Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Eur Arch Otorhinolaryngol. 2023 Oct;280(10):4351-4359. doi: 10.1007/s00405-023-08095-6. Epub 2023 Jul 5.
Obstructive sleep apnoea (OSA) is an increasing health problem in children. The "gold standard" for OSA diagnosis at the moment is overnight polysomnography (PSG). Some researchers think portable monitors (PMs) are promising methods for diagnosing OSA, which make children more comfortable and lower costs. Compared with PSG, our comprehensively evaluated the diagnostic accuracy of PMs for diagnosing OSA in pediatrics.
This study aims to determine whether PMs can replace PSG in pediatric OSA diagnosis.
The PubMed, Embase, Medline databases Scopus, Web of Science, and Cochrane Library databases were searched systematically for studies published up to December 2022, evaluating the ability of PMs to diagnose OSA in children. For estimating the pooled sensitivity and specificity of the PMs in the included studies, we used a random-effects bivariate model. Studies included in this meta-analysis were evaluated systematically according to QUADAS-2 guidelines for assessing diagnostic accuracy studies. Two independent investigators conducted each stage of the review independently.
A total of 396 abstracts and 31 full-text articles were screened, and 41 full-text articles were chosen for final review. There were 707 pediatric patients enrolled in these twelve studies, and 9 PMs were evaluated. There was a wide range of diagnostic sensitivity and specificity among PM systems as compared to AHI measured by PSG. The pooled sensitivity and specificity in diagnosing pediatric OSA were, respectively, 0.91 [0.86, 0.94] and 0.76 [0.58, 0.88] for PMs. According to the summary receiver operating characteristic (SROC) curve, the AUC of PMs in diagnosing OSA in pediatric population was 0.93 [0.90, 0.95].
PMs were more sensitive but slightly less specific for pediatric OSA. The combination of PMs and questionnaires appeared to be a reliable tool for the diagnosis of pediatric OSA. This test may be used for screening subjects or populations at high risk of OSA when there is a high demand for PSG, but the quantity is limited. No clinical trial was involved in the current study.
阻塞性睡眠呼吸暂停（OSA）是儿童日益严重的健康问题。目前，OSA 的“金标准”诊断方法是整夜多导睡眠图（PSG）。一些研究人员认为，便携式监测仪（PM）是诊断 OSA 的有前途的方法，它可以使儿童更舒适，降低成本。与 PSG 相比，我们全面评估了 PM 诊断儿科 OSA 的诊断准确性。
本研究旨在确定 PM 是否可以替代 PSG 用于儿科 OSA 诊断。
系统检索了 PubMed、Embase、Medline 数据库、Scopus、Web of Science 和 Cochrane 图书馆数据库，以评估截至 2022 年 12 月发表的评估儿童 PM 诊断 OSA 能力的研究。为了估计纳入研究中 PM 的汇总敏感性和特异性，我们使用了随机效应二变量模型。根据评估诊断准确性研究的 QUADAS-2 指南，对纳入的这项荟萃分析的研究进行了系统评估。两名独立的调查员独立进行了审查的各个阶段。
共筛选了 396 篇摘要和 31 篇全文文章，最终选择了 41 篇全文文章进行最终审查。这 12 项研究共纳入了 707 名儿科患者，评估了 9 种 PM 系统。与 PSG 测量的 AHI 相比，PM 系统的诊断灵敏度和特异性差异很大。PM 诊断儿科 OSA 的汇总敏感性和特异性分别为 0.91[0.86,0.94]和 0.76[0.58,0.88]。根据汇总受试者工作特征（SROC）曲线，PM 诊断儿科人群 OSA 的 AUC 为 0.93[0.90,0.95]。
PM 对儿科 OSA 更敏感，但特异性略低。PM 与问卷相结合似乎是诊断儿科 OSA 的可靠工具。当对 PSG 的需求较高，而数量有限时，该测试可用于筛查 OSA 高危人群或人群。本研究未涉及临床试验。
