The Canadian Thoracic Society/Canadian Sleep Society Guideline on the Diagnosis of Obstructive Sleep Apnea in Children

Access to polysomnography, the recommended standard for the diagnosis of OSA in children, is limited in many jurisdictions. Many children undergo treatment for OSA without confirmatory testing, are denied treatment in the absence of testing, or have a delay in treatment of other sleep disorders until OSA can be ruled out.

An expert panel conducted a systematic review and meta-analysis examining alternative testing to polysomnography. Recommendations formulation followed a process of proposal, discussion, revisions and voting, considering the evidence, panel members' judgment, as well as patient and family preferences.

A total of 250 articles across 5 types of clinical assessment were included. Most articles excluded children with comorbidities or did not report exclusions (62% and 26%, respectively). Only 13% of articles included children under 2-years of age. Limited data were appropriate for meta-analysis.

The panel upholds polysomnography as the recommended standard for the diagnosis of OSA in children given the absence of an alternative test that could be considered a replacement. Level 3/Home Sleep Apnea Testing is recommended as an alternative option to diagnose OSA in otherwise healthy children over 5-years of age for whom access to polysomnography is effectively absent. While the Pediatric Sleep Questionnaire and overnight oximetry add information to the clinical assessment, we suggest that these should not be used to diagnose OSA in children. Given patient and family preferences for testing at home, further investment is needed in developing accurate and accessible home-based testing options to diagnose OSA in children.