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08.08.2021 | Sleep Breathing Physiology and Disorders • Original Article

Accuracy of the sleep clinical record for the diagnosis of pediatric moderate-to-severe obstructive sleep apnea syndrome

verfasst von: Anna Maria Mylona, Georgia Rapti, George Vavougios, Vasileios A. Lachanas, Panagiotis Liakos, Charalambos Skoulakis, Athanasios G. Kaditis, Konstantinos Gourgoulianis, Emmanouil I. Alexopoulos

Erschienen in: Sleep and Breathing | Ausgabe 2/2022

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Abstract

Purpose

The sleep clinical record (SCR) has been used to diagnose obstructive sleep apnea syndrome (OSAS) in children when access to polysomnography (PSG) is limited. Our aim was to determine the best SCR score that could facilitate diagnosis of moderate-to-severe OSAS in children with snoring.

Methods

Healthy children with history of snoring, who were referred for PSG, were prospectively recruited. The SCR score was calculated. Receiver operating characteristic curves (ROCs) were plotted to determine the area under curve (AUC), and the optimum SCR cutoff value was determined using the Youden index (J).

Results

Two hundred and seventy-three children were recruited (mean age 6.3 ± 2.5 years; median obstructive apnea–hypopnea index 1.5 episodes/h; range 0–61.1). The mean SCR score was 6.9 ± 3.6. Forty-six children had moderate-to-severe OSAS. Subjects with moderate-to-severe OSAS had a significantly higher mean SCR score (10.2 ± 2.9) than those with mild OSAS (6.2 ± 3.3; P < 0.001). Based on the plotted ROC, the AUC was 0.811 (95% confidence interval: 0.747–0.876; P < 0.001). Calculation of J, based on its ROC coordinates, indicated that the optimum cutoff SCR score to predict moderate-to-severe OSAS was 8.25, corresponding to a sensitivity of 83% and a specificity of 70%.

Conclusion

Among children with history of snoring, an SCR score above 8.25 can identify those with moderate-to-severe OSAS.

Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H et al (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 47:69–94. https://doi.org/10.1183/13993003.00385-2015CrossRefPubMed

Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, Mitchell RB, Amin R, Katz ES, Arens R et al (2013) A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 368:2366–2376. https://doi.org/10.1056/nejmoa1215881CrossRefPubMedPubMedCentral

Mitchell RB, Pereira KD, Friedman NR (2006) Sleep-disordered breathing in children: survey of current practice. Laryngoscope 116:956–958. https://doi.org/10.1097/01.mlg.0000216413.22408.fdCrossRefPubMed

Papadakis CE, Chaidas K, Chimona TS, et al. Use of oximetry to determine need for adenotonsillectomy for sleep-disordered breathing. Pediatrics. 2018;142(3). https://doi.org/10.1542/peds.2017-3382

Brouilette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, Hunt C (1984) A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 105:10–14. https://doi.org/10.1016/s0022-3476(84)80348-0CrossRefPubMed

Chervin RD, Hedger K, Dillon JE, Pituch KJ (2000) Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med 1:21–32. https://doi.org/10.1016/s1389-9457(99)00009-xCrossRefPubMed

Villa MP, Paolino MC, Castaldo R, Vanacore N, Rizzoli A, Miano S, Del Pozzo M, Montesano M (2013) Sleep clinical record: an aid to rapid and accurate diagnosis of paediatric sleep disordered breathing. Eur Respir J 41:1355–1361. https://doi.org/10.1183/09031936.00215411CrossRefPubMed

Franco RA Jr, Rosenfeld RM, Rao M: First place—resident clinical science award, (1999) Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg 2000(123):9–16. https://doi.org/10.1067/mhn.2000.105254CrossRef

Villa MP, Pietropaoli N, Supino MC, Vitelli O, Rabasco J, Evangelisti M, Del Pozzo M, Kaditis AG (2015) Diagnosis of pediatric obstructive sleep apnea syndrome in settings with limited resources. JAMA Otolaryngol Head Neck Surg 141:990–996. https://doi.org/10.1001/jamaoto.2015.2354CrossRefPubMed

10.

DuPaul GJ, McGoey KE, Eckert TL, VanBrakle J (2001) Preschool children with attention-deficit/hyperactivity disorder: impairments in behavioral, social, and school functioning. J Am Acad Child Adolesc Psychiatry 40:508–515. https://doi.org/10.1097/00004583-200105000-00009CrossRefPubMed

11.

Brodsky L (1989) Modern assessment of tonsils and adenoids. Pediatr Clin N Am 36:1551–1569. https://doi.org/10.1016/s0031-3955(16)36806-7CrossRef

12.

Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8:597–619CrossRef

13.

Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35. https://doi.org/10.1002/1097-0142(1950)3:1%3c32::aid-cncr2820030106%3e3.0.co;2-3CrossRefPubMed

14.

Carroll JL, McColley SA, Marcus CL, Curtis S, Loughlin GM (1995) Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest 108:610–618. https://doi.org/10.1378/chest.108.3.610CrossRefPubMed

15.

Rosen CL (1999) Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children. Pediatr Pulmonol 27:403–409. https://doi.org/10.1002/(sici)1099-0496(199906)27:6%3c403::aid-ppul7%3e3.0.co;2-8CrossRefPubMed

16.

Lamm C, Mandeli J, Kattan M (1999) Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnea syndrome (OSAS) in children. Pediatr Pulmonol 27:267–272. https://doi.org/10.1002/(sici)1099-0496(199904)27:4%3c267::aid-ppul7%3e3.0.co;2-xCrossRefPubMed

17.

