Clinical screening of school children for polysomnography to detect sleep-disordered breathing--the Tucson Children's Assessment of Sleep Apnea study (TuCASA).

James L. Goodwin, Kris L. Kaemingk, Shelagh A. Mulvaney, Wayne J Morgan, Stuart F Quan

Research output: Contribution to journalArticle

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Abstract

STUDY OBJECTIVES: This report describes the associations, specificities, sensitivities, and positive likelihood ratios of clinical symptoms to a finding of sleep-disordered breathing (SDB) on polysomnography in children. METHODS: Four hundred eighty unattended home polysomnograms were completed in a community-based cohort of children 6 to 11 years of age (50% boys, 42.3% Hispanic, and 52.9% between the ages of 6 and 8 years). SDB was present if the child had a respiratory disturbance index of > or = 1 event per hour. MEASUREMENTS AND RESULTS: Boys were twice as likely as girls to have SDB (p < .01); however, witnessed apnea, ethnicity, age, obesity, and airway size (based on clinical evaluation) were not significantly different between those with SDB and without SDB. The sensitivity of any individual or combined clinical symptoms was poor, with male sex (60%) and snoring (29.5%) having the greatest proportion of SDB children. However, high specificities for snoring (89.5%), excessive daytime sleepiness (86.3%), and learning problems (95.9%) were noted. Combinations of symptoms such as snoring+male sex (95.1%), snoring+excessive daytime sleepiness (97.0%), and snoring+learning problems (98.9%) had specificities approaching 1. Positive likelihood ratios for snoring (2.8), learning (2.8), and symptoms combined with snoring such as snoring+male sex (3.9), snoring+learning problems (4.0), and snoring+excessive daytime sleepiness (2.9) were observed. CONCLUSIONS: Snoring, excessive daytime sleepiness, and learning problems are each highly specific, but not sensitive, for SDB in 6- to 11-year old children. However, specificities and positive likelihood ratios for the combination of some of these symptoms is sufficiently high to suggest that some children may not require a polysomnogram for the diagnosis of SDB.

Original languageEnglish (US)
Pages (from-to)247-254
Number of pages8
JournalJournal of Clinical Sleep Medicine
Volume1
Issue number3
StatePublished - Jul 15 2005

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Snoring
Polysomnography
Sleep Apnea Syndromes
Learning
Apnea
Hispanic Americans
Obesity

ASJC Scopus subject areas

  • Clinical Neurology
  • Pulmonary and Respiratory Medicine
  • Neurology

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Clinical screening of school children for polysomnography to detect sleep-disordered breathing--the Tucson Children's Assessment of Sleep Apnea study (TuCASA). / Goodwin, James L.; Kaemingk, Kris L.; Mulvaney, Shelagh A.; Morgan, Wayne J; Quan, Stuart F.

In: Journal of Clinical Sleep Medicine, Vol. 1, No. 3, 15.07.2005, p. 247-254.

Research output: Contribution to journalArticle

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title = "Clinical screening of school children for polysomnography to detect sleep-disordered breathing--the Tucson Children's Assessment of Sleep Apnea study (TuCASA).",
abstract = "STUDY OBJECTIVES: This report describes the associations, specificities, sensitivities, and positive likelihood ratios of clinical symptoms to a finding of sleep-disordered breathing (SDB) on polysomnography in children. METHODS: Four hundred eighty unattended home polysomnograms were completed in a community-based cohort of children 6 to 11 years of age (50{\%} boys, 42.3{\%} Hispanic, and 52.9{\%} between the ages of 6 and 8 years). SDB was present if the child had a respiratory disturbance index of > or = 1 event per hour. MEASUREMENTS AND RESULTS: Boys were twice as likely as girls to have SDB (p < .01); however, witnessed apnea, ethnicity, age, obesity, and airway size (based on clinical evaluation) were not significantly different between those with SDB and without SDB. The sensitivity of any individual or combined clinical symptoms was poor, with male sex (60{\%}) and snoring (29.5{\%}) having the greatest proportion of SDB children. However, high specificities for snoring (89.5{\%}), excessive daytime sleepiness (86.3{\%}), and learning problems (95.9{\%}) were noted. Combinations of symptoms such as snoring+male sex (95.1{\%}), snoring+excessive daytime sleepiness (97.0{\%}), and snoring+learning problems (98.9{\%}) had specificities approaching 1. Positive likelihood ratios for snoring (2.8), learning (2.8), and symptoms combined with snoring such as snoring+male sex (3.9), snoring+learning problems (4.0), and snoring+excessive daytime sleepiness (2.9) were observed. CONCLUSIONS: Snoring, excessive daytime sleepiness, and learning problems are each highly specific, but not sensitive, for SDB in 6- to 11-year old children. However, specificities and positive likelihood ratios for the combination of some of these symptoms is sufficiently high to suggest that some children may not require a polysomnogram for the diagnosis of SDB.",
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