Comparison between three abbreviated methods for the diagnosis of obstructive sleep apnea syndrome in children and adolescents in a real-world setting - a prospective study using polysomnography

Background: Oximetry was proposed as an abbreviated exam, easily accepted by the child, for the diagnosis of obstructive sleep apnea (OSA) for children located in regions where access to pediatric sleep labs is limited. The objective of this study was to determine the diagnostic value of the oxygen desaturation index (ODI), the number of ≥ 3% oxygen desaturations per hour of recording, obtained by portable oximetry performed in parallel with video-polysomnography (PSG), in a cohort of children, with and without comorbidities, referred for OSA.

Methods: Data from portable oximetry performed in parallel with PSG were prospectively collected. The diagnostic value, sensitivity, and specificity of ODI to identify a moderate/severe OSA were computed.

Results: 81 children aged 3 to 18 years were included, 56 (69%) with comorbidities, 50 (62%) with moderate/severe OSA. The area under the ROC curves was 0.92 for ODI by PSG, 0.86 for ODI by PSG's oximetry and 0.78 for ODI by portable oximetry, to diagnose a moderate/severe OSA. All ODIs presented high specificity (1.0 for PSG, 0.90 for PSG's oximetry, 0.87 for portable oximetry) and moderate sensitivity (0.84 for PSG, 0.72 for PSG's oximetry, 0.60 for portable oximetry).

Conclusion: In children referred for OSA, particularly in those with a pre-existing comorbidity, ODI obtained by an abbreviated method had high specificity for the diagnosis of moderate/severe OSA and might be used to prioritize the access to a comprehensive sleep recording. Its low sensitivity suggests that a comprehensive sleep exam must be performed in case of a negative test.