Abstract â–¡ 162

Obstructive sleep apnea syndrome (OSA) in children is a disorder of breathing during sleep characterized by upper airway obstruction that disrupts normal gas exchange and sleep. The most accurate and comprehensive method of diagnosing OSA is nocturnal polysomnography. However, such testing is expensive and time-consuming. Thus, an abbreviated testing modality would be very helpful. We originally proposed that parental responses to questions about snoring, difficulty breathing during sleep, and observed obstructive apnea might distinguish normal children from those with OSA. However, subsequent studies indicated that questionnaire responses could not reliably distinguish children with OSA from those with simple snoring. The present lecture will review the role of nocturnal polysomnography in diagnosing sleep-disordered breathing in infants and children, and will review other diagnostic modalities that have been tried for diagnosing OSA. Emphasis will be placed on the home polysomnography system developed and validated in Montreal. A final topic will be the usefulness of pulse oximetry as a diagnostic modality. Oximetry graphics from the last 349 children referred to us for possible OSA were compared to results from in-laboratory or home olysomnography. The positive predictive value of oximetry was 97% (90/93); however, the sensitivity of oximetry was only 43% (90/210). A normal or inconclusive oximetry did not rule out OSA: the negative predictive value of oximetry was 53%. If a child suspected of having OSA has an abnormal nocturnal oximetry tracing, he (she) has at least a 97% chance of having OSA when tested by polysomnography. Oximetry could: 1) be the definitive diagnostic test for straightforward OSA due to adenotonsillar hypertrophy or 2) could quickly and inexpensively identify a subset of children with a history suggestive of OSA who are likely to have more severe disease and who would benefit from nocturnal polysomnography to elucidate the type and severity of sleep-disordered breathing.