Goldstein N A, Sculerati N, Walsleben J A, Bhatia N, Friedman D M, Rapoport D M
Department of Otolaryngology, New York University School of Medicine, NY 10016.
Otolaryngol Head Neck Surg. 1994 Nov;111(5):611-7. doi: 10.1177/019459989411100512.
The decision to perform tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea syndrome is often made on a clinical basis without formal polysomnography. To examine the accuracy of the clinical diagnosis of pediatric obstructive sleep apnea syndrome, we prospectively evaluated 30 children with obstructive symptoms by a standardized history, physical examination, and review of a tape recording of breathing during sleep. On the basis of this clinical evaluation, patients were divided into three predictive groups: (1) definite obstructive sleep apnea syndrome, (2) possible obstructive sleep apnea syndrome, and (3) unlikely to have obstructive sleep apnea syndrome. Nocturnal polysomnography was used to determine the presence or absence of true sleep apnea. Ten of 18 (55.6%) patients predicted clinically to have definite obstructive sleep apnea syndrome had positive nocturnal polysomnographies. Two of six (33.3%) patients predicted to have possible obstructive sleep apnea syndrome had positive nocturnal polysomnographies. One of six (16.7%) patients predicted to be unlikely to have obstructive sleep apnea syndrome had a positive nocturnal polysomnography. Six nocturnal polysomnographies negative by conventional criteria were suspicious for apnea, but considering these positive for obstructive sleep apnea syndrome did not improve the specificity of the clinical prediction. Our results show that clinical assessment of obstructive sleep apnea syndrome in children is sensitive (92.3%) but not specific (29.4%) for making the diagnosis of obstructive sleep apnea syndrome as compared with nocturnal polysomnography and may contribute to the decision to obtain nocturnal polysomnography in specific circumstances.
对于小儿阻塞性睡眠呼吸暂停综合征的治疗，扁桃体切除术和腺样体切除术的决策通常基于临床判断，而非正式的多导睡眠图检查。为了检验小儿阻塞性睡眠呼吸暂停综合征临床诊断的准确性，我们通过标准化病史、体格检查以及回顾睡眠期间呼吸录音，对30名有阻塞症状的儿童进行了前瞻性评估。基于该临床评估，患者被分为三个预测组：（1）明确的阻塞性睡眠呼吸暂停综合征；（2）可能的阻塞性睡眠呼吸暂停综合征；（3）不太可能患有阻塞性睡眠呼吸暂停综合征。夜间多导睡眠图用于确定是否存在真正的睡眠呼吸暂停。临床预测为明确的阻塞性睡眠呼吸暂停综合征的18名患者中，有10名（55.6%）夜间多导睡眠图结果呈阳性。预测为可能的阻塞性睡眠呼吸暂停综合征的6名患者中，有2名（33.3%）夜间多导睡眠图结果呈阳性。预测不太可能患有阻塞性睡眠呼吸暂停综合征的6名患者中，有1名（16.7%）夜间多导睡眠图结果呈阳性。按照传统标准夜间多导睡眠图结果为阴性的6例对呼吸暂停可疑，但将这些结果视为阻塞性睡眠呼吸暂停综合征阳性并不能提高临床预测的特异性。我们的结果表明，与夜间多导睡眠图相比，儿童阻塞性睡眠呼吸暂停综合征的临床评估对于诊断阻塞性睡眠呼吸暂停综合征具有敏感性（92.3%）但不具有特异性（29.4%），并且可能有助于在特定情况下决定是否进行夜间多导睡眠图检查。
