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Published on: December 6, 2016
Screening for obstructive sleep apnea in the resource-limited setting of the COVID-19 pandemic (SPARE study)
Refika Ersu1, Roya Shamsi2, Vid Bjelic2
1Division of Respirology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Home video recordings show high sensitivity for screening pediatric obstructive sleep apnea (OSA). This approach can help identify children at risk, enabling earlier diagnosis and intervention, especially when traditional methods are limited.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Diagnostic Technologies
Background:
- Obstructive sleep apnea (OSA) poses significant health risks to children.
- Diagnosing pediatric OSA is challenging, exacerbated by limited access to polysomnography (PSG) during the COVID-19 pandemic.
- Previous research explored using short sleep videos for OSA assessment, developing the Monash score.
Purpose of the Study:
- To evaluate the efficacy of home video recordings using mobile technology for identifying children at risk of moderate to severe OSA.
- To test the hypothesis that clinicians can use these videos to screen for pediatric OSA.
Main Methods:
- Children aged 3-18 years referred for OSA evaluation recorded 3-minute sleep videos over three nights.
- Sleep physicians, blinded to polygraphy (PG) results, scored videos using the Monash score.
- Polygraphy (PG) served as the reference standard, with OSA defined by specific obstructive apnea hypopnea index (oAHI) and oximetry metrics.
Main Results:
- The Monash score demonstrated 100% sensitivity and 29.6% specificity for moderate-to-severe OSA.
- The Monash score achieved 91.7% sensitivity and 70.4% specificity for mild-to-severe OSA.
- Oxygen desaturation index (ODI) ≥4.3 showed the highest diagnostic accuracy (AUC 98.5).
Conclusions:
- Home-recorded sleep videos demonstrate high sensitivity for pediatric OSA screening.
- This method can help prioritize children at risk in resource-limited settings.
- Utilizing home videos can facilitate earlier diagnosis and intervention for pediatric OSA.
Introduction:
Obstructive sleep apnea (OSA) significantly impacts children's health, but diagnosing OSA is challenging, especially during the COVID-19 pandemic with limited access to polysomnography (PSG). A recent study used 1-2-min sleep videos to assess OSA, developing the Monash score, which demonstrated 100 % sensitivity and 36 % specificity for moderate to severe OSA diagnosis with a score of 3 or higher.
Hypothesis:
We hypothesized that home video recordings using mobile technology could help clinicians identify children at risk of moderate to severe OSA.
Methods:
This study included children 3-18 years referred for OSA evaluation. Parents recorded 3-min sleep videos over three nights. Sleep physicians, blinded to polygraphy (PG) results scored videos using the Monash score. PG with the Nox T3 device served as the reference standard, measuring airflow, respiratory patterns, and oxygen saturation. OSA was defined as mild-to-severe with obstructive apnea hypopnea index (oAHI) ≥1.5 events/hour, moderate-to-severe with oAHI ≥5, and severe with oAHI >10. Oximetry metrics (oxygen desaturation index 3 % (ODI3) ≥4.3 or >7, and McGill Oximetry Score (MOS) ≥2) indicated OSA presence.
Results:
Among 51 children (45 % female) included in the study, the Monash score showed 91.7 % sensitivity and 70.4 % specificity for mild-to-severe OSA, and 100 % sensitivity with 29.6 % specificity for moderate-to-severe OSA. ODI ≥4.3 had the highest diagnostic accuracy (AUC 98.5, 95 %CI 96-100), while the Monash score had an AUC of 84.5 (95 %CI 73.1-96.3).
Conclusion:
Home-recorded videos offer high sensitivity for pediatric OSA screening and could prioritize at-risk children in resource-limited settings, enabling earlier diagnosis and intervention.
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