Sproson E L, Hogan A M, Hill C M
Department of ENT, Queen Alexandra Hospital, Portsmouth, UK.
J Laryngol Otol. 2009 Sep;123(9):1002-9. doi: 10.1017/S0022215109005532. Epub 2009 May 22.
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.
Sixty-seven children aged three to eight years underwent clinical assessment and overnight polysomnography.
Polysomnography detected a significant apnoea-hypopnoea index (i.e. > or =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.
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.
确定儿童阻塞性睡眠呼吸暂停临床诊断的敏感性和特异性，并确定一种已发表的临床算法能否识别出腺样体扁桃体切除术后并发症的高危儿童。
对67名3至8岁的儿童进行了临床评估和整夜多导睡眠图监测。
多导睡眠图监测显示，临床诊断为阻塞性睡眠呼吸暂停的13名儿童（43%）和未诊断为此病的6名儿童（19%）存在显著的呼吸暂停低通气指数（即≥5，表明存在显著的阻塞性睡眠呼吸暂停）。临床评估的敏感性为68.4%，特异性为59.5%。术后风险算法未能识别出任何高危儿童，尽管实际上有7名儿童经多导睡眠图监测确诊为严重阻塞性睡眠呼吸暂停。
这项对两个英国中心的研究证实，阻塞性睡眠呼吸暂停的临床诊断过程相当不敏感且特异性较低。所研究的算法在区分有和没有严重阻塞性睡眠呼吸暂停的儿童方面表现不佳。在英国，获得多导睡眠图监测的机会有限，因此早就应该制定切实可行的儿科睡眠呼吸暂停诊断筛查指南。
