CLINICAL-DIAGNOSIS OF PEDIATRIC OBSTRUCTIVE SLEEP-APNEA VALIDATED BY POLYSOMNOGRAPHY

The decision to perform tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea syndrome is often made on a clini cal basis without formal polysomnography. To examine the accuracy of t he clinical diagnosis of pediatric obstructive sleep apnea syndrome, w e prospectively evaluated 30 children with obstructive symptoms by a s tandardized history, physical examination, and review of a tape record ing of breathing during deep. On the basis of this clinical evaluation , patients were divided into three predictive groups: (1) definite obs tructive sleep apnea syndrome, (2) possible obstructive sleep apnea sy ndrome, and (3) unlikely to have obstructive sleep apnea syndrome. Noc turnal polysomnography was used to determine the presence or absence o f true sleep apnea. Ten of 18 (55.6%) patients predicted clinically to have definite obstructive sleep apnea syndrome had positive nocturnal polysomnographies. Two of six (33.3%) patients predicted to have poss ible obstructive sleep apnea syndrome had positive nocturnal polysomno graphies. One of six (16.7%) patients predicted to be unlikely to have obstructive sleep apnea syndrome had a positive nocturnal polysomnogr aphy. Six nocturnal polysomnographies negative by conventional criteri a were suspicious for apnea, but considering these positive for obstru ctive sleep apnea syndrome did not improve the specificity of the clin ical prediction. Our results show that clinical assessment of obstruct ive sleep apnea syndrome in children is sensitive (92.3%) but not spec ific (29.4%) for making the diagnosis of obstructive sleep apnea syndr ome as compared with nocturnal polysomnography and may contribute to t he decision to obtain nocturnal polysomnography in specific circumstan ces.