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Night-to-night variability in respiratory sleep parameters to diagnose obstructive sleep apnea in children: A
Han Qin1, Guimin Huang2, Xinnan Zong3
1Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China.
Insights
Night-to-night variability in pediatric sleep apnea (OSA) is not significant overall but differs by severity. Single-night studies may misdiagnose children with moderate-to-severe OSA due to this variability.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
- Diagnostic Accuracy
Background:
- Obstructive sleep apnea (OSA) is a common sleep disorder in children.
- Accurate diagnosis relies on polysomnography, but single-night studies are often used.
- Understanding night-to-night variability (NtNV) is crucial for diagnostic reliability.
Purpose of the Study:
- To systematically review the night-to-night variability (NtNV) of respiratory sleep parameters in children.
- To evaluate the accuracy of diagnosing pediatric obstructive sleep apnea (OSA) using single-night sleep studies.
Main Methods:
- Systematic literature search of PubMed, EMBASE, and Cochrane Library databases.
- Inclusion of 5 articles comprising 395 pediatric patients.
- Analysis of apnea-hypopnea index (AHI) and other respiratory parameters.
Main Results:
- The overall NtNV in AHI was not statistically significant across the pediatric cohort.
- Significant differences in NtNV were observed between children with mild OSA and those with moderate-to-severe OSA.
- Diagnostic rates for OSA in single-night studies ranged from 83% to 91% across included studies.
Conclusions:
- While overall NtNV in pediatric AHI is not significant, it is higher in moderate-to-severe OSA cases.
- Individual NtNV in respiratory sleep parameters poses a risk of misdiagnosis in children undergoing single-night sleep evaluations.
- Further investigation into multi-night sleep studies may be warranted for accurate pediatric OSA diagnosis.
Purpose:
This systematic review aims to assess the night-to-night variability (NtNV) in respiratory sleep parameters in children and the accuracy of diagnosing obstructive sleep apnea (OSA) in children based on a single-night sleep study.
Methods:
The PubMed, EMBASE, and Cochrane Library databases were searched until March 8, 2021. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42021239838).
Results:
Our study included 395 patients from 5 articles. The mean (SD) age of all included patients was 11.78 (4.05) years. AHI was reported for 325 participants in 4 studies, and the mean change between two consecutive nights was -0.13 [95% CI: -0.40, 0.14] events per hour. The mean change in OAI was -0.07 [95% CI: -0.27, 0.12] events per hour in 187 participants across 3 studies. Based on the diagnostic criteria used, three studies reported that the diagnostic rates of OSA patients in a single-night sleep study were 83%, 84.6%, and 91%. The NtNV in AHI in children with severe and moderate OSA was greater than that in children with mild OSA (3.35 [95% CI: 0.07, 6.62] events per hour vs -0.15 [95% CI: -0.42, 0.12] events per hour), and these children with more severe OSA may have shown a higher AHI on the first night.
Conclusions:
The NtNV in AHI was not statistically significant in the group sample of children. However, there were significant differences in NtNV in AHI between children with mild and moderate-to-severe OSA. Individual NtNV in respiratory sleep parameters may cause children to be misdiagnosed by single-night diagnostic sleep studies.
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