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The difficulty in using the history and examination to determine the severity of sleep disordered breathing in children is well established. The relative prevalence of sleep disordered breathing symptoms in children, and the relative paucity of capacity and restrictive cost of polysomnography make this a very important issue. The disputed and limited role of overnight oxygen saturation monitoring has not solved the issue. Lavi et al have addressed the issue by asking the parents. A great many symptom-based questionnaires have been proposed, with little significant progress in identifying children with OSA. The authors have taken a different approach. Using a five-point Likert scale they have asked to what extent parents think their child needs surgery, and then secondarily, to what extent the breathing at night is a concern. These, in addition to various other screening questionnaires, were applied to 95 children undergoing polysomnography. In keeping with previous reports, there were no correlations between symptom-based questionnaires and apnoea hypopnoea index (AHI). And furthermore, the extent to which breathing was a concern did not correlate with AHI, although it correlated with the symptom-based score. However, the extent to which parents felt their children needed surgery did correlate with AHI (r=0.22, p=0.29). If parents scored more than 4/5 on the Likert scale, there was a sensitivity of 0.57 and a specificity of 0.79 for the detection of moderate-severe OSA. Now it is true that these results may not be widely generalisable. Also, those correlations aren’t particularly strong, and the sensitivity may not be high enough to rely on this measure; however this study shows us that asking a parent if they feel their child needs an operation may well be one of the most useful things you can ask in a consultation.

Parental concern as an indicator of the severity of Obstructive Sleep Apnoea in children.
Lavi M, Tauman R, Greenfeld M, et al.
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Robert Nash

BM BCh, MA(Oxon), MRCS, MA, DOHNS, FRCS (ORL-HNS), Great Ormond Street Hospital, London, UK.

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