclusions And Relevance:
The combined use of the SCR score and nocturnal oximetry results has moderate success in predicting sleep-disordered breathing severity when PSG testing is not an option.
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