Formula for the prediction of apnea / hypopnea index in children with obstructive sleep apnea without polysomnography according to the clinical parameters: Is it reliable?

Background The paediatric population has a high incidence of sleep-related breathing disorders (SRBD). A notable risk factor is the presence of craniofacial abnormalities. The objective of the study was therefore to survey the prevalence of SRBD in patients presenting for interceptive treatment. Material and Methods Prospective study with a sample of 249 healthy patients. The “Paediatric Sleep Questionnaire” and “Sleep Disturbance Scale for Children” were completed by the children’s parents and the results were evaluated. All patients had their medical records reviewed and underwent orthodontic diagnosis by oral examination, as well as dental cast and cephalometric analysis. Finally, we compared the results of the pre- and post-treatment questionnaires of 50 patients in the sample. Results Based on the results of the questionnaires, 22.8% of the study sample had SRBD. No statistically significant correlation was found between SRBD and the anthropometric characteristics and occlusal variables assessed. According to the cast analysis, patients with SRBD had a smaller maxillary width ( p <0.003), and according to the cephalometric study, less overbite ( p <0.003). Furthermore, the prevalence of SRBD was higher among patients with a history of adenotonsillectomy ( p <0.02). Comparison of the results of pre- and post-treatment questionnaires revealed significant differences after orthodontic treatment ( p <0.0005). Conclusions It is necessary to identify the presence of SRBD in orthodontic patients given its high prevalence. Patients with SRBD have a smaller maxillary width and less overbite. Key words: Sleep-related breathing disorders, paediatric sleep questionnaire, cephalometry.

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“…With regard to BMI, our study found that obesity is not a risk factor for OSAS in children, unlike in adults ( 9 , 10 ).…”

Section: Discussioncontrasting

confidence: 47%

Prevalence of sleep-related breathing disorders in children with malocclusion

et al. 2020

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“…Moreover, a small number of participants was included and verification using separate participants was not performed. In addition, various other formulas for predicting OSA have been developed so far [21,40], such as a decision tree for OSA [41], a formula that allows perioperative patients to predict OSA [42], or a formula that can predict OSA in pediatric populations [43]. However, most of the clinical prediction formulas did not gain popularity after development, particularly because each formula came with their own set of parameters that were often population specific or many factors that need to be plugged into the PLOS ONE formula were not available.…”

Section: <A Clinical Formula With Physical Examination Factors>mentioning

confidence: 99%

Risk factors and clinical prediction formula for the evaluation of obstructive sleep apnea in Asian adults

et al. 2021

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Obstructive sleep apnea is a highly prevalent cyclic repetitive hypoxia-normoxia respiratory sleep disorder characterized by intermittent upper-airway collapse. It is mainly diagnosed using in-laboratory polysomnography. However, the time-spatial constraints of this procedure limit its application. To overcome these limitations, there have been studies aiming to develop clinical prediction formulas for screening of obstructive sleep apnea using the risk factors for this disorder. However, the applicability of the formula is restricted by the group specific factors included in it. Therefore, we aimed to assess the risk factors for obstructive sleep apnea and develop clinical prediction formulas, which can be used in different situations, for screening and assessing this disorder. We enrolled 3,432 Asian adult participants with suspected obstructive sleep apnea who had successfully undergone in-laboratory polysomnography. All parameters were evaluated using correlation analysis and logistic regression. Among them, age, sex, hypertension, diabetes mellitus, anthropometric factors, Berlin questionnaire and Epworth Sleepiness Scale scores, and anatomical tonsil and tongue position were significantly associated with obstructive sleep apnea. To develop the clinical formulas for obstructive sleep apnea, the participants were divided into the development (n = 2,516) and validation cohorts (n = 916) based on the sleep laboratory visiting date. We developed and selected 13 formulas and divided them into those with and without physical examination based on the ease of application; subsequently, we selected suitable formulas based on the statistical analysis and clinical applicability (formula including physical exam: sensitivity, 0.776; specificity, 0.757; and AUC, 0.835; formula without physical exam: sensitivity, 0.749; specificity, 0.770; and AUC, 0.839). Analysis of the validation cohort with developed formulas showed that these models and formula had sufficient performance and goodness of fit of model. These tools can effectively utilize medical resources for obstructive sleep apnea screening in various situations.

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“…There is conflicting data on these associations in the literature with some studies finding history 13,14 and tonsil size 15,19 to be poor predictors of OSA severity whereas others report the contrary. 23 However, in the CHAT study, the ability of otolaryngologists to predict the presence of PSG confirmed OSA in children who presented to their office with oSDB symptoms was approximately 50%. We found that children ages under 4 were less likely to have normal sleep studies (in the adjusted model, P = .001 compared to those ages 4-6).…”

Section: Discussionmentioning

confidence: 90%

Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms

Abraham

Bains

Rubin

et al. 2021

Ann Otol Rhinol Laryngol

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Objective: To determine the prevalence and characteristics of children with normal elective polysomnography for obstructive sleep disordered breathing (oSDB) based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. Study Design: In this retrospective cohort study, we identified patients ages 2 to 18 who underwent diagnostic polysomnography (PSG) ordered by our otolaryngology department for SDB between 2012 and 2018. Setting: All patients were seen by otolaryngologists at an urban tertiary safety net hospital. Subjects and Methods: There were a total of 456 patients studied (average age 5.66 ± 3.19; 263 (57.7%) males, 193 (42.3%) females. Demographic factors (age, gender, race, ethnicity, language, insurance status) and clinical findings (symptom severity, tonsil size) were recorded. The data were analyzed by univariate and multivariate analysis. Results: Two hundred four patients (44.7%) had no obstructive sleep apnea (OSA) based on AHI<2 on PSG. Children with a larger tonsil size had 3.18 times the odds of OSA compared to those with a medium tonsil size (95% CI 1.64, 6.19) when adjusting for symptoms, age category, and race ( P = .0007). Children ages 4 to 6 years had 0.25 times the odds of OSA compared to those ages 2-3 years (95% CI 0.12, 1.54) when adjusting for symptoms, tonsil size, and race ( P = .0011). White children had 0.28 times the odds of OSA compared to Black children (95% CI 0.14, 0.57) when adjusting for symptoms, tonsil size, and age category ( P = .0004). Conclusion: Among our patient population, 44.7% had normal sleep studies. Younger children (ages 2-3) were less likely to have normal polysomnography. This research demonstrates that obtaining sleep studies in otherwise healthy children with SDB can affect management decisions, and they should be discussed with families with a focus on patient centered decision making.

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Formula for the prediction of apnea / hypopnea index in children with obstructive sleep apnea without polysomnography according to the clinical parameters: Is it reliable?

Cited by 17 publications

References 15 publications

Prevalence of sleep-related breathing disorders in children with malocclusion

Prevalence of sleep-related breathing disorders in children with malocclusion

Risk factors and clinical prediction formula for the evaluation of obstructive sleep apnea in Asian adults

Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms

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