Diagnosis of obstructive sleep apnea in children: A systematic review

Brockmann, Pablo E.; Schaefer, Christine; Poets, Anette; Poets, Christian F.; Urschitz, Michael S.

doi:10.1016/j.smrv.2012.08.004

Cited by 86 publications

(62 citation statements)

References 70 publications

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“…[25][26][27][28][29][30][31] A systematic review concluded that although there is limited evidence concerning diagnostic alternatives to PSG for identifying OSA in children, polygraphy may be a valid test, a conclusion that will require confi rmation in subsequent studies. 32 We have evaluated LRP by performing concomitant RP and PSG. 14 Th is study showed that an RDI cutoff Ն 4.6 exhibited excellent sensitivity and specifi city for identifying OSAS in children and was useful in both the diagnosis and follow-up of children with OSAS.…”

Section: Discussionmentioning

confidence: 99%

Reliability of Home Respiratory Polygraphy for the Diagnosis of Sleep Apnea in Children

Alonso-Álvarez

Terán-Santos

Carbajo

et al. 2015

Chest

135

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OBJECTIVE:Th e objective of this study was to evaluate the diagnostic reliability of home respiratory polygraphy (HRP) in children with a clinical suspicion of OSA-hypopnea syndrome (OSAS). METHODS:A prospective blind evaluation was performed. Children between the ages of 2 to 14 years with clinical suspicion of OSAS who were referred to the Sleep Unit were included. An initial HRP followed by a later date , same night, in-laboratory overnight respiratory polygraphy and polysomnography (PSG) in the sleep laboratory were performed. Th e apneahypopnea index (AHI)-HRP was compared with AHI-PSG, and therapeutic decisions based on AHI-HRP and AHI-PSG were analyzed using intraclass correlation coeffi cients, BlandAltman plots, and receiver operator curves (ROCs). RESULTS:Twenty-seven boys and 23 girls, with a mean age of 5.3 Ϯ 2.5 years, were studied, and 66% were diagnosed with OSAS based on a PSG-defi ned obstructive respiratory disturbance index Ն 3/h total sleep time. Based on the availability of concurrent HRP-PSG recordings, the optimal AHI-HRP corresponding to the PSG-defi ned OSAS criterion was established as Ն 5.6/h Th e latter exhibited a sensitivity of 90.9% (95% CI, 79.6%-100%) and a specifi city of 94.1% (95% CI, 80%-100%).CONCLUSIONS: HRP recordings emerge as a potentially useful and reliable approach for the diagnosis of OSAS in children. However, more research is required for the diagnosis of mild OSAS using HRP in children. ENT 5 ear, nose, and throat; HRP 5 home respiratory polygraphy; ICC 5 interclass correlation coeffi cient; LRP 5 in-laboratory respiratory polygraphy; OAHI 5 obstructive apnea-hypopnea index; ORDI 5 obstructive respiratory disturbance index; OSAS 5 OSAhypopnea syndrome; PSG 5 polysomnography; RDI 5 respiratory disturbance index; ROC 5 receiver operating characteristic; RP 5 respiratory polygraphy; Sp o 2 5 oxygen saturation using pulse oximetry; SU 5 Sleep Unit AFFILIATIONS: From the Sleep Unit (Drs Alonso-Álvarez, Terán-Santos, Ordax Carbajo, Cordero-Guevara, and Navazo-Egüia), the CIBER of Respiratory Diseases (Drs Alonso-Álvarez and Terán-Santos), Instituto Carlos III, CIBERES, and the

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Section: Discussionmentioning

confidence: 99%

Reliability of Home Respiratory Polygraphy for the Diagnosis of Sleep Apnea in Children

Alonso-Álvarez

Terán-Santos

Carbajo

et al. 2015

Chest

135

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“…11 Despite robust published evidence showing that the apneahypopnea index is inherently underestimated, 12 RP is rapidly becoming a widely implemented alternative to PSG in clinical settings. 8,9,11 Furthermore, ambulatory RP at home (HRP) has been suggested as a valid approach in low resource settings when in-laboratory PSG is not available. 11 A recent study demonstrated the feasibility of HRP to evaluate children with OSA at home.…”

