Abstract
Aims: To develop a reliable tool, PSG validated, for diagnosis of SDB and to reduce the use of PSG.
Methods: Children with referred SDB undergoing a PSG for the first time. We propose the Sleep Clinical Record (SCR) to predict SDB in children, based on clinical experience. It consists of objective data, subjective symptoms, clinical history, behavioural and cognitive problems. These items were used in a model which combine subjective and objective parameters to create the sleep clinical score (SCS) with the higher predictive value.
Results: We studied 289 children (6.2±3.1 yrs, 63.3% M). We found 28% children's with primary snoring (PS) and 72% with OSAS. The SCS was higher in children with OSAS than children with PS (8.8±2.7 vs 7.4±3.1, p< 0.005) and it was correlated with AHI (r=0.156, p=0.008). The SCS's distribution has identified the value of 6.5 as its 25° centile, so the SCS was defined as positive when it was major of 6.5. The SCS was positive in 224 of the 289 children studied, of these 177 had OSAS (real positives) and 47 were PS (false positives). 65 children had a negative SCS, of these 31 were diagnosed as OSAS (false negatives). These children had lower AHI than OSAS'children with positive score (5.1±4.9 vs 8.9±10.1 p = 0,04).
Conclusion: This SCS is useful to screen SDB in selected population with referred symptoms, and is able to perform diagnosis of OSAS with a positive predictive value of 79% and an accuracy of 73%. It is a useful instrument to select patients with OSAS that could be treated without PSG diagnosis when the study is difficult to perform or is unavailable.
- © 2011 ERS
