Diagnosis of Pediatric Obstructive Sleep Apnea Syndrome in Settings With Limited Resources

Villa, Maria Pia; Pietropaoli, Nicoletta; Supino, Maria Chiara; Vitelli, Ottavio; Rabasco, Jole; Evangelisti, Melania; Pozzo, Marco; Kaditis, Athanasios G.

doi:10.1001/jamaoto.2015.2354

Cited by 79 publications

(66 citation statements)

References 26 publications

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“…Initially in a group of 279 children, an AUC of 0.80 (95% CI: 0.74‐0.87) was calculated, with sensitivity of 96% and specificity of 67%. A validation study with 268 children of similar age with suspected OSA produced a similar sensitivity (92%) but lower specificity (41%) . In this latter study, the researchers then used the McGill Oximetry Score from overnight pulse oximetry to further stratify those with positive scores to try to identify those with moderate to severe OSA.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of clinical scoring tools for the diagnosis of pediatric obstructive sleep apnea

2019

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Objectives To assess the diagnostic test accuracy of questionnaire and clinical examination‐based scoring tools in the diagnosis of pediatric obstructive sleep apnea (OSA). Methods A comprehensive literature search was performed to identify studies published from 1960 to 2018 that evaluated the accuracy of clinical scoring tools in the diagnosis of pediatric OSA. Studies that did not include attended polysomnography as a reference standard were excluded. The study populations were children under 18 years old without craniofacial abnormalities, congenital syndromes, or other complex medical conditions. Outcomes measures were diagnostic test accuracy (DTA) statistics including sensitivity, specificity, and area under the curve (AUC) from receiver operating characteristic curve analysis. Results Fifteen different scoring tools were identified. Authors chose different polysomnographic criteria to diagnose OSA. Four of the tools had undergone multiple DTA studies by different authors (OSA Score, Sleep‐Related Breathing Disorder [SRBD] scale, Severity Score, and OSA‐18). The Pediatric Sleep Questionnaire SRBD scale, which is widely used, has a sensitivity of 71% to 84% in included studies, but specificity as low as 13% and a low AUC of 0.57‐0.69, indicating poor diagnostic accuracy. None of the 15 scoring tools performed well enough to be considered accurate diagnostic tests for pediatric OSA. Conclusions A well‐designed questionnaire can provide crucial information on the impact of sleep‐disordered breathing on a child's physical and psychological health, which may not be adequately reflected in objective polysomnography outcomes measures. However, DTA results indicate that published clinical scoring tools do not accurately predict a diagnosis of pediatric OSA as defined by polysomnography outcome measures. Laryngoscope, 130:1034–1043, 2020

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Section: Resultsmentioning

confidence: 99%

Accuracy of clinical scoring tools for the diagnosis of pediatric obstructive sleep apnea

2019

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“…115 A McGill oximetry score > 1 has over 90% positive predictive value for AHI > 5 episodes/hr among children with symptoms and clinical findings consistent with obstructive SDB. 116 An elevated oxygen desaturation of hemoglobin index (ODI 3 [!3% drop] !3.5 episodes/hr and/or ODI 4 [!4% drop] !1.5 episodes/hr) predicts significant improvement in nocturnal desaturations post-adenotonsillectomy for >95% of children. 117 There is lack of high-quality evidence for published guidelines and consensus statements to recommend treatment of PS.…”

Section: When Should We Treat the Otherwise Healthy Child Who Snores?mentioning

confidence: 99%

When and why to treat the child who snores?

Tan

Álvarez

Tsaoussoglou

et al. 2016

Pediatric Pulmonology

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Obstructive sleep-disordered breathing (SDB) can result in cardiovascular and neurocognitive morbidity as well as adversely affect behavior, growth, quality of life, and nocturnal continence. This article summarizes the latest evidence regarding the morbidity related to obstructive SDB, commenting on the impact of severity of obstruction, that is, the difference in effects seen of moderate to severe obstructive sleep apnea syndrome (OSAS) compared to those of mild OSAS or primary snoring. The impact of therapy is discussed, focusing on which children are likely to benefit from treatment interventions; namely those with moderate or severe OSAS irrespective of the presence of morbidity, children with mild OSAS with associated morbidity or predictors of SDB persistence such as obesity, and children with complex conditions accompanied by upper airway obstruction like craniosynostosis and Prader-Willi syndrome. The co-existing conditions which may improve when treatment for obstructive SDB is offered are reviewed, while the clinical parameters associated with spontaneous improvement or resolution of obstructive SDB are discussed. The intention being to enable clinicians to make informed decisions on who should be treated, when and why. Pediatr Pulmonol. 2017;52:399-412. © 2016 Wiley Periodicals, Inc.

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“…Obstructive respiratory events were scored as previously reported [11]. In particular, the number of obstructive apneas (OA; n./hour) plus central apneas (CA; n./hour) plus hypopneas (H; n./hour) was divided by hours of TST and then expressed as apnea-hypopnea index (AHI, n./hour) [12].…”

Section: In-laboratory Overnight Respiratory Polygraphmentioning

confidence: 99%

Childhood nasal obstruction and sleep-disordered breathing during clinical setting: Myth or reality?

Zaffanello

Lippi

Tenero

et al. 2019

The European Research Journal

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Objectives: .The severity of sleep apneas largely depends on abnormal size of upper airway. Therefore, nasal examination is essential part of clinical evaluation of children with sleep-disordered breathing. Methods: We performed a retrospective survey involving children aged 4 years and older which underwent in-laboratory overnight cardiorespiratory polygraph study between January 2016 and May 2017. Nasal obstruction test was used to score severity. Results: Fifty-three children (62% males) with a median age of 6.1 (IQR 3.1) years were enrolled in this study. Linear regression analysis showed that nasal obstruction score was correlated with apnea-hypopnea index (β = 0.345; p < 0.014) and oxygen desaturation index (β = 0.328; p < 0.022), whilst no association was found with age, BMI z-score, snoring and phase angle. Correlation analysis also showed that nasal obstruction score was correlated with apnea-hypopnea index (r = 0.364; p = 0.009) and oxygen desaturation index (r = 0.350; p = 0.012) after adjustment for age and BMI z-score., but not with snoring time or phase angle degree. Conclusions: Nasal obstruction test may be a useful, time saving assessment which aid exploring sleep disordered breathing in children. However, this test should not be used alone because it is plagued by objective consideration and at risk of under or overestimation.

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Diagnosis of Pediatric Obstructive Sleep Apnea Syndrome in Settings With Limited Resources

Abstract: The combined use of the SCR score and nocturnal oximetry results has moderate success in predicting sleep-disordered breathing severity when PSG testing is not an option.

Cited by 79 publications

References 26 publications

Accuracy of clinical scoring tools for the diagnosis of pediatric obstructive sleep apnea

Accuracy of clinical scoring tools for the diagnosis of pediatric obstructive sleep apnea

When and why to treat the child who snores?

Childhood nasal obstruction and sleep-disordered breathing during clinical setting: Myth or reality?

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