Introduction
Pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS) is the most
severe clinical entity in the obstructive sleep disordered breathing
(OSDB) spectrum [1]. In children
without comorbidities (type 1 OSAHS
[2]), it is often caused by
adeno-tonsillar (AT) hypertrophy, leading to upper airway obstruction
[3, 4].
OSAHS is responsible for fragmented nonrestorative sleep, which affects
the child’s behavior and school performance, delays somatic growth, and
causes cardiovascular and metabolic problems that can last into
adulthood [5,
6].
Clinical assessment of OSAHS is based on clinical findings (physical
examination and medical history collection) preferably supplemented by a
sleep questionnaire [4]. In 2012,
Spruyt et al devised a severity hierarchy score (SHS) based on a
set of six questions [7]. The SHS
provides an easy-to-apply clinical tool, which correlates with PSG
results and accurately predicts moderate to severe OSAHS (AHI ≥ 5) with
the score value of ˃ 2.75. A French version of the SHS was validated in
2017 [8].
In children without comorbidities presenting with OSDB, an objective
assessment of OSAHS is mandatory prior to tonsillectomy in the following
situations [9]: (i) doubt about
procedure efficiency, especially in case of discordance between
tonsillar size on physical examination and the reported severity of
sleep-disordered breathing; (ii) additional surgical or anesthetic risk,
such as hemostasis disorder or cardiac condition.
Overnight polysomnography (PSG) in a sleep laboratory is the reference
method for the diagnosis of OSAHS. Respiratory polygraphy (RP) is a
reliable alternative to in-lab PSG [10,
11], but tends to underestimate OSAHS
severity, and also raises the issue of its availability. Sleep
recordings allow identification of central and obstructive apneas,
hypopneas, and sleep arousal due to respiratory effort. These events are
assessed by the 2012 and 2015 criteria of the American Academy of Sleep
Medicine (AASM) [12,
13]. OSAHS severity is defined by the
obstructive apnea-hypopnea index (OAHI) per hour of sleep: mild OSAHS
for an OAHI between 1.5 and 5, moderate between 5 and 10 and severe for
over 10 [14,
15].
Access to sleep recordings is limited because they are cost and
time-consuming [16]. Only 10% of
snoring children undergoing adenotonsillectomy for OSAHS are offered a
preoperative sleep recording [17].
Therefore, there is a need to develop reliable alternative tools for
pediatric OSAHS diagnosis. Sivan et al. suggested in 1996 that
home sleep video recording could serve as a reliable tool for OSAHS
screening in children [18]. The
analyses of 30-minute video recordings were highly correlated with the
PSG results, showing a sensitivity of 94% and a specificity of 68%.
Video scores ˃ 10 appeared to be predictive of OSAHS whereas scores ˂ 5
indicated normal sleep.
The aim of this pilot study was to assess the reliability of a similar
scoring system, calculated on two different time windows (30 and 10
minutes), and applied to a complete sleep cycle obtained on PSG video
recordings.
Our main objective was to look for a correlation between the risk score
obtained on 30 minutes (RS30) and 10 minutes (RS10) from the PSG video
recordings and the OAHI from the same synchronized PSG.
Our secondary objectives were to look for a correlation between the
RS30/RS10 and: (i) the oxygen desaturation index (ODI) from the same
PSG; (ii) the SHS questionnaire results.