ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Clinical Signs and Symptoms Alone Lack Validity to Diagnose Obstructive Sleep Apnea in Pediatric Patients
Clinical Question In pediatric patients, do clinical signs and symptoms of OSA provide enough information to provide a diagnosis?
Clinical Bottom Line Clinical signs and symptoms lack evidence to diagnose obstructive sleep apnea in pediatric patients. The overnight polysomnography is the gold standard in diagnosing obstructive sleep apnea.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22886768Certal/20121,525 pediatric OSA patientsSystematic Review and Meta-Analysis
Key results“Seven models of a combination of symptoms and signs presented moderate sensitivity (range, 0.04-0.94) and specificity (range, 0.28-0.99). The HSROC indicates poor diagnostic performance of the symptoms and signs in predicting pediatric OSA.”
#2) 11927742Schechter/2002Pediatric OSA PatientsPractice Guidelines with Systematic Review
Key results“Overnight polysomnography (PSG) is recognized as the gold standard for diagnosis of OSAS, and there are currently no satisfactory alternatives. The diagnostic accuracy of symptom questionnaires and other purely clinical approaches is low.”
Evidence Search (("obstructive sleep apnoea"[All Fields] OR "sleep apnea, obstructive"[MeSH Terms] OR ("sleep"[All Fields] AND "apnea"[All Fields] AND "obstructive"[All Fields]) OR "obstructive sleep apnea"[All Fields] OR ("obstructive"[All Fields] AND "sleep"[All Fields] AND "apnea"[All Fields])) AND ("pediatrics"[MeSH Terms] OR "pediatrics"[All Fields] OR "pediatric"[All Fields]) AND clinical[All Fields] AND ("Assessment"[Journal] OR "assessment"[All Fields]) AND ("diagnosis"[Subheading] OR "diagnosis"[All Fields] OR "diagnosis"[MeSH Terms])) AND ((systematic[sb] OR Meta-Analysis[ptyp] OR Randomized Controlled Trial[ptyp]) AND "humans"[MeSH Terms] AND English[lang] AND ("infant"[MeSH Terms] OR "child"[MeSH Terms] OR "adolescent"[MeSH Terms]))
Comments on
The Evidence
Certal (2012) provides a meta-analysis of 1,525 pediatric patients. The authors conducted a search of four databases with many of the results providing a comparison to the gold standard of OSA diagnosis, overnight polysomnography. Schechter (2002) performed a review of 113 articles, “these articles were mainly case series and cross-sectional studies; overall, very few methodologically strong cohort studies or randomized, controlled trials concerning OSAS have been published”. Schechter (2002) also lists overnight polysomnography as the gold standard for OSA diagnosis.
Applicability The results of this study can be applied to patients ages 1-18 who experience clinical signs and symptoms of OSA. Currently diagnosis of OSA in children should be determined by overnight polysomnography and not observation of clinical signs and symptoms.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Pediatric Dentistry)
Keywords Obstructive Sleep Apnea Pediatric Diagnosis
ID# 2362
Date of submission: 02/19/2013spacer
E-mail garzag3@uthscsa.edu
Author Gino R. Garza
Co-author(s) Shahad M. Abudawood, DDS
Co-author(s) e-mail Abudawood@uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
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