Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-22T09:26:55.565Z Has data issue: false hasContentIssue false
  • English
  • Français

Accuracy of clinical assessment of paediatric obstructive sleep apnoea in two English centres

Published online by Cambridge University Press:  22 May 2009

E L Sproson ,
A M Hogan  and
C M Hill
E L Sproson*
Affiliation:
Department of ENT, Queen Alexandra Hospital, Portsmouth, UK
A M Hogan
Affiliation:
Developmental Cognitive Neuroscience Unit, UCL Institute of Child Health, University College London, UK
C M Hill
Affiliation:
Division of Clinical Neuroscience, University of Southampton School of Medicine, Southampton General Hospital, UK
*
Address for correspondence: Miss Eleanor Sproson, ENT Department, Queen Alexandra Hospital, Cosham, Portsmouth PO16 3LY, UK. Fax: 01962 863528 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To ascertain the sensitivity and specificity of clinical diagnosis of obstructive sleep apnoea in children, and to determine if a published clinical algorithm identifies those at high risk of post-adenotonsillectomy complications.

Method:

Sixty-seven children aged three to eight years underwent clinical assessment and overnight polysomnography.

Results:

Polysomnography detected a significant apnoea–hypopnoea index (i.e. ≥5, indicating significant obstructive sleep apnoea) in 13 (43 per cent) children with a clinical diagnosis of obstructive sleep apnoea and in six (19 per cent) children with no such diagnosis. The sensitivity of clinical assessment was 68.4 per cent and the specificity 59.5 per cent. The post-operative risk algorithm failed to identify any high risk children, although in actuality seven had severe obstructive sleep apnoea confirmed by polysomnography.

Conclusions:

This study of two English centres confirms that the clinical diagnostic process for obstructive sleep apnoea is reasonably insensitive and has low specificity. The studied algorithm discriminated poorly between children with and without severe obstructive sleep apnoea. Realistic diagnostic screening guidelines for paediatric sleep apnoea are overdue in the UK, where access to polysomnography is limited.

Keywords

Sleep Disordered BreathingObstructive Sleep ApnoeaClinical DiagnosisSleep Disordered Breathing QuestionnairePolysomnographyRespiratory ComplicationsRiskAdenotonsillectomy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 9 , September 2009 , pp. 1002 - 1009
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the South West Laryngological Association Spring Meeting, 8 May 2008, Southampton, UK, and the Joint Royal Society of Medicine & ENTUK Anglo-American Meeting, 8 July 2008, Dublin, Republic of Ireland.

