Polysomnography Remains Standard For Pediatric Obstructive Sleep Apnea Diagnosis

Ron B. Mitchell, MD Professor of Otolaryngology and Pediatrics William Beckner Distinguished Chair in Otolaryngology Chief of Pediatric Otolaryngology UT Southwestern and Children's Medical Center Dallas ENT Clinic Dallas, TX 75207MedicalResearch.com Interview with:
Ron B. Mitchell, MD

Professor of Otolaryngology and Pediatrics
William Beckner Distinguished Chair in Otolaryngology
Chief of Pediatric Otolaryngology
UT Southwestern and Children’s Medical Center Dallas
ENT Clinic Dallas, TX 75207

Medical Research: What is the background for this study? What are the main findings?

Dr. Mitchell: The “gold standard” for the diagnosis of and quantification of obstructive sleep apnea (OSA) is polysomnography (PSG or a ‘sleep study’). However, the majorities of T&A procedures are done without PSG and are based on a clinical diagnosis. This is because PSG is expensive, requires overnight observation and is often unavailable. It is important to diagnose and quantify OSA as it allows for surgical planning and predicts the need and type of treatment after surgery.

We used data from the Childhood Adenotonsillectomy (CHAT) study; a large multicenter
trial (RCT), to look at the ability of clinical parameters to predict the severity of obstructive sleep apnea in children scheduled for a T&A.

The main findings of the study are that certain clinical parameters such as obesity and African American race as well as high scores on certain validated questionnaires (such as the pediatric sleep questionnaire- PSQ) are associated, but cannot predict OSA severity. PSG remains the only way to measure objectively the severity of OSA.

Medical Research: What should clinicians and patients take away from your report?

Dr. Mitchell: Children who are obese, African American or have high scores on the PSQ are more likely to have severe OSA. These factors do not, however, predict severe T&A., as the majority of these children have mild to moderate OSA. PSG remains the objective test to diagnose and quantify OSA in children.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Mitchell: PSG is the ‘gold standard’ for diagnosing and quantifying OSA and yet the majority of children who undergo T&A do not undergo the test. Clinical parameters alone cannot identify children with severe OSA. Future research should be directed at finding a combination of clinical parameters and objective tests that are inexpensive, easily available and are able to predict severe OSA in the majority of children. The prevalence of OSA in children and the large number of T&A procedures performed each year, makes this a public health priority.

Citation:

Mitchell RB, Garetz S, Moore RH, et al. The Use of Clinical Parameters to Predict Obstructive Sleep Apnea Syndrome Severity in Children: The Childhood Adenotonsillectomy (CHAT) Study Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online December 04, 2014. doi:10.1001/jamaoto.2014.3049.