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Reliability of Home Sleep Apnea Test as a Diagnostic Modality in Children With Obstructive Sleep Apnea- a Systematic
Adnan Zafar1, Umme Roman2, Abdul Haseeb2
1Pediatric Pulmonology Department, John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
Insights
Home sleep apnea testing (HSAT) is a reliable and cost-effective alternative to polysomnography (PSG) for diagnosing pediatric sleep disordered breathing. This method is well-tolerated by children, offering comparable diagnostic yields to traditional PSG.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Diagnostic Technologies
Background:
- Pediatric sleep disordered breathing (SDB) incidence is rising due to factors like obesity and improved diagnostics.
- Obstructive sleep apnea (OSA) commonly affects children aged 2-8 years, necessitating early diagnosis.
- Polysomnography (PSG) is the gold standard, but home sleep apnea testing (HSAT) is increasingly used.
Purpose of the Study:
- To review the existing literature on the diagnostic validity of HSAT in children.
- To compare the efficacy of HSAT with PSG for diagnosing pediatric SDB.
- To assess HSAT as a feasible alternative to PSG in pediatric populations.
Main Methods:
- Systematic review adhering to Cochrane Handbook and PRISMA guidelines.
- Risk of bias assessment using the Cochrane Handbook tool.
- Appraisal of included studies using the Joanna Briggs Institute critical appraisal tool.
Main Results:
- Nine studies were included; only three used simultaneous HSAT and PSG.
- HSAT and PSG showed nearly equivalent diagnostic yields (mean AHI: 2.5 vs. 2.7, p>0.05).
- Mean AHI in HSAT-alone studies ranged from 0.8-10.3 in healthy children and 2.2-13 in children with Down syndrome.
Conclusions:
- Diagnosing pediatric SDB in labs is challenging; HSAT offers a viable alternative.
- HSAT is cost-effective and better tolerated by children than PSG.
- Multi-channel HSAT, including EEG and capnography, is a reliable diagnostic tool.
Background:
The incidence of pediatric sleep disordered breathing has increased in the last decade because of many factors, such as childhood obesity, metabolic syndrome, and access to better diagnostic methods. OSA peaks between 2 and 8 years in children. Early diagnosis is recommended to prevent long-term complications. While PSG is the gold standard for diagnosis, it may not be feasible in certain circumstances; hence, HSAT is now being increasingly used to screen and diagnose OSA.
Methods:
This review was conducted using the methodology in the "Cochrane handbook on systematic reviews". PRISMA flowchart was used to report the results. The risk of bias assessment was done using the "Cochrane handbook for systematic review reviews tool for Interventional studies". All studies were analysed using the Joanna Briggs Institute's critical appraisal tool.
Results:
A total of nine studies were included in this review. Of these, only three studies employed simultaneous HSAT and PSG testing to evaluate the validity of HSAT indices. In one of the largest studies comparing HSAT with PSG, the mean AHI observed was 2.5 ± 3 for HSAT and 2.7 ± 2.9 for PSG (p > 0.05), indicating that the diagnostic yields of both methods were nearly equivalent. In studies utilizing HSAT alone, the mean apnea-hypopnea index (AHI) ranged from 0.8 to 10.3 events per hour in healthy children, compared to 2.2 to 13 events per hour in children with Down syndrome.
Conclusions:
Diagnosing sleep disordered breathing in children can be challenging in a laboratory setting. HSAT is cost-effective and better tolerated in the younger population compared to PSG. It is a reliable alternative to PSG when used with multiple channels, including EEG and capnography.
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