NEW YORK (Reuters Health) – Polysomnography remains the gold standard for diagnosing sleep-disordered breathing in children and adults, but several new tools hold promise for easier, less resource-intensive diagnoses, according to a new report.
Dr. Brian McGrath and Dr. Jerrold Lerman from Women and Children’s Hospital of Buffalo, New York, review new and emerging methods for diagnosing pediatric sleep-disordered breathing in their June 1 Current Opinion in Anesthesiology paper.
The prevalence of obstructive sleep apnea syndrome (OSAS) in children ranges from 1.2% to 5.7%, they note, and the demand for polysomnography (PSG) testing has outstripped the number of sleep study facilities to ensure patient access to a study in a timely manner.
Home PSG has emerged as an alternative and is highly predictive in adults, but there are limited data to support its use in children.
Among the newer diagnostic tools, the six-question screening questionnaire for children 5-9 years old and the STOP-BANG questionnaire for those older than 9 years are predictive of OSAS in these age groups, the authors say.
Drug-induced sleep endoscopy (DISE), a technique intended to simulate natural sleep, can diagnose areas of obstruction in the upper airway from the nasal airways to the vocal cords. It, too, has been used to reliably diagnose OSAS in children and adults.
While nocturnal enuresis is a recognized sequela of OSAS in children, it has not been incorporated in any diagnostic forecasting of the severity of OSAS in children so far.
Pulse oximetry in children has a high predictive value, but a negative test does not rule out the diagnosis of OSAS, according to Drs. McGrath and Lerman.
A number of diagnostic biomarkers are under investigation, and the urinary biomarkers uromodulin, orosomucoid, kallikrein and urocortin might eventually offer the opportunity to diagnose OSAS in children noninvasively.
“Whether individually or in combination, these new diagnostic tools may ultimately supplant the expensive, overnight PSG in children, a testament to the power of research to shape clinical medicine,” the authors conclude.
Dr. Lerman did not respond to a request for comments.
SOURCE: http://bit.ly/2q1qRBu
Curr Opin Anesthesiol 2017;30:357-361.
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