References

1 Ali, NJ, Pitson, DJ, Stradling, JR. Snoring, sleep disturbance, and behaviour in 4–5 year olds. Arch Dis Child 1993;68:360–6CrossRefGoogle ScholarPubMed
2 Brunetti, L, Rana, S, Lospalluti, MR, Pietrafesa, A, Francavilla, R, Fanelli, M et al. Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of Southern Italy. Chest 2001;120:1930–5CrossRefGoogle Scholar
3 Marcus, CL. Sleep-disordered breathing in children. Am J Respir Crit Care Med 2001;164:16–30CrossRefGoogle ScholarPubMed
4 Shintani, T, Asakura, K, Kataura, A. The effect of adenotonsilletomy in children with OSA. Int J Pediatr Otorhinolaryngol 1998;44:51–8CrossRefGoogle ScholarPubMed
5 Jain, A, Sahni, JK. Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy. J Laryngol Otol 2002;116:711–15CrossRefGoogle ScholarPubMed
6 Brouillette, RT, Fernbach, SK, Hunt, CE. Obstructive sleep apnea in infants and children. J Pediatr 1982;100:31–40CrossRefGoogle ScholarPubMed
7 Hill, CM, Hogan, AM, Onugha, N, Harrison, D, Cooper, S, McGrigor, VJ et al. Increased cerebral blood flow velocity in children with mild sleep-disordered breathing: a possible association with abnormal neuropsychological function. Pediatrics 2006;118:1100–8CrossRefGoogle ScholarPubMed
8 Section on Pediatric Pulmonology and Subcommittee on Obstructive Sleep Apnea Syndrome. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:704–12CrossRefGoogle Scholar
9 Scottish Intercollegiate Guidelines Network. Management of Obstructive Apnoea/Hypopnoea Syndrome in Adults. A National Clinical Guideline. Scottish Intercollegiate Guidelines Network: Edinburgh, 2003Google Scholar
10 Messner, A. Evaluation of obstructive sleep apnea by polysomnography prior to pediatric adenotonsillectomy. Arch Otolaryngol Head Neck Surg 1999;125:353–6CrossRefGoogle ScholarPubMed
11 Hill, CM. Polysomnography in children – 2005 survey of UK centres. Presented to British Sleep Society Paediatric Special Interest Group. September UKGoogle Scholar
12 Leong, AC, Davis, JP. Morbidity after adenotonsillectomy for paediatric obstructive sleep apnoea syndrome: waking up to a pragmatic approach. J Laryngol Otol 2007;121:809–17CrossRefGoogle ScholarPubMed
13 Brietzke, SE, Katz, ES, Robertson, DW. Can history and physical examination reliably diagnose pediatric obstructive sleep apnea/hypopnea syndrome? A systematic review of the literature. Otolaryngol Head Neck Surg 2004;131:827–32CrossRefGoogle ScholarPubMed
14 Carroll, JL, McColley, SA, Marcus, CL, Curtis, S, Loughlin, GM. Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest 1995;108;610–18CrossRefGoogle ScholarPubMed
15 Wang, RC, Elkins, TP, Keech, D, Wauquier, A, Hubbard, D. Accuracy of clinical evaluation in pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg 1998;118:69–73CrossRefGoogle ScholarPubMed
16 Nieminen, P, Tolonen, U, Lopponen, H, Lopponen, T, Luotonen, J, Jokinen, K. Snoring children: factors predicting sleep apnea. Acta Otolaryngol Suppl (Stockh) 1997;529:190–4CrossRefGoogle ScholarPubMed
17 Suen, JS, Arnold, JE, Brooks, LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 1995;121:525–30CrossRefGoogle ScholarPubMed
18 Nieminen, P, Tolonen, U, Lopponen, H. Snoring and obstructive sleep apnea in children; 6-month follow-up study. Arch Otolaryngol Head Neck Surg 2000;126:481–6CrossRefGoogle ScholarPubMed
19 Leach, J, Olson, J, Herman, J, Manning, S. Polysomnographic and clinical findings in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992;118:741–4CrossRefGoogle ScholarPubMed
20 Brouilette, R, Hanson, D, David, R, Klemka, L, Szatkowski, A, Fernbach, S et al. A diagnostic approach to suspected obstructive sleep apnea in children. Pediatrics 1984;105;10–14Google ScholarPubMed
21 Rosen, CL. Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children. Pediatr Pulmonol 1999;27:403–93.0.CO;2-8>CrossRefGoogle ScholarPubMed
22 Goldstein, NA, Sculerati, N, Walsleben, JA, Bhatia, N, Friedman, DM, Rapoport, DM. Clinical diagnosis of pediatic obstructive sleep apnea validated by polysomnography. Otolaryngol Head Neck Surg 1994;111:611–17CrossRefGoogle Scholar
