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Clinical assessment of pediatric obstructive sleep apnea: A systematic review and meta-analysis

Authors

  • Victor Certal MD,

    Corresponding author
    1. Department of Otorhinolaryngology, Hospital Sao Sebastiao, Santa Maria da Feira, Portugal
    2. Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
    • Departamento de Ciências da Informação e da Decisão em Saúde, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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  • Emanuel Catumbela MD,

    1. Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
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  • João C. Winck MD, PhD,

    1. Department of Pulmonology, Faculty of Medicine, University of Porto, Porto, Portugal
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  • Inês Azevedo MD, PhD,

    1. Department of Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
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  • Armando Teixeira-Pinto MD, PhD,

    1. Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
    2. Department of Biostatistics and Medical Informatics, Faculty of Medicine, University of Porto, Porto, Portugal
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  • Altamiro Costa-Pereira MD, PhD

    1. Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Clinical symptoms and signs are routinely used to investigate pediatric obstructive sleep apnea (OSA). This study aimed to systematically assess the evidence for the diagnostic accuracy of individual or combined clinical symptoms and signs in predicting pediatric OSA.

Study Design:

A systematic review of the literature and diagnostic meta-analysis.

Methods:

Four medical databases were searched (from inception to August 2011). Studies were included that compared the clinical assessment with the current gold standard (full polysomnography). The study quality was assessed using the quality assessment tool for diagnostic accuracy studies. Summary estimates of diagnostic accuracy were determined using the sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and hierarchical summary receiver operating characteristic (HSROC) model for meta-analyses.

Results:

Ten diagnostic studies with 1,525 patients were included in the review. There was substantial variation in the sensitivity and specificity among different symptoms and signs, as well as across studies. Tonsillar size and snoring reported by parents or caregivers had high sensitivity but low specificity. In contrast, excessive daytime somnolence, observed apnea, and difficulty in breathing during sleep had high specificity but low sensitivity. Seven models of a combination of symptoms and signs presented moderate sensitivity (range, 0.04–0.94) and specificity (range, 0.28–0.99). The HSROC indicates poor diagnostic performance of the symptoms and signs in predicting pediatric OSA.

Conclusions:

Neither single nor combined symptoms and signs have satisfactory performance in predicting pediatric OSA. Alternative diagnostic models are necessary to improve the accuracy.

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