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.