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Obstructive sleep apnea in preschool-aged Japanese children - efficiency of screening using lateral neck radiography
Takuro Kitamura1, Soichiro Miyazaki2, Ryuichi Kobayashi3
1a Department of Otorhinolaryngology-Head and Neck Surgery , University of Occupational and Environmental Health , Kitakyushu , Japan ;
Insights
Obstructive sleep apnea (OSA) is more prevalent in preschoolers using newer diagnostic criteria. Lateral neck radiography can help detect OSA but isn't recommended for all children due to radiation concerns.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Diagnostic Imaging
Background:
- Obstructive sleep apnea (OSA) is a common sleep disorder in children.
- Accurate diagnosis and prevalence estimation are crucial for effective management.
- Previous diagnostic criteria may underestimate OSA prevalence in young children.
Purpose of the Study:
- To determine the prevalence of OSA in preschool-aged children using updated criteria.
- To evaluate the effectiveness of lateral neck radiography as a screening tool for pediatric OSA.
- To compare diagnostic yields between ICSD-2 and ICSD-3 criteria.
Main Methods:
- A community-based study involving 211 preschool children aged 3-6 years.
- Sleep-related questionnaires administered to parents.
- Home-based type 3 portable monitoring and clinical examinations, including lateral neck radiography, for eligible subjects.
Main Results:
- The weighted prevalence of OSA was 7.3% by ICSD-2 and 12.8% by ICSD-3.
- Lateral neck radiography showed a slightly better predictive value for OSA than visual inspection of tonsil size.
- Radiographic ratios (adenoidal/nasopharyngeal, tonsil/pharyngeal) demonstrated diagnostic utility.
Conclusions:
- The prevalence of OSA in preschoolers is higher when diagnosed using ICSD-3 criteria compared to ICSD-2.
- Lateral neck radiography is effective in assessing upper airway anatomy for OSA detection in this age group.
- Routine use of radiography for OSA screening in all preschool children is not recommended due to radiation exposure concerns.
Abstract:
Conclusions The prevalence of obstructive sleep apnea (OSA) in preschool-aged children diagnosed by the International Classification of Sleep Disorders (ICSD) version 3 criteria was relatively higher than that diagnosed by ICSD-2. Although the assessment of the upper airway by lateral neck radiography was effective for detecting OSA in this age group, this assessment is not recommended for all children as a screening method because of parental concern related to radiation exposure. Objective This study investigated the prevalence of OSA and the screening capacity of lateral neck radiography in community-based preschool-aged children. Methods Parents of 211 children aged 3-6 years were requested to complete the sleep-related questionnaire. Subjects who agreed to further investigations were invited to undergo home type 3 portable monitoring and clinical examination, including radiography. We estimated the prevalence of OSA and evaluated the detection power of radiography for predicting OSA. Results One hundred and eighty-eight (89.1%) subjects completed the questionnaire and 67 (31.8%) agreed to further examinations. The weighted prevalence was 7.3% and 12.8% by ICSD-2 and 3, respectively. Area under the receiver operator curve for the adenoidal/nasopharyngeal and tonsil/pharyngeal ratios measured using radiography was slightly larger than that for tonsil size graded by visual inspection.
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