Chervin RD, Weatherly RA, Garetz SL, Ruzicka DL, Giordani BJ, Hodges EK, Dillon JE, Guire KE (2007) Pediatric sleep questionnaire: prediction of sleep apnea and outcomes. Arch Otolaryngol Head Neck Surg 133:216–222. https://doi.org/10.1001/archotol.133.3.216CrossRefPubMed

18.

Sproson EL, Hogan AM, Hill CM (2009) Accuracy of clinical assessment of paediatric obstructive sleep apnoea in two English centres. J Laryngol Otol 123:1002–1009. https://doi.org/10.1017/s0022215109005532CrossRefPubMed

19.

Bertran K, Mesa T, Rosso K, Krakowiak MJ, Pincheira E, Brockmann PE (2015) Diagnostic accuracy of the Spanish version of the Pediatric Sleep Questionnaire for screening of obstructive sleep apnea in habitually snoring children. Sleep Med 16:631–636. https://doi.org/10.1016/j.sleep.2014.10.024CrossRefPubMed

20.

Ehsan Z, Kercsmar CM, Collins J, Simakajornboon N (2017) Validation of the pediatric sleep questionnaire in children with asthma. Pediatr Pulmonol 52:382–389. https://doi.org/10.1002/ppul.23568CrossRefPubMed

21.

Chan A, Chan CH, Ng DK (2012) Validation of sleep-related breathing disorder scale in Hong Kong Chinese snoring children. Pediatr Pulmonol 47:795–800. https://doi.org/10.1002/ppul.22505CrossRefPubMed

22.

Spruyt K, Gozal D (2012) Screening of pediatric sleep-disordered breathing: a proposed unbiased discriminative set of questions using clinical severity scales. Chest 142:1508–1515. https://doi.org/10.1378/chest.11-3164CrossRefPubMedPubMedCentral

23.

Kadmon G, Shapiro CM, Chung SA, Gozal D (2013) Validation of a pediatric obstructive sleep apnea screening tool. Int J Pediatr Otorhinolaryngol 77:1461–1464. https://doi.org/10.1016/j.ijporl.2013.06.009CrossRefPubMed

24.

Abumuamar AM, Chung SA, Kadmon G, Shapiro CM (2018) A comparison of two screening tools for paediatric obstructive sleep apnea. J Sleep Res 27:e12610. https://doi.org/10.1111/jsr.12610CrossRefPubMed

25.

Nguyen XL, Levy P, Beydon N, Gozal D, Fleury B (2017) Performance characteristics of the French version of the severity hierarchy score for paediatric sleep apnoea screening in clinical settings. Sleep Med 30:24–28. https://doi.org/10.1016/j.sleep.2016.01.021CrossRefPubMed

26.

Borgstrom A, Nerfeldt P, Friberg D (2013) Questionnaire OSA-18 has poor validity compared to polysomnography in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 77:1864–1868. https://doi.org/10.1016/j.ijporl.2013.08.030CrossRefPubMed

27.

Kang KT, Weng WC, Yeh TH, Lee PL, Hsu WC (2014) Validation of the Chinese version OSA-18 quality of life questionnaire in Taiwanese children with obstructive sleep apnea. J Formos Med Assoc 113:454–462. https://doi.org/10.1016/j.jfma.2012.10.002CrossRefPubMed

28.

Ishman SL, Yang CJ, Cohen AP, Benke JR, Meinzen-Derr JK, Anderson RM, Madden ME, Tabangin ME (2015) Is the OSA-18 predictive of obstructive sleep apnea: comparison to polysomnography. Laryngoscope 125:1491–1495. https://doi.org/10.1002/lary.25098CrossRefPubMed

29.

Walter LM, Biggs SN, Cikor N, Rowe K, Davey MJ, Horne RS, Nixon GM (2016) The efficacy of the OSA-18 as a waiting list triage tool for OSA in children. Sleep Breath 20:837–844. https://doi.org/10.1007/s11325-015-1289-5CrossRefPubMed

30.

Chan EY, Ng DK, Chan CH, Kwok KL, Chow PY, Cheung JM, Leung SY (2009) Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: a retrospective study. Sleep Breath 13:59–63. https://doi.org/10.1007/s11325-008-0205-7CrossRefPubMed

31.

Wu D, Li X, Guo X, Qin J, Li S (2017) A simple diagnostic scale based on the analysis and screening of clinical parameters in paediatric obstructive sleep apnoea hypopnea syndrome. J Laryngol Otol 131:363–367. https://doi.org/10.1017/s0022215117000238CrossRefPubMed

32.

Power M, Fell G, Wright M (2013) Principles for high-quality, high-value testing. Evid Based Med 18:5–10. https://doi.org/10.1136/eb-2012-100645CrossRefPubMedPubMedCentral

Titel: Accuracy of the sleep clinical record for the diagnosis of pediatric moderate-to-severe obstructive sleep apnea syndrome
verfasst von: Anna Maria Mylona
Georgia Rapti
George Vavougios
Vasileios A. Lachanas
Panagiotis Liakos
Charalambos Skoulakis
Athanasios G. Kaditis
Konstantinos Gourgoulianis
Emmanouil I. Alexopoulos
Publikationsdatum: 08.08.2021
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 2/2022
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02471-4

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Accuracy of the sleep clinical record for the diagnosis of pediatric moderate-to-severe obstructive sleep apnea syndrome