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Original Investigation |

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

Maria Pia Villa, MD1; Nicoletta Pietropaoli, MD1; Maria Chiara Supino, MD1; Ottavio Vitelli, MD, PhD1; Jole Rabasco, MD1; Melania Evangelisti, MD, PhD1; Marco Del Pozzo, RPSGT1; Athanasios G. Kaditis, MD2
[+] Author Affiliations
1Pediatric Sleep Disease Center, Child Neurology, Department of Neuroscience, Mental Health, and Sense Organs, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
2Pediatric Pulmonology Unit, Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children’s Hospital, Athens, Greece
JAMA Otolaryngol Head Neck Surg. 2015;141(11):990-996. doi:10.1001/jamaoto.2015.2354.
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Importance  Although polysomnographic (PSG) testing is the gold standard for the diagnosis of obstructive sleep apnea syndrome (OSAS) in children, the number of pediatric sleep laboratories is limited. Developing new screening methods for identifying OSAS may reduce the need for PSG testing.

Objective  To evaluate the combined use of the sleep clinical record (SCR) and nocturnal oximetry testing for predicting PSG results in children with clinically suspected OSAS.

Design, Setting, and Participants  Prospective study over 10 months. A cohort of 268 consecutive children (mean [SD], age 6 [3] years) referred for clinically suspected OSAS was studied at a pediatric sleep center at a university hospital. Children with disorders other than adenotonsillar hypertrophy or obesity were excluded.

Main Outcomes and Measures  Mild OSAS (obstructive apnea–hypopnea index [AHI], 1-5 episodes/h) and moderate-to-severe OSAS (AHI, >5 episodes/h) were the main outcome measures. Sleep clinical record scores greater than or equal to6.5 were considered positive, as were McGill oximetry scores (MOS) greater than 1, and these positive scores were the main explanatory variables in our study. Each participant was evaluated by the SCR, followed by pulse oximetry test the first night and PSG test in the sleep laboratory the second night.

Results  Of the total participants, 236 (88.1%) were diagnosed with OSAS, 236 (88.1%) had a positive SCR score, and 50 (18.7%) had a positive MOS. Participants with positive SCR scores had significantly increased risk of an AHI greater than or equal to 1 (adjusted odds ratio [AOR], 9.3; 95% CI, 3.7-23.2; P < .001). Children with an MOS greater than 1 were significantly more likely to have an AHI greater than 5 episodes/h than children with an MOS equal to 1 (AOR, 26.5; 95% CI, 7.8-89.2; P < .001). A positive SCR score had satisfactory sensitivity (91.9%) and positive predictive value (91.9%) but limited specificity (40.6%) and negative predictive value (40.6%) for OSAS. An MOS greater than 1 had excellent specificity (97.4%) and positive predictive value (94%) but low sensitivity (39.2%) and fair negative predictive value (60.8%) for moderate-to-severe OSAS among children with a positive SCR score. The combination of SCR scores and MOS correctly predicted primary snoring, mild OSAS, or moderate-to-severe OSAS in 154 of 268 (57.4%) participants.

Conclusions and Relevance  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.

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Figure.
SCR Score and MOS Algorithm for Evaluating Sleep-Disordered Breathing

A positive SCR score is greater than or equal to 6.5 and indicates OSAS. Mild OSAS has an AHI of 1 to 5 episodes/h, and moderate-to-severe OSAS has an AHI of greater than 5 episodes/h. A positive MOS is greater than 1. An MOS equal to 1 indicates primary snoring and/or mild OSAS, and an MOS greater than 1 indicates moderate-to-severe OSAS. In step 1, an SCR score is determined for each patient in the cohort. In step 2, MOS are determined and used to identify the subgroup of children with positive SCR scores who are at high risk of moderate-to-severe OSAS. Children with MOS equal to 1 and positive SCR scores are at risk of mild OSAS. AHI indicates the obstructive apnea–hypopnea index; MOS, McGill oximetry score; OSAS, obstructive sleep apnea syndrome; SCR, sleep clinical record.

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