Chest
Volume 118, Issue 2, August 2000, Pages 360-365
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Clinical Investigations: Sleep and Breathing
Should Children With Suspected Obstructive Sleep Apnea Syndrome And Normal Nap Sleep Studies Have Overnight Sleep Studies?

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Study objectives

Overnight polysomnography (ONP) is the “gold standard” for the diagnosis of sleep-disordered breathing, but it is expensive and time-consuming. Thus, daytime nap studies have been used as screening tests. If the findings of a nap study are normal or mildly abnormal, should ONP be performed? Do specific abnormalities in nap studies predict abnormal findings in ONP? To answer these questions, we conducted this study.

Design

Retrospective chart review.

Setting

Children's hospital.

Participants

One hundred forty-three children with suspected obstructive sleep apnea syndrome secondary to isolated adenotonsillar hypertrophy, who had normal or mildly abnormal nap studies, and underwent ONP.

Measurements and results

We compared daytime nap and overnight polysomnograms in 143 children (52 girls; mean [± SD] age, 5.6 ± 3.1 years). Total sleep time was 1 h in daytime nap, and 5.1 ± 1.3 h in ONP. The interval between the two studies was 5.9 ± 4.8 months. The findings of 59% of the nap studies were mildly abnormal, while 66% of overnight studies were abnormal. No individual nap study parameter (including short obstructive apneas, hypopneas, hypoxemia, hypoventilation, snoring, paradoxical breathing, gasping, retractions) had good sensitivity at predicