Utility of the Pediatric Sleep Questionnaire and Pulse Oximetry as Screening Tools in Pediatric Patients with Suspected Obstructive Sleep Apnea Syndrome
Objective. To assess the screening tools in snoring patients. Material and Methods. A retrospective review of data was conducted from children between 2 and 15 years old who were referred on suspicion of obstructive sleep apnea-hypopnea (OSAH) between June 2008 and June 2011. We excluded patients with significant comorbidities. Pediatric Sleep Questionnaire (PSQ), physical exam (PE), and pulse-oximetry data were collected and correlated with the results of the nightly polygraph at home. Results. We selected 98 patients. The 22-item version of the PSQ had sensitivity of 96% and specificity of 36.8%. The overall value of the clinic predictor of OSAH (PSQ and PE together) exhibited an increased specificity 57.6% with 94.6% of sensitivity. The nocturnal home oximetry method used alone was very specific, 92.1%, but had a lower sensitivity, 77.1%. The set of clinical assessment tools used together with pulse-oximetry screening provided excellent specificity 98.1% and a positive predictive value 94.1% globally. The performance of this screening tool is related with the severity of OSAH and accuracy is better in moderate and severe cases. Conclusion. The combination of clinical assessment and pulse-oximetry screening can provide a sufficient diagnostic approach for pediatric patients with suspected OSAH at least in moderate and severe cases. 1. Introduction Snoring is a common symptom in children. It is estimated that 5–17% of children between the ages of 2 and 14 years snore, and that 2-3% within this age group suffer from obstructive sleep apnea-hypopnea (OSAH) [1–5]. Given the high prevalence of this group of symptoms, a series of tools have been designed in recent years with the purpose of identifying patients with greater clinical suspicion of OSAH in order to provide specialized treatment. Some of these tools include pediatric sleep questionnaires, such as the Pediatric Sleep Questionnaire (PSQ) designed by Chervin et al. [6] that has been validated in several studies [7], and the nocturnal pulse oximetry McGill scale described by Nixon et al. [8]. The current gold standard test for diagnosing obstructive sleep apnea-hypopnea (OSAH) is polysomnography (PSG), which is performed in a sleep laboratory. However, PSG is an expensive test that requires substantial resources, and is not available in all hospitals. As a diagnostic alternative, some centers used home cardiorespiratory polygraphy, which has already demonstrated its usefulness in the diagnosis of OSAH in children and adults [9, 10] and offers distinct advantages, such as not requiring hospital
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