In reference to <i>is polysomnography required prior to tonsillectomy and adenoidectomy for the diagnosis of obstructive sleep apnea versus mild sleep‐disordered breathing in children?</i>

Verhulst, Stijn; Kaditis, Athanasios G.

doi:10.1002/lary.21433

Cited by 1 publication

(1 citation statement)

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“…Thus, it further lends support to the critiques on the limitations of assessing patients' complaints of snoring as suffi cient in the process of discriminating apneic vs nonapneic snorers, 16,17,31 an approach that is nevertheless heavily endorsed by many profession als. 32,33 Given that it is often used as a sin gle question, in addition to the intrinsic differences in posing the question and scoring the answer, the statistical characteristics found in this study on its use should provide further opportunities for critical discussion. Independently, the psychometric properties of posing such questions will affect agreement with objective measurements such as NPSG.…”

Section: Discussionmentioning

confidence: 92%

Screening of Pediatric Sleep-Disordered Breathing

Spruyt

Gozal

2012

Chest

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Sleep-disordered breathing (SDB) is a frequent condition in children. In the last 2 decades, associations between SDB and behavioral, neurocognitive, cardiovascular, and metabolic morbidities have been extensively reported, and dose-dependent relationships with certain polysomnographic measures and even sleep-related questions have been suggested. [1][2][3][4][5][6] However, the eventual impact of SDB on impairments in the quality of life of a developing child 7,8 may be best understood in the context of a spectrum of disease, rather than specifi c clinical categories (eg, mild, moderate, severe). Although the primary symptom of SDB is habitual snoring, which is indicative of the presence of increased upper airway resistance during sleep, the actual perception as to the presence of snoring and associated symptoms is highly subjective. [9][10][11][12] Complaints of snoring and somnolence, 13 diminished performance, behavioral problems, 14 or headaches 15 by nonapneic snorers will not reliably discriminate them from those with habitual snoring who suffer Background: Identifi cation of sleep-disordered breathing (SDB) using questionnaires is critical from a clinical and research perspective. However, which questions to use and how well such questionnaires perform has thus far been fraught with substantial uncertainty. We aimed at delineating the usefulness of a set of questions for identifying pediatric SDB. Methods: Random prospective sampling of urban 5-to 9-year-old children from the community and enriched for habitual snoring underwent overnight sleep study. Subjective indicators or questions were evaluated to further characterize and discriminate SDB. Results: Of 1,133 subjects, 52.8% were habitual snorers. This sample was analyzed based on a clinical grouping (ie, established apnea-hypopnea index cutoffs). Several statistical steps were performed and indicated that complaints can be ranked according to a severity hierarchy: shake child to breathe, apnea during sleep, struggle breathing when asleep, and breathing concerns while asleep, followed by loudness of snoring and snoring while asleep. With a posteriori cutoff, a predictive score . 2.72 on the severity scale was found (ie, area under the curve, 0.79 Ϯ 0.03; sensitivity, 59.03%; specifi city, 82.85%; positive predictive value, 35.4; negative predictive value, 92.7), making this cutoff applicable for confi rmatory purposes. Conclusions: As a result, the set of six hierarchically arranged questions will aid the screening of children at high risk for SDB but cannot be used as the sole diagnostic approach.CHEST 2012; 142(6):1508-1515

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