Medical test helps children and cuts costs

A new way of quickly and inexpensively identifying children with a potentially dangerous disorder of breathing during sleep (Obstructive Sleep Apnea, or OSA) has offered "at least a 97% positive predictive value," say the authors of a study published in the February issue of Pediatrics by Dr Robert Brouillette, division head of the Respiratory Medicine and Newborn Medicine divisions at the McGill University Health Centre’s Montreal Children’s Hospital, and a team of colleagues. The researchers performed a cross-sectional study of 349 patients referred to the MCH pediatric sleep laboratory for possible OSA. Obstructive sleep apnea (OSA) in children is a disorder of breathing during sleep characterized by upper airway obstruction that disturbs sleep and disrupts normal respiratory gas exchange.

The most accurate and comprehensive method of diagnosing OSA is expensive and time-consuming. Dr Brouillette and his colleagues, Angela Morielli, Andra Leimanis, Karen Waters, Rina Luciano and Francine Ducharme, believe the abbreviated testing, called pulse oximetry, might well help distinguish children with OSA from those with simple snoring. They also suggest that oximetry could be the definitive diagnostic test for children suffering from breathing obstruction related to tonsils or adenoids. No additional testing should be needed before performing an adenotonsillectomy for most children who have sleep-related signs and symptoms of airway obstruction but are otherwise well, although "careful perioperative monitoring, including postoperative in-hospital observation, is recommended," they write.

The team’s experience of using the abbreviated testing with oximetry indicates a substantial reduction in equipment, supplies and staffing costs, compared to other methods for testing OSA. Although parental responses to questions about their child’s breathing were evaluated, they turned out to be too inaccurate to be helpful.

The research was supported by the Montreal Children’s Hospital, McGill University Research Institute, the Hospital for Sick Children Foundation, the Canadian Foundation for the Study of Infant Deaths, the Jeremy Rill Centre for Sudden Infant Death Syndrome and Respiratory Control Disorders, and the Canadian Lung Association/Medical Research Council of Canada.