De Luca Canto Graziela, Singh Vandana, Major Michael P, Witmans Manisha, El-Hakim Hamdy, Major Paul W, Flores-Mir Carlos
Dr. Canto is an adjunct professor, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil, and a postdoctoral fellow, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Address correspondence to Dr. Canto at Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, 5-83 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada T6G1C9,
J Am Dent Assoc. 2014 Feb;145(2):165-78. doi: 10.14219/jada.2013.26.
The reference standard for the diagnosis of pediatric sleep-disorder breathing (SDB) is a full polysomnography (PSG) (an overnight sleep study). There are many obstacles to children being able to undergo a full PSG; therefore, the authors evaluated the diagnostic value of alternative diagnostic methods (clinical history and physical examination) for pediatric SDB.
The authors selected articles in which the investigators' primary objective was to evaluate the diagnostic capability of physical evaluations and questionnaires compared with the current reference standard (that is, a full PSG) to diagnose SDB in children younger than 18 years. The authors searched several electronic databases without limitations.
Using a two-step selection process, the authors identified 24 articles and used them to conduct a qualitative analysis. They conducted a meta-analysis on 11 of these articles. Among these articles, only one involved a test that had diagnostic accuracy good enough to warrant its use as a screening method for pediatric SDB, but its diagnostic accuracy was not sufficient to be considered a true diagnostic tool (that is, a replacement for full PSG) for pediatric SDB. Practical Implications. The involvement of dentists in the screening process for pediatric SDB can contribute significantly to children's health. The identified questionnaire could be considered an acceptable screening test to determine which children to refer to a sleep medicine specialist.
小儿睡眠呼吸障碍（SDB）诊断的参考标准是全夜多导睡眠图（PSG）（一项夜间睡眠研究）。儿童接受全夜PSG检查存在诸多障碍；因此，作者评估了小儿SDB替代诊断方法（临床病史和体格检查）的诊断价值。
作者选择了研究者主要目的是评估体格检查和问卷与当前参考标准（即全夜PSG）相比对18岁以下儿童SDB诊断能力的文章。作者对多个电子数据库进行了无限制检索。
通过两步筛选过程，作者确定了24篇文章并用于进行定性分析。他们对其中11篇文章进行了荟萃分析。在这些文章中，只有一篇涉及一项诊断准确性足以用作小儿SDB筛查方法的测试，但其诊断准确性不足以被视为小儿SDB的真正诊断工具（即替代全夜PSG）。实际意义。牙医参与小儿SDB筛查过程对儿童健康有显著贡献。所确定的问卷可被视为一种可接受的筛查测试，以确定哪些儿童应转诊至睡眠医学专家处。
