Screening of pediatric obstructive sleep apnea using video monitoring

Introduction: According to International classification of sleep disorder (ICSD-3), overnight polysomnography (PSG) is the gold standard examination for the diagnosis of pediatric obstructive sleep apnea (OSA). However, most of the patients in Japan are not able to access the specialized sleep medical facilities for PSG due to less availability and cost issues. Purpose of this study is to examine whether combination of video monitoring items and other clinical examinations can reliably predict the severity of pediatric OSA compared with PSG. Methods: The study subjects were children diagnosed with sleep related breathing disorder (SRBD) who attended the Department of Otorhinolaryngology at Ota General Hospital between 2012 and 2019. A total of 175 cases were included in this individual retrospective-cohort study, consisting of 122 boys and 53 girls, with ages from 3 to 12 years (median: 8.00). Clinical data included the children's medical history, physical examinations, imaging cephalograms, rhinomanometry, and PSG with video monitoring performed by sleep technicians for all patients. Multiple linear regression analyses were performed to identify independent predictors significantly related to the severity of OSA (AHI: apnea hypopnea index, 5/h and 10/h). Results: For AHI greater than 5/h, the independent predictors were nocturnal oximetry (PSG-ODI 3 %> 3/h), total nasal resistance, tonsil size, one video monitoring item, and the total video monitoring score. The accuracy of this predictive statistic model was 88.0 % (sensitivity 78.3 %, specificity 93.0 %). For AHI greater than 10/h, the independent predictors included facial axis of cephalogram, nocturnal oximetry (PSG-ODI 3 % > 5/h), and BMI <15, along with video monitoring parameters such as whole-night inspiratory noise (loud) and chest retraction. The sensitivity of this model was 88.7 %, specificity was 84.1 %, and accuracy was 86.9 %, which is much higher than the accuracy of the model without video monitoring score. Conclusions: Instead of relying solely on PSG, the combination of video monitoring score and multiple clinical examinations could provide a reliable diagnostic approach for pediatric OSA. These results will support the establishment of more efficient diagnostic strategies for both patients and physicians.