Abstract
Efficient screening for severe obstructive sleep apnea (OSA) is important for children with snoring before time-consuming standard polysomnography. This retrospective cross-sectional study aimed to compare clinical variables, home snoring sound analysis, and home sleep pulse oximetry on their predictive performance in screening severe OSA among children who habitually snored. Study 1 included 9 (23%) girls and 30 (77%) boys (median age of 9 years). Using univariate logistic regression models, 3% oxygen desaturation index (ODI3) ≥ 6.0 events/h, adenoidal-nasopharyngeal ratio (ANR) ≥ 0.78, tonsil size = 4, and snoring sound energy of 801–1000 Hz ≥ 22.0 dB significantly predicted severe OSA in descending order of odds ratio. Multivariate analysis showed that ODI3 ≥ 6.0 events/h independently predicted severe pediatric OSA. Among several predictive models, the combination of ODI3, tonsil size, and ANR more optimally screened for severe OSA with a sensitivity of 91% and a specificity of 94%. In Study 2 (27 (27%) girls and 73 (73%) boys; median age, 7 years), this model was externally validated to predict severe OSA with an accuracy of 76%. Our results suggested that home sleep pulse oximetry, combined with ANR, can screen for severe OSA more optimally than ANR and tonsil size among children with snoring.
Highlights
Obstructive sleep apnea (OSA) is characterized by intermittent episodes of upper airway collapse during sleep
In Study 1, three children were excluded from statistical analysis due to insufficient pulse oximetry data
Home sleep apnea tests with technically adequate devices have been used to diagnose moderate to severe OSA in uncomplicated adult patients [40] and school-aged children [41,42] with sleep-disturbed breathing; these devices are not recommended for the diagnosis of pediatric OSA [43]
Summary
Obstructive sleep apnea (OSA) is characterized by intermittent episodes of upper airway collapse during sleep. It is a chronic and severe breathing-related disorder, which affects approximately 2 to 3% of school-aged children [1,2]. A substantial volume of evidence has linked pediatric OSA and cardiovascular/metabolic dysfunctions [1,2]. Adenotonsillectomy remains the preferred treatment for pediatric OSA [4,5]; older children have been reported to have less satisfactory surgical outcomes [6]. Delay in the diagnosis of severe pediatric OSA has been one of the major attributable causes for compromised treatment outcomes for pediatric sleep-disordered breathing
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