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Accuracy of clinical scoring tools for the diagnosis of pediatric obstructive sleep apnea
Author(s) -
Patel Anant P.,
Meghji Sheneen,
Phillips John S.
Publication year - 2020
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.28146
Subject(s) - polysomnography , medicine , receiver operating characteristic , obstructive sleep apnea , sleep apnea , medical diagnosis , craniofacial , physical therapy , likelihood ratios in diagnostic testing , area under the curve , sleep study , apnea , pediatrics , radiology , psychiatry
Objectives To assess the diagnostic test accuracy of questionnaire and clinical examination‐based scoring tools in the diagnosis of pediatric obstructive sleep apnea (OSA). Methods A comprehensive literature search was performed to identify studies published from 1960 to 2018 that evaluated the accuracy of clinical scoring tools in the diagnosis of pediatric OSA. Studies that did not include attended polysomnography as a reference standard were excluded. The study populations were children under 18 years old without craniofacial abnormalities, congenital syndromes, or other complex medical conditions. Outcomes measures were diagnostic test accuracy (DTA) statistics including sensitivity, specificity, and area under the curve (AUC) from receiver operating characteristic curve analysis. Results Fifteen different scoring tools were identified. Authors chose different polysomnographic criteria to diagnose OSA. Four of the tools had undergone multiple DTA studies by different authors (OSA Score, Sleep‐Related Breathing Disorder [SRBD] scale, Severity Score, and OSA‐18). The Pediatric Sleep Questionnaire SRBD scale, which is widely used, has a sensitivity of 71% to 84% in included studies, but specificity as low as 13% and a low AUC of 0.57‐0.69, indicating poor diagnostic accuracy. None of the 15 scoring tools performed well enough to be considered accurate diagnostic tests for pediatric OSA. Conclusions A well‐designed questionnaire can provide crucial information on the impact of sleep‐disordered breathing on a child's physical and psychological health, which may not be adequately reflected in objective polysomnography outcomes measures. However, DTA results indicate that published clinical scoring tools do not accurately predict a diagnosis of pediatric OSA as defined by polysomnography outcome measures. Laryngoscope , 130:1034–1043, 2020