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Published on: December 6, 2016
Inter-rater reliability of video clips to assess for obstructive sleep apnea in children
S L Katz1, H Blinder2, N Dussah2
1Children's Hospital of Eastern Ontario, Division of Pediatric Respirology, Department of Pediatrics, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Video recordings show high reliability for screening pediatric obstructive sleep apnea (OSA). This method could offer a more accessible alternative to polysomnography for diagnosing this common childhood sleep disorder.
Area of Science:
- Pediatric Sleep Medicine
- Diagnostic Technologies
Background:
- Pediatric obstructive sleep apnea (OSA) is linked to significant neurocognitive and cardiovascular issues.
- Current diagnostic methods like polysomnography are resource-intensive, leading to diagnostic delays.
- There is a critical need for efficient screening tools for pediatric OSA.
Purpose of the Study:
- To evaluate the reliability and predictive accuracy of video recordings for screening pediatric obstructive sleep apnea (OSA).
- To assess the performance of the Monash score using video data in a pediatric population.
Main Methods:
- A cross-sectional study involving 109 children (3-18 years) suspected of having OSA.
- Parents recorded 3-minute sleeping videos of their children.
- Two blinded pediatric sleep physicians assessed videos using clinical impressions and the Monash score, with inter-rater reliability assessed via Cohen's Kappa and predictive accuracy via ROC analysis.
Main Results:
- High inter-rater reliability was observed for both the Monash score (kappa 0.94) and clinician impression (kappa 0.84) of OSA presence and severity.
- The Monash score demonstrated excellent ability to discriminate OSA presence (AUC 0.99).
- Reliability was consistent across healthy children and those with comorbidities like Down syndrome, obesity, and autism.
Conclusions:
- Video-based assessments, particularly using the Monash score, exhibit high inter-rater reliability for pediatric OSA screening.
- Video recordings show promise as an accessible screening tool for pediatric OSA.
- Further research is warranted to validate these findings against polysomnography in clinical settings.
Background:
Pediatric obstructive sleep apnea (OSA) involves repeated breathing interruptions during sleep and is linked to neurocognitive impairment and cardiovascular issues. Early diagnosis is crucial, but the current gold-standard -overnight polysomnography-is expensive, complex, and scarce, causing long wait times. This underscores the need for a more efficient screening tool for pediatric OSA.
Method:
This cross-sectional study recruited children aged 3-18 years referred for polysomnography for suspected OSA (2019-2024). Parents recorded 3-min videos of their children sleeping. Two blinded pediatric sleep physicians scored videos for OSA using clinical impressions and the Monash score. Inter-rater reliability was evaluated with Cohen's Kappa. Monash score's ability to predict OSA was evaluated with receiver operating characteristic (ROC) analysis.
Results:
109 children (median age: 7.2 years, 61 % male) participated, including 66 healthy children, 21 with Down syndrome, 9 with obesity, and 13 with autism. Inter-rater reliability was high for both Monash score severity and dichotomized Monash score (kappa 0.94 and 0.79, both p < 0.001), with strong agreement on clinician impression of OSA presence and severity (kappa 0.84 and 0.70, both p < 0.001). Inter-rater reliability was highest in healthy children, with no significant differences between groups. The Monash score effectively discriminated OSA presence (area under curve 0.99 (95 % CI: 0.98, 1.00), with excellent performance across groups.
Discussion:
Video assessments showed high inter-rater reliability for OSA presence and severity. Although videos are promising for OSA screening, further research comparing them to polysomnography is needed to confirm clinical validity.
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