23 Preutthipan, A, Chantarojanasiri, T, Suwanjutha, S, Udomsubpayakul, U. Can parents predict the severity of obstructive sleep apnoea? Acta Paediatr 2000;89:708–12CrossRefGoogle ScholarPubMed
24 Brouillette, RT, Moriellu, A, Leimanis, A, Waters, KA, Luciano, R, Ducharme, FM. Nocturnal pulse oximetry as an abbreviated testing modality for paediatric sleep apnea. Pediatrics 2000;105:405–12CrossRefGoogle Scholar
25 Jacob, SV, Morielli, A, Mograss, MA, Ducharme, FM, Schloss, MD, Brouillette, RT. Home testing for pediatric obstructive sleep apnea syndrome secondary to adenotonsillar hypertrophy. Pediatr Pulmonol 1995;20:241–52CrossRefGoogle ScholarPubMed
26 Sivan, Y, Kornecki, A, Schonfeld, T. Screening obstructive sleep apnoea syndrome by home videotape recording in children. Eur Respir J 1996;10:2127–31CrossRefGoogle Scholar
27 Lamm, C, Mandeli, J, Kattan, M. Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnea syndrome (OSAS) in children. Pediatr Pulmonol 1999;27:267–723.0.CO;2-X>CrossRefGoogle ScholarPubMed
28 Saeed, MM, Keens, TG, Stabile, MW, Bolokowicz, J, Davidson Ward, SL. Should children with suspected obstructive sleep apnea syndrome and normal nap sleep studies have overnight sleep studies? Chest 2000;118:360–5CrossRefGoogle ScholarPubMed
29 Marcus, CL, Keens, TG, Ward, SL. Comparison of nap and overnight polysomnography in children. Pediatr Pulmonol 1992;13:16–21CrossRefGoogle ScholarPubMed
30 Wilson, K, Lakheeram, I, Morielli, A, Brouilette, R, Brown, K. Can assessment for obstructive sleep apnea help predict postadenotonsillectomy respiratory complications? Anesthesiology 2002;96:313–22CrossRefGoogle ScholarPubMed
31 McColley, SA, April, MM, Carroll, JL, Naclerio, RM, Loughlin, GM. Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992;118:940–3CrossRefGoogle ScholarPubMed
32 Chervin, RD, Hedger, K, Dillon, JE, Pituch, KJ. Pediatric Sleep Questionnaire (PSQ): validity and reliability of scales for sleep disordered breathing, snoring, sleepiness and behavioral problems. Sleep Medicine 2000;1:21–32CrossRefGoogle ScholarPubMed
33 American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996;153:866–78CrossRefGoogle Scholar
34 Marcus, CL, Omlin, KJ, Basinki, DJ, Bailey, SL, Rachal, AB, Von Pechmann, WS et al. Normal polysomnographic values for children and adolescents. Am Rev Respir Dis 1992;146:1235–9CrossRefGoogle ScholarPubMed
35 American Academy of Sleep Medicine. International Classification of Sleep Disorders, 2nd edn. Diagnostic and coding manual, American Academy of Sleep Medicine, Westchester, IL, 2005Google Scholar
36 Verhulst SL Schrauwen, N, Haentjens, D, Van Gaal, L, De Backer, WA, Desager, KN. Reference values for sleep-related respiratory variables in asymptomatic European children and adolescents. Pediatr Pulmonol 2007;42:159–67CrossRefGoogle Scholar
37 Traeger, N, Schultz, B, Pollock, AN, Mason, T, Marcus, CL, Arens, R. Polysomnographic values in children 2–9 years old: additional data and review of the literature. Pediatr Pulmonol 2005;40:22–30CrossRefGoogle ScholarPubMed
38 O'Brien, LM, Mervis, CB, Holbrook, CR, Bruner, JL, Klaus, CJ, Rutherford, J et al. Neurobehavioral implications of habitual snoring in children. Pediatrics 2004;114:44–9CrossRefGoogle ScholarPubMed
39 Magalang, UJ, Dmochowski, J, Veeramachaneni, S, Draw, A, Mador, MJ, El-Solh, A et al. Prediction of the apnea-hypopnea index from overnight pulse oximetry. Chest 2003;124:1694–701CrossRefGoogle ScholarPubMed
40 Nixon, GM, Kermack, AS, Davis, GM, Manoukian, JJ, Brown, KA, Brouillette, RT. Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry. Pediatrics 2004;113:19–25CrossRefGoogle ScholarPubMed
41 Hill, CM, Hogan, AM, Karmiloff-Smith, A. To sleep, perchance to enrich learning? Arch Dis Child 2007;92:637–43CrossRefGoogle ScholarPubMed
42 Richards, W, Ferdman, RM. Prolonged morbidity due to delays in the diagnosis and treatment of obstructive sleep apnea in children. Clin Pediatr 2000;39:103–8CrossRefGoogle ScholarPubMed
43 Chervin, RD, Archbold, KH, Panahi, P, Pituch, KJ. Sleep problems seldom addressed at two general pediatric clinics. Pediatrics 2001;107:1375–80CrossRefGoogle ScholarPubMed