Screening of Pediatric Sleep-Disordered Breathing

Abstract

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

Frequency of snoring, rather than apnea–hypopnea index, predicts both cognitive and behavioral problems in young children

“…It is possible that parents who are aware of a possible link between SDB and behavioral problems could provide biased estimates of either measure. However, prior research using community samples has suggested strong associations between parent-reported and objectively measured snoring [49] and shown that parents are generally unaware of an association between SDB and psychiatric outcomes [69]. Thus, the potential for such bias here is likely low.…”

“…During the morning, following NPSG assessment, children were asked to complete the cognitive tasks outlined above, and parents responded to standardized surveys concerning sleep habits and behavioral outcomes. Snoring status was reported by a parent as “never,” “rarely” (once per week), “occasionally” (twice per week), “frequently” (three times per week), and “almost always” (more than four times per week) as part of a validated and commonly used questionnaire [49]. Prior research examining parent-reported snoring status in relation to PSG analysis of snoring has demonstrated high sensitivity (0.66–0.94) and moderate to high specificity (0.20–0.73), depending on specific snoring cut-off values used for analyses [49,50].…”

Urinary biomarkers and obstructive sleep apnea in patients with Down syndrome

“…These HC children resided in Chicago and were recruited through community announcements and distribution of materials in the Well Child Clinic at the University of Chicago Medical Center. All children were considered healthy, did not have any identifiable risk factors for the development of OSA, did not suffer from any specific disorder, and did not snore based on their responses to a validated questionnaire [22]. …”

Pediatric sleep studies

“…Spruyt and Gozal [12] have proposed a set of questions to identify pediatric SDB. Unfortunately, there are no surveys that reliably predict the PSG findings, that is, clinical evaluation does not reliably detect OSA.…”

“…Clinical questions for a severity hierarchy for sleep-disordered breathing are as follows [12]: Clinical questions for a severity hierarchy for sleep-disordered breathing are as follows [12]:…”