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Accuracy of clinical assessment of paediatric obstructive sleep apnoea in two English centres

Published online by Cambridge University Press:  22 May 2009

E L Sproson ,
A M Hogan  and
C M Hill
E L Sproson*
Affiliation:
Department of ENT, Queen Alexandra Hospital, Portsmouth, UK
A M Hogan
Affiliation:
Developmental Cognitive Neuroscience Unit, UCL Institute of Child Health, University College London, UK
C M Hill
Affiliation:
Division of Clinical Neuroscience, University of Southampton School of Medicine, Southampton General Hospital, UK
*
Address for correspondence: Miss Eleanor Sproson, ENT Department, Queen Alexandra Hospital, Cosham, Portsmouth PO16 3LY, UK. Fax: 01962 863528 E-mail: [email protected]
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Abstract

Objectives:

To ascertain the sensitivity and specificity of clinical diagnosis of obstructive sleep apnoea in children, and to determine if a published clinical algorithm identifies those at high risk of post-adenotonsillectomy complications.

Method:

Sixty-seven children aged three to eight years underwent clinical assessment and overnight polysomnography.

Results:

Polysomnography detected a significant apnoea–hypopnoea index (i.e. ≥5, indicating significant obstructive sleep apnoea) in 13 (43 per cent) children with a clinical diagnosis of obstructive sleep apnoea and in six (19 per cent) children with no such diagnosis. The sensitivity of clinical assessment was 68.4 per cent and the specificity 59.5 per cent. The post-operative risk algorithm failed to identify any high risk children, although in actuality seven had severe obstructive sleep apnoea confirmed by polysomnography.

Conclusions:

This study of two English centres confirms that the clinical diagnostic process for obstructive sleep apnoea is reasonably insensitive and has low specificity. The studied algorithm discriminated poorly between children with and without severe obstructive sleep apnoea. Realistic diagnostic screening guidelines for paediatric sleep apnoea are overdue in the UK, where access to polysomnography is limited.

Keywords

Sleep Disordered BreathingObstructive Sleep ApnoeaClinical DiagnosisSleep Disordered Breathing QuestionnairePolysomnographyRespiratory ComplicationsRiskAdenotonsillectomy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 9 , September 2009 , pp. 1002 - 1009
Copyright
Copyright © JLO (1984) Limited 2009

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Footnotes

Presented at the South West Laryngological Association Spring Meeting, 8 May 2008, Southampton, UK, and the Joint Royal Society of Medicine & ENTUK Anglo-American Meeting, 8 July 2008, Dublin, Republic of Ireland.

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