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Vol. 44. Issue 6.
Pages 318-323 (January 2008)
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Vol. 44. Issue 6.
Pages 318-323 (January 2008)
Original Articles
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Reliability of Respiratory Polygraphy for the Diagnosis of Sleep Apnea-Hypopnea Syndrome in Children
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María Luz Alonso Álvareza,b,
Corresponding author
mari63@separ.es

Correspondence: Dr M.L. Alonso Álvarez Unidad de Trastornos Respiratorios del Sueño Servicio de Neumología, Complejo Asistencial de Burgos Avda del Cid, 9609005 Burgos, Spain
, Joaquín Terán Santosa,b, José Aurelio Cordero Guevaraa,b, Ana Isabel Navazo Egüiaa,b, Estrella Ordax Carbajoa,b, Juan Fernando Masa Jiménezb,c, Rafael Pelayod
a Unidad de Trastornos Respiratorios del Sueño, Sección de Neumología, Complejo Asistencial de Burgos, Burgos, Spain
b CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
c Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
d Department of Psychiatry and Behavioral Science, Stanford University, Stanford, California, USARafael Pelayo holds a grant from the Spanish Society for Pulmonology and Thoracic Surgery (SEPAR)
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Objective

Overnight polysomnography (PSG) is thegold standard diagnostic tool for sleep apnea-hypopneasyndrome (SAHS) in children. The aim of the present studywas to evaluate the usefulness of diagnostic respiratorypolygraphy in children with clinically suspected SAHSreferred to our sleep-disordered breathing clinic.

Patients and Methods

We studied 53 children referredwith clinical suspicion of SAHS; 29 (54.7%) were boys andthe mean (SD) age was 6.4 (2.9) years. After a medicalhistory was taken and a physical examination performed, patients underwent respiratory polygraphy (Edentec)simultaneously with overnight PSG in the sleep laboratory. The 2 diagnostic tools were compared using statisticalanalysis.

Results

SAHS was defined by an obstructive apnea-hypopnea index (OAHI) of 3 or more in overnight PSG anda respiratory disturbance index (RDI) of 3 or more inrespiratory polygraphy. The rate of diagnostic agreementwas 84.9%. The difference between the mean OAHI andRDI values was not significant (0.7 [5.4]; P =.34). Theintraclass correlation coefficient between the OAHI andRDI was 89.4 (95% confidence interval, 82.4-93.7; P <.001).

When receiver operating characteristic curves werecalculated for the OAHI cutoff points used for the diagnosisof SAHS (1, 3, and 5), the best RDI cutoff for all 3 OAHI valuesconsidered was found to be 4.6. When age strata wereconsidered, in children 6 years or older the best RDI cutofffor the 3 OAHI values was 2.1. In children younger than 6 years the best RDI cutoff was 3.35 for OAHI 1 and 5.85 forOAHI 3 and 5.

Conclusions

Respiratory polygraphy in the sleeplaboratory is a valid method for the diagnosis of SAHS inchildren.

Key words:
Sleep-disordered breathing
Children
Sleep
Obstructive sleep apnea
Apnea
Sleep studies
Objetivo

La polisomnografía (PSG) nocturna es la técni-ca diagnóstica de referencia del síndrome de apneas-hipop-neas durante el sueño (SAHS) en niños. El objetivo del estu-dio ha sido evaluar la utilidad diagnóstica de la poligrafíarespiratoria (PR) en niños con sospecha clínica de SAHS re-mitidos a la Unidad de Trastornos Respiratorios del Sueño.

Pacientes y métodos

Se estudió a 53 niños remitidos porsospecha clínica de SAHS (29 varones; 54,7%), con unaedad media ± desviación estándar de 6,4 ± 2,9 años. A todosellos se les realizaron historia clínica, exploración física, PR(Edentec®) y PSG nocturna simultáneamente en el labora-torio de sueño. Se realizó el análisis estadístico para compa-rar ambas técnicas diagnósticas.

Resultados

Definiendo el diagnóstico de SAHS como lapresencia de un índice de apneas-hipopneas obstructivas(IAHO) igual o mayor de 3 en la PSG y un índice de eventosrespiratorios (IER) de 3 o superior en la PR, la coincidenciadiagnóstica fue del 84,9%. La diferencia de medias entre elIAHO y el IER no fue significativa (0,7 ± 5,4; p = 0,34). Elcoeficiente de correlación intraclase entre el IAHO y el IERfue de de 89,4 (intervalo de confianza del 95%, 82,4-93,7; p < 0,001).

Para el diagnóstico de SAHS se consideraron los valoresde IAHO iguales o mayores de 1; iguales o mayores de 3, eiguales o mayores de 5. Se calcularon las curvas de eficaciadiagnóstica para cada uno de ellos y 4,6 resultó ser el mejorIER para los 3 valores de IAHO considerados. Al analizarpor estratos de edad, en niños de 6 años o más el mejor IERobtenido para los 3 valores de IAHO considerados fue 2,1.En niños menores de 6 años se obtuvieron los siguientes va-lores de IER: 3,35 para IAHO de 1 o superior y 5,85 paraIAHO de 3 o mayor y de 5 o superior.

Conclusiones

La PR realizada en el laboratorio de sue-ño es un método válido para el diagnóstico de SAHS en ni-ños.

Palabras clave:
Trastornos respiratorios del sueño
Niños
Sueño
Apnea obstructiva del sueño
Apnea
Estudios de sueño
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Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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