The specificities of diagnostic examination of childhood Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

T Séailles,M.-F Vecchierini

doi:10.1051/odfen/2018104

Abstract

The diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children depends both on daytime and nighttime symptoms which vary subjectively between individuals and on the results of nocturnal monitoring, intended to supply an objective basis and precision for diagnosis and assessment of severity. Nocturnal monitoring measures the apnea and hypopnea index (AHI): if the score is >1.5 per hour of sleep, diagnosis is confirmed and the score is a key to determining management. Simple respiratory polygraphy can confirm OSAHS is 77% of cases, but cannot identify upper airway resistance syndrome (UARS), where apnea and desaturating hypopnea are often absent but in which restricted inspiration leads to cortical micro-arousal. UARS is relatively frequent in children and requires full polysomnography, although this tool is not readily available. The clinician can provide critical interpretation of the results of nocturnal monitoring if he or she is aware of the various techniques and their respective diagnostic sensitivity; in the light of the individual clinical context, a patient-centered approach can thus be adopted, improving management of sleep disordered breathing.

Highlights

In children with suspected sleep disordered breathing, which may range from primary snoring to upper airway resistance syndrome (UARS) and obstructive sleep a pnea-hypopnea syndrome (OSAHS)13, diagnostic examinations are the key to identifying respiratory abnormality and defining the disorder
A questionnaire may be associated to oximetry to enhance detection of OSAHS and improve severity assessment; such an examination can help determine an order of priority when several children require sleep recording and the waiting list is long[8]
Sleep structure and airway physiology in children leads to underestimation of respiratory and neurological events, explaining why studies in healthy children give obstructive apnea scores well below 1/h; in adults, apnea scores greater than 5/h are taken as diagnosing OSAHS, whereas in children a score greater than 1/h is taken as threshold up to the age of 18 years[36]

Summary

Introduction

In children with suspected sleep disordered breathing, which may range from primary snoring to upper airway resistance syndrome (UARS) and obstructive sleep a pnea-hypopnea syndrome (OSAHS)13, diagnostic examinations are the key to identifying respiratory abnormality and defining the disorder. Primary or habitual snoring is defined as occurring during sleep more than 3 times per week, not usually associated with apnea or hypopnea, gas exchange disorder or cortical micro-arousal; AHI on PSG is < 1/h.

Results

Conclusion