Section: Introductionmentioning

confidence: 99%

Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings

Álvarez

Alonso-Álvarez

Gutiérrez‐Tobal

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Nocturnal oximetry has become known as a simple, readily available, and potentially useful diagnostic tool of childhood obstructive sleep apnea (OSA). However, at-home respiratory polygraphy (HRP) remains the preferred alternative to polysomnography (PSG) in unattended settings. The aim of this study was twofold: (1) to design and assess a novel methodology for pediatric OSA screening based on automated analysis of at-home oxyhemoglobin saturation (SpO2), and (2) to compare its diagnostic performance with HRP. Methods: SpO2 recordings were parameterized by means of time, frequency, and conventional oximetric measures. Logistic regression models were optimized using genetic algorithms (GAs) for three cutoffs for OSA: 1, 3, and 5 events/h. The diagnostic performance of logistic regression models, manual obstructive apnea-hypopnea index (OAHI) from HRP, and the conventional oxygen desaturation index ≥ 3% (ODI3) were assessed. Results: For a cutoff of 1 event/h, the optimal logistic regression model significantly outperformed both conventional HRP-derived ODI3 and OAHI: 85.5% accuracy (HRP 74.6%; ODI3 65.9%) and 0.97 area under the receiver operating characteristics curve (AUC) (HRP 0.78; ODI3 0.75) were reached. For a cutoff of 3 events/h, the logistic regression model achieved 83.4% accuracy (HRP 85.0%; ODI3 74.5%) and 0.96 AUC (HRP 0.93; ODI3 0.85) whereas using a cutoff of 5 events/h, oximetry reached 82.8% accuracy (HRP 85.1%; ODI3 76.7) and 0.97 AUC (HRP 0.95; ODI3 0.84). Conclusions: Automated analysis of at-home SpO2 recordings provide accurate detection of children with high pretest probability of OSA. Thus, unsupervised nocturnal oximetry may enable a simple and effective alternative to HRP and PSG in unattended settings. Keywords: at-home respiratory polygraphy, automated pattern recognition, blood oxygen saturation, genetic algorithms, nocturnal oximetry Citation: Álvarez D, Alonso-Álvarez ML, Gutiérrez-Tobal GC, Crespo A, Kheirandish-Gozal L, Hornero R, Gozal D, Terán-Santos J, Del Campo F. Automated screening of children with obstructive sleep apnea using nocturnal oximetry: an alternative to respiratory polygraphy in unattended settings. J Clin Sleep Med. 2017;13(5):693-702.

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“…Elle pose un problème de coût et d'accessibilité plus particuliè-rement en pédiatrie. Les centres du sommeil, qui s'occupent d'adultes sont surchargés, n'ont pas les qualifications pour accueillir les enfants de moins de 6 ans [13,17,18] et ne prennent pas toujours en compte les critères pédiatriques d'interprétation. Lorsque des PSG ont pu être réalisées, les équipes pédiatriques se sont adaptées en fonction de la clinique si l'IAH était < 10/h et débutaient une ventilation d'emblée si l'IAH !…”

Section: Discussionunclassified

“…La recherche de ces troubles respiratoires chez les enfants obèses nécessite au moins une attention clinique : l'association des deux pathologies potentialise notamment le risque cardiovasculaire et de syndrome métabolique, avec un retentissement persistant à l'âge adulte [3,10,13,16]. L'accessibilité limitée des enfants aux laboratoires du sommeil et le coût de réalisation d'une PSG posent un problème majeur de diagnostic pédiatrique de SAOS [13,17,18]. La présente étude avait pour but d'évaluer les pratiques de dépistage des troubles respiratoires liés à l'obésité et la prise en charge de ces troubles au sein de la cohorte d'enfants à obésité sévère explorée dans un centre pédiatrique spécialisé de l'obésité.…”

Section: Introductionunclassified

Dépistage et prise en charge des anomalies respiratoires de l’enfant obèse : syndrome d’apnée obstructive du sommeil et syndrome d’obésité hypoventilation

Gachelin¹,

Reynaud²,

Dubus³

et al. 2015

Archives de Pédiatrie

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Diagnosis of obstructive sleep apnea in children: A systematic review

Cited by 86 publications

References 70 publications

Reliability of Home Respiratory Polygraphy for the Diagnosis of Sleep Apnea in Children

Reliability of Home Respiratory Polygraphy for the Diagnosis of Sleep Apnea in Children

Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings

Dépistage et prise en charge des anomalies respiratoires de l’enfant obèse : syndrome d’apnée obstructive du sommeil et syndrome d’obésité hypoventilation

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