Medline ® Abstracts for References 93,94
of 'Evaluation of suspected obstructive sleep apnea in children'
Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnea syndrome (OSAS) in children.
Lamm C, Mandeli J, Kattan M
Pediatr Pulmonol. 1999;27(4):267.
Snoring occurs commonly in children and is sometimes associated with obstructive sleep apnea syndrome (OSAS). Based on clinical history alone, it is difficult to distinguish primary snoring, characterized by noisy breathing during sleep without apnea or hypoventilation, from snoring indicative of OSAS. An overnight polysomnogram (PSG) is required to establish a definitive diagnosis of OSAS. Because sleep evaluations are costly and resources are limited, we evaluated whether a home audiotape recording could accurately identify children with OSAS. We studied 36 children referred by pediatricians and otolaryngologists for possible OSAS. Parents completed a questionnaire about their child's sleep and breathing and made a 15-min audiotape of the child's breath sounds during sleep. Overnight PSGs were performed on all patients. There were 29 patients who completed the study: 15 patients in the Primary Snoring group (apnea/hypopnea index<5) and 14 patients in the OSAS group (apnea/hypopnea index>or = 5). No significant statistical differences existed between the two groups for physical characteristics or questionnaire responses. Seven observers analyzed the audiotapes for the presence of a struggle sound and respiratory pauses. The median sensitivity of the audiotape as a predictor of OSAS was 71% (range 43-86%), and the median specificity was 80% (range 67-80%). The presence of a struggle sound on the audiotape was the parameter most predictive of OSAS. There was a good level of agreement among the seven audiotape observers, as demonstrated by a mean and range kappa statistic of 0.70 (0.50-0.93) for the 21 pairs of observers. Using a clinical score to predict OSAS, the sensitivity was 46%, and the specificity was 83%. We conclude that findings on a home audiotape can be suggestive of OSAS, but are not sufficiently specific to reliably distinguish primary snoring from OSAS.
Pediatric Pulmonary and Critical Care Division, Mount Sinai School of Medicine, New York, New York 10029, USA.
Clinical diagnosis of pediatric obstructive sleep apnea validated by polysomnography.
Goldstein NA, Sculerati N, Walsleben JA, Bhatia N, Friedman DM, Rapoport DM
Otolaryngol Head Neck Surg. 1994;111(5):611.
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.
Department of Otolaryngology, New York University School of Medicine, NY 10016.