Suzuki Masaaki, Furukawa Taiji, Sugimoto Akira, Kotani Ryosuke, Hosogaya Rika
Department of Otorhinolaryngology, Teikyo University Chiba Medical Center, Chiba, Japan.
Departments of Laboratory Medicine, Teikyo University, Tokyo, Japan.
Int J Pediatr Otorhinolaryngol. 2017 Mar;94:54-58. doi: 10.1016/j.ijporl.2017.01.015. Epub 2017 Jan 12.
Sleep studies for diagnosing obstructive sleep apnea (OSA) in children are laborious, expensive, inconvenient, and often not readily available. Out-of-center sleep test (OCST) devices have been studied for diagnosing OSA in adults, but few OCST studies have been done in children. The purpose of this study was to clarify the diagnostic reliability of OCST devices for children.
OCSTs using pulse oximetry and in-laboratory polysomnography (PSG) were performed separately in 686 adults and 119 children. For each apnea-hypopnea index (AHI) measured with PSG, accuracy, sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and positive/negative predictive value (PPV/NPV) were calculated for several cutoff values of 3% oxygen desaturation index (ODI) measured with OCST and analyzed.
For definitive diagnosis in adults, the specificity, PLR, and PPV with a cutoff value of OCST-ODI 20/h were 98.3%, 29.26, and 97.4%, respectively, to detect PSG-AHI ≥20/h. Corresponding values with a cutoff value of OCST-ODI 15/h were 99%, 46.19, and 99.6% to detect an AHI ≥5/h. For exclusive diagnosis (screening) in adults, sensitivity, NLR, and NPV with a cutoff value of OCST-ODI 5/h were 96.4%, 0.068, and 91.9% to detect PSG-AHI <20/h and 84.1%, 0.21, and 45.9% to detect PSG-AHI <5/h. or definitive diagnosis in children, the corresponding values with a cutoff value of OCST-ODI 25/h were 98.6%, 16.0, and 90.9% to detect PSG-AHI ≥10/h and 98.1%, 8.281, and 90.9% for PSG-AHI ≥5/h. For exclusive diagnosis in children, with a cutoff of OCST-ODI 10/h, the corresponding values were 62.2%, 0.446, and 78.2% to detect PSG-AHI <10/h, 45.3%, 0.674, and 55.1% for PSG-AHI <5/h, and 34.0%, 0.908, and 10.3% for PSG-AHI <1/h. Statistical data of preschool children tended to be worse than those of school age children.
In adults, OCST is reliable for the definitive diagnosis of AHI ≥20/h or ≥5/h and the exclusive diagnosis of AHI <20/h. However, in children, OCST should not be used alone for the definitive diagnosis or exclusive diagnosis.
用于诊断儿童阻塞性睡眠呼吸暂停（OSA）的睡眠研究费力、昂贵、不便，且往往难以获得。院外睡眠测试（OCST）设备已用于成人OSA的诊断研究，但针对儿童的OCST研究较少。本研究旨在明确OCST设备对儿童的诊断可靠性。
分别对686名成人和119名儿童进行了使用脉搏血氧饱和度仪的OCST和实验室多导睡眠图（PSG）检查。对于PSG测量的每个呼吸暂停低通气指数（AHI），针对OCST测量的几个3%氧饱和度下降指数（ODI）临界值计算准确性、敏感性、特异性、阳性/阴性似然比（PLR/NLR）以及阳性/阴性预测值（PPV/NPV）并进行分析。
对于成人的明确诊断，以OCST - ODI 20/h为临界值时，检测PSG - AHI≥20/h的特异性、PLR和PPV分别为98.3%、29.26和97.4%。以OCST - ODI 15/h为临界值时，检测AHI≥5/h的相应值分别为99%、46.19和99.6%。对于成人的排除诊断（筛查），以OCST - ODI 5/h为临界值时，检测PSG - AHI <20/h的敏感性、NLR和NPV分别为96.4%、0.068和91.9%，检测PSG - AHI <5/h的分别为84.1%、0.21和45.9%。对于儿童的明确诊断，以OCST - ODI 25/h为临界值时，检测PSG - AHI≥10/h的相应值分别为98.6%、16.0和90.9%，检测PSG - AHI≥5/h的为98.1%、8.281和90.9%。对于儿童的排除诊断，以OCST - ODI 10/h为临界值时，检测PSG - AHI <10/h的相应值分别为62.2%、0.446和78.2%，检测PSG - AHI <5/h的为45.3%、0.674和55.1%，检测PSG - AHI <1/h的为34.0%、0.908和10.3%。学龄前儿童的统计数据往往比学龄儿童的更差。
在成人中，OCST对于AHI≥20/h或≥5/h的明确诊断以及AHI <20/h的排除诊断是可靠的。然而，在儿童中，OCST不应单独用于明确诊断或排除诊断。
