Please use this identifier to cite or link to this item: https://repository.monashhealth.org/monashhealthjspui/handle/1/42180
Conference/Presentation Title: A prediction model for the presence of moderate/severe obstructive sleep apnoea in childhood based on clinical findings and oximetry.
Authors: Horne R.S.C.;Nixon G.M. ;Ranasinha S.;Weichard A.;Davey M.J. 
Monash Health Department(s): Paediatric - Respiratory and Sleep (Melbourne Children's Sleep Centre)
Institution: (Nixon, Weichard, Horne) Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Australia (Ranasinha) School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (Nixon, Davey) Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
Presentation/Conference Date: 2-Feb-2015
Copyright year: 2014
Publisher: Blackwell Publishing
Publication information: Sleep and Biological Rhythms. Conference: 26th ASM of Australasian Sleep Association and Australasian Sleep Technologists Association: Sleep Frontiers, Sleep DownUnder 2014. Perth, WA Australia. Conference Publication: (var.pagings). 12 (SUPPL. 1) (pp 53), 2014. Date of Publication: October 2014.
Abstract: Introduction: Formally defining the presence of obstructive sleep apnoea (OSA) in a snoring child requires polysomnography (PSG), a test with limited availability. In this study we aimed to examine which combination of clinical factors, oximetry and actigraphy measures provide the most effective model for prediction of moderate-severe OSA (MS OSA) for possible use as a tool outside specialist centres. Method(s): Children referred for PSG for possible OSA were recruited prospectively and underwent clinical investigations including: OSA-18 questionnaire, physical examination, and home overnight oximetry (Masimo Radical 2-sec averaging time) with concurrent actigraphy. Variables assessed for inclusion in the predictive model were: age, gender, OSA-18 (total, sub-scale and individual question scores), BMI z-score, tonsil size, Mallampati score, Friedman pharyngeal score, Angle's dental malocclusion score, oximetry parameters (SpO2 nadir, dips below 90%/h, dips of 4%/h, pulse rate (PR) standard deviation and PR increases of 15 bpm/h), and movement fragmentation index from actigraphy. The primary outcome variable dichotomised the obstructive respiratory disturbance index from PSG into <5/h (primary snoring/ mild OSA) and >=5/h (MS OSA). Stepwise forward elimination logistic regression was used to define significant variables (p > 0.1) and a model was then developed to predict MS OSA. Result(s): 89 children (38F; mean +/- SD age 5.5 +/- 2.5 y) with full PSG results were included. 37 (42%) had MS OSA. OSA-18 Q16 (parent concerned child not getting enough air), dental malocclusion score, SpO2 nadir and PR increases of 15 bpm/h were identified as significant predictor variables and the model was developed on these parameters, dividing SpO2 nadir and PRI15 into tertiles and OSA-18 Q16 scores into two categories. ROC analysis gave an area under the curve of 0.88 using this model, indicating very good discrimination. 81% of children were correctly classified, with sensitivity 82%, specificity 81%, positive predictive value 77% and negative predictive value 85%. Conclusion(s): We have developed a clinical risk score for having moderate-severe OSA that has very good discrimination properties and correctly classifies 81% of children referred for PSG.
Conference Start Date: 2014-10-09
Conference End Date: 2014-10-11
DOI: http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/sbr.12082
ISSN: 1446-9235
URI: https://repository.monashhealth.org/monashhealthjspui/handle/1/42180
Type: Conference Abstract
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