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Home respiratory polygraphy in obstructive sleep apnea syndrome in children: Comparison with a screening
Albane B R Maggio1, Maurice Beghetti2, Hélène Cao Van3
1Health and Movement Consultation, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, Switzerland.
Insights
The Obstructive Airway Child test (OACT) questionnaire effectively rules out moderate to severe obstructive sleep apnea syndrome (OSAS) in children without maxillofacial issues. A low OACT score can prevent unnecessary sleep studies, saving time and resources.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Diagnostic Accuracy Studies
Background:
- Obstructive sleep apnea syndrome (OSAS) affects up to 59% of children with sleep-disordered breathing.
- Accurate diagnosis is crucial, but current methods like home respiratory polygraphy (HRP) can be resource-intensive.
Purpose of the Study:
- To evaluate the Obstructive Airway Child test (OACT) questionnaire's adequacy in identifying OSAS in children.
- To compare OACT questionnaire results against home respiratory polygraphy (HRP) findings.
Main Methods:
- A cohort of 45 children (5-16 years) with suspected OSAS underwent both the 12-item OACT questionnaire and HRP.
- OSAS severity was determined using the apnea-hypopnea index (AHI) from HRP.
Main Results:
- HRP identified mild OSAS in 60% and moderate OSAS in 15% of children.
- The OACT questionnaire demonstrated high sensitivity (93% for mild, 71% for moderate OSAS) but low specificity.
- An OACT score below 61 showed a strong negative predictive value (87%) for moderate to severe OSAS.
Conclusions:
- The OACT questionnaire is a valuable tool for excluding moderate to severe OSAS in children without maxillofacial malformations.
- Children scoring under 61 on the OACT may avoid HRP or polysomnography (PSG), reducing healthcare costs.
- A score above 61 necessitates further evaluation with HRP or PSG due to the questionnaire's limited performance in identifying OSAS at higher scores.
Objectives:
The prevalence of obstructive sleep apnea syndrome (OSAS) in children referred for sleep-disordered breathing reaches up to 59%. We aimed to test the adequacy of a questionnaire compared to home respiratory polygraphy (HRP), in 45 subjects (5-16 years-old), without maxillofacial malformations nor other comorbidities, presenting with symptoms compatible with OSAS.
Methods:
All children passed a 12-items questionnaire (Obstructive Airway Child test: OACT) and the HRP. OSAS was classified in severity according to the apnea-hypopnea index (AHI).
Results:
With HRP, 60% and 15% children were detected to have at least mild (AHI ≥1) and moderate (AHI >5) OSAS, respectively. The sensitivity of the questionnaire to detect mild and moderate OSAS was good (93% and 71%, respectively) but the specificity was very low (11% and 34%). However, an OACT score under 61 showed a very good negative predictive value for moderate and severe OSAS (87%). With the questionnaire, we could have avoided a complementary PSG or HRP in 25/45 (56%) of our subjects as in children with mild OSAS and without comorbidities only clinical observation is usually advised.
Conclusions:
The OACT questionnaire has shown to be a good and quick instrument to exclude moderate and severe OSAS in our population of children without maxillofacial malformations. Indeed children scoring under 61 could avoid a constraining and expensive sleep exam. However, if the score is above this cut-off, the performance to recognize OSAS is low and the child's evaluation must be completed by a HRP or PSG.
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