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Clinical assessment of pediatric obstructive sleep apnea: A systematic review and meta‐analysis
Author(s) -
Certal Victor,
Catumbela Emanuel,
Winck João C.,
Azevedo Inês,
TeixeiraPinto Armando,
CostaPereira Altamiro
Publication year - 2012
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.23465
Subject(s) - medicine , diagnostic odds ratio , polysomnography , obstructive sleep apnea , gold standard (test) , meta analysis , diagnostic accuracy , sleep apnea , likelihood ratios in diagnostic testing , apnea , receiver operating characteristic , physical therapy , pediatrics
Objectives/Hypothesis: Clinical symptoms and signs are routinely used to investigate pediatric obstructive sleep apnea (OSA). This study aimed to systematically assess the evidence for the diagnostic accuracy of individual or combined clinical symptoms and signs in predicting pediatric OSA. Study Design: A systematic review of the literature and diagnostic meta‐analysis. Methods: Four medical databases were searched (from inception to August 2011). Studies were included that compared the clinical assessment with the current gold standard (full polysomnography). The study quality was assessed using the quality assessment tool for diagnostic accuracy studies. Summary estimates of diagnostic accuracy were determined using the sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and hierarchical summary receiver operating characteristic (HSROC) model for meta‐analyses. Results: Ten diagnostic studies with 1,525 patients were included in the review. There was substantial variation in the sensitivity and specificity among different symptoms and signs, as well as across studies. Tonsillar size and snoring reported by parents or caregivers had high sensitivity but low specificity. In contrast, excessive daytime somnolence, observed apnea, and difficulty in breathing during sleep had high specificity but low sensitivity. Seven models of a combination of symptoms and signs presented moderate sensitivity (range, 0.04–0.94) and specificity (range, 0.28–0.99). The HSROC indicates poor diagnostic performance of the symptoms and signs in predicting pediatric OSA. Conclusions: Neither single nor combined symptoms and signs have satisfactory performance in predicting pediatric OSA. Alternative diagnostic models are necessary to improve the accuracy.