A DIAGNOSTIC APPROACH TO CHILDREN WITH SUSPECTED OBSTRUCTIVE SLEEP APNEA (OSA)

Abstract

Most children with OSA will benefit from tonsillectomy and adenoidectomy. Although polygraphic monitoring remains the definitive diagnostic technique, we wondered if all children suspected of having OSA require such evaluation. We therefore administered a standardized questionnaire to the parents of 23 children with polygraphically proven OSA due to adenotonsillar hypertrophy, 46 age and sex-matched normal children, and 23 children subsequently referred for possible OSA. Significantly increased frequencies of the following symptoms were found in the OSA group compared to the control group: difficulty breathing during sleep, 96% vs 2%; apneas observed by the parents, 78% vs 5%; snoring, 96% vs 9%; restless sleep, 78% vs 23%; chronic rhinorrhea, 61% vs 11%; and mouth breathing when awake, 87% vs 18%. Using discriminant analysis, an OSA score was derived which correctly classified all controls and 22 of 23 OSA patients. Considering the data from all groups, we found that (1) OSA scores > 3.5 were highly predictive of OSA requiring adenotonsillectomy, (2) no child with an OSA score < -1 had OSA, and (3) children with OSA scores between -1 and 3.5 require polygraphic monitoring to determine the severity of sleep-related airway obstruction and the need for surgical treatment. Use of the OSA score should decrease the need for polygraphic monitoring and facilitate selection of children for adenotonsillectomy. (Supported in part by the Children's Research Guild).

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