Alternative tests for the identification of obstructive sleep apnea in children: A systematic review

Abstract

Background: Obstructive sleep apnea (OSA) is a common multi-factorial condition that is common in childhood with important impacts on physical and mental health as well as daytime function. Polysomnography is the recommended standard for establishing the diagnosis of OSA in children but access to this testing is limited or unavailable in many jurisdictions. The role of alternative tests to identify OSA is unclear. The aim of this systematic review is to determine which alternative tests lead to appropriate diagnosis of obstructive sleep apnea in children. Methods: Studies were eligible for inclusion in this systematic review if they reported the results of at least one comparison of OSA diagnosed in children (aged 0-17 years) by polysomnography to an alternative means of identifying OSA. The search strategy was designed for PubMed NCBI and adapted for OVID Medline, CINAHL EDSCO, and Cochrane. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool was used for the assessment of the quality of the included studies. Results: The search strategy identified 2947 unique articles with 550 eligible for full-text review and 160 eligible for inclusion. The articles stemmed from 28 countries and were published between 1984 and 2019. A total of 25,256 children were included in these studies, 15,710 (62%) of whom were children with suspected OSA. Most studies (68%) excluded children with comorbidities with exclusion criteria not listed for an additional 22%. Polysomnography was conducted in-laboratory in all but two studies. There were 68 different polysomnography derived definitions of OSA across the studies. A total of 194 alternative tests were spread across six test groups with clinical history (34%) and physiological assessments (31%) comprising the two biggest groups (Table 1); 43% of alternative tests were conducted at home. Combining individual alternative tests with OSA definitions resulted in 492 comparisons. Measures of sensitivity and specificity were included for 69% and 68% of comparisons respectively. Conclusion: Despite a large body of work investigating alternatives to polysomnography for the diagnosis of OSA in children, considerable variation in the polysomnographic definition of OSA and individual alternative test types means that there is a paucity of data that can be combined for quantitative analysis. In addition, a sizeable portion of studies do not include the data needed to assess the level of agreement between polysomnography and alternative tests. These limitations in the field impede identification of the accuracy of alternative testing for the diagnosis of OSA in children.L6353061442021-06-22 <br />