C. Lamm et al., Evaluation of home audiotapes as an abbreviated test for obstructive sleepapnea syndrome (OSAS) in children, PEDIAT PULM, 27(4), 1999, pp. 267-272
Snoring occurs commonly in children and is sometimes associated with obstru
ctive sleep apnea syndrome (OSAS). Based on clinical history alone, it is d
ifficult to distinguish primary snoring, characterized by noisy breathing d
uring sleep without apnea or hypoventilation, from snoring indicative of OS
AS. An overnight polysomnogram (PSG) is required to establish a definitive
diagnosis of OSAS. Because sleep evaluations are costly and resources are l
imited, we evaluated whether a home audiotape recording could accurately id
entify children with OSAS. We studied 36 children referred by pediatricians
and otolaryngologists for possible OSAS. Parents completed a questionnaire
about their child's sleep and breathing and made a 15-min audiotape of the
child's breath sounds during sleep. Overnight PSGs were performed on all p
atients.
There were 29 patients who completed the study: 15 patients in the Primary
Snoring group (apnea/hypopnea index <5) and 14 patients in the OSAS group (
apnea/hypopnea index greater than or equal to 5). No significant statistica
l differences existed between the two groups for physical characteristics o
r questionnaire responses. Seven observers analyzed the audiotapes for the
presence of a struggle sound and respiratory pauses. The median sensitivity
of the audiotape as a predictor of OSAS was 71% (range 43-86%), and the me
dian specificity was 80% (range 67-80%). The presence of a struggle sound o
n the audiotape was the parameter most predictive of OSAS. There was a good
level of agreement among the seven audiotape observers, as demonstrated by
a mean and range kappa statistic of 0.70 (0.50-0.93) for the 21 pairs of o
bservers. Using a clinical score to predict OSAS, the sensitivity was 46%,
and the specificity was 83%.
We conclude that findings on a home audiotape can be suggestive of OSAS, bu
t are not sufficiently specific to reliably distinguish primary snoring fro
m OSAS. (C) 1999 Wiley-Liss, Inc.