Clinical Diagnosis of Pediatric Obstructive Sleep Apnea Validated by Polysomnography

Abstract

The decision to perform tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea syndrome is often made on a clinical basis without formal polysomnography. To examine the accuracy of the clinical diagnosis of pediatric obstructive sleep apnea syndrome, we prospectively evaluated 30 children with obstructive symptoms by a standardized history, physical examination, and review of a tape recording of breathing during sleep. On the basis of this clinical evaluation, patients were divided into three predictive groups: (1) definite obstructive sleep apnea syndrome, (2) possible obstructive sleep apnea syndrome, and (3) unlikely to have obstructive sleep apnea syndrome. Nocturnal polysomnography was used to determine the presence or absence of true sleep apnea. Ten of 18 (55.6%) patients predicted clinically to have definite obstructive sleep apnea syndrome had positive nocturnal polysomnographies. Two of six (33.3%) patients predicted to have possible obstructive sleep apnea syndrome had positive nocturnal polysomnographies. One of six (16.7%) patients predicted to be unlikely to have obstructive sleep apnea syndrome had a positive nocturnal polysomnography. Six nocturnal polysomnographies negative by conventional criteria were suspicious for apnea, but considering these positive for obstructive sleep apnea syndrome did not improve the specificity of the clinical prediction. Our results show that clinical assessment of obstructive sleep apnea syndrome in children is sensitive (92.3%) but not specific (29.4%) for making the diagnosis of obstructive sleep apnea syndrome as compared with nocturnal polysomnography and may contribute to the decision to obtain nocturnal polysomnography in specific circumstances.

Outcome of Adenotonsillectomy for Sleep and Breathing Difficulties in Nigerian Children with Obstructive Adenotonsillar Enlargement

“…Most otolaryngologists make decisions or recommendations based on medical history that is suggestive of SDB, as well as on physical examination demonstrating adenoid and/or tonsillar hypertrophy [2,[8][9][10]. However, predictive accuracy of clinically suspected OSAS may be as low as 30% when PSG testing was performed as well [13,19]. Unlike polysomnography that measures derangements in physiologic parameters during sleep in obstructive children, the SS, like other health-related clinical surveys, focuses on the physical problems and functional limitations consequent on upper airway obstruction as reported by caregivers.…”

“…When parents were unsure of their observations, they were asked to observe their children at intermittent intervals during the daytime and during sleep, over a period of 1 week, and the history was then retaken. Previous studies documented reliability of graded symptoms and signs in predicting the degree of upper airway obstruction in children with adenoid hypertrophy [13][14][15].…”

“…Although polysomnography performed overnight in a laboratory setting is considered the gold standard for evaluation of OSAS, it is expensive, time-consuming, and not widely available for evaluation of SDB in children [1,[9][10][11][12][13]. The 'Symptomatology score' (SS) and other graded clinical assessments have been validated against roentgenographic ratings of upper airway obstruction by adenoid vegetations, and shown to be simple, reliable and easy-to-use tools in evaluating the obstructive impact of adenoid vegetations in children [14][15][16].…”

Clinical Manifestations

“…Although polysomnography is the current gold standard, authorities cite the lack of reliable sleep laboratories for children, excess cost, and lack of consensus on interpretation of polysomnograms as reasons it is not required for diagnosis. 16,17 The parameters originally used to evaluate childhood polysomnograms were based on adult values. OSA in adults is defined as a respiratory pause lasting more than 10 seconds.…”

Resultados na qualidade de vida em longo prazo de crianças submetidas à adenoidectomia/adenotonsilectomia por distúrbios obstrutivos do sono

“…However, clinical findings alone cannot precisely define if the OSD is a mild condition of mild snoring or the more severe UARS or OSAHS. [9][10][11] A precise differentiation requires a polysomnographic test, which is the gold standard in such cases.…”