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Can portable sleep monitors replace polysomnography for diagnosis of pediatric OSA: a systematic review and
Aikebaier Tuohuti1, Zehua Lin1, Jie Cai1
1Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
Insights
Portable monitors (PMs) show high sensitivity for diagnosing pediatric obstructive sleep apnoea (OSA), offering a promising alternative to polysomnography (PSG). Combining PMs with questionnaires enhances diagnostic reliability for children with OSA.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Diagnostic Accuracy Studies
Background:
- Obstructive sleep apnoea (OSA) is a growing pediatric health concern.
- Polysomnography (PSG) is the current gold standard for OSA diagnosis.
- Portable monitors (PMs) offer a potentially more comfortable and cost-effective alternative for diagnosing pediatric OSA.
Approach:
- Systematic literature search of major databases up to December 2022.
- Meta-analysis using a random-effects bivariate model to pool diagnostic accuracy data.
- Evaluation of study quality using QUADAS-2 guidelines.
Key Points:
- Twelve studies involving 707 pediatric patients and 9 different PMs were analyzed.
- Pooled sensitivity for PMs in diagnosing pediatric OSA was 0.91 (95% CI: 0.86-0.94).
- Pooled specificity was 0.76 (95% CI: 0.58-0.88), with an AUC of 0.93 (95% CI: 0.90-0.95).
Conclusions:
- PMs demonstrate high sensitivity but moderate specificity for pediatric OSA diagnosis.
- Combining PMs with questionnaires may improve diagnostic accuracy.
- PMs can serve as a valuable screening tool for high-risk pediatric populations when PSG is limited.
Background:
Obstructive sleep apnoea (OSA) is an increasing health problem in children. The "gold standard" for OSA diagnosis at the moment is overnight polysomnography (PSG). Some researchers think portable monitors (PMs) are promising methods for diagnosing OSA, which make children more comfortable and lower costs. Compared with PSG, our comprehensively evaluated the diagnostic accuracy of PMs for diagnosing OSA in pediatrics.
Research Question:
This study aims to determine whether PMs can replace PSG in pediatric OSA diagnosis.
Study Design And Methods:
The PubMed, Embase, Medline databases Scopus, Web of Science, and Cochrane Library databases were searched systematically for studies published up to December 2022, evaluating the ability of PMs to diagnose OSA in children. For estimating the pooled sensitivity and specificity of the PMs in the included studies, we used a random-effects bivariate model. Studies included in this meta-analysis were evaluated systematically according to QUADAS-2 guidelines for assessing diagnostic accuracy studies. Two independent investigators conducted each stage of the review independently.
Results:
A total of 396 abstracts and 31 full-text articles were screened, and 41 full-text articles were chosen for final review. There were 707 pediatric patients enrolled in these twelve studies, and 9 PMs were evaluated. There was a wide range of diagnostic sensitivity and specificity among PM systems as compared to AHI measured by PSG. The pooled sensitivity and specificity in diagnosing pediatric OSA were, respectively, 0.91 [0.86, 0.94] and 0.76 [0.58, 0.88] for PMs. According to the summary receiver operating characteristic (SROC) curve, the AUC of PMs in diagnosing OSA in pediatric population was 0.93 [0.90, 0.95].
Interpretation:
PMs were more sensitive but slightly less specific for pediatric OSA. The combination of PMs and questionnaires appeared to be a reliable tool for the diagnosis of pediatric OSA. This test may be used for screening subjects or populations at high risk of OSA when there is a high demand for PSG, but the quantity is limited. No clinical trial was involved in the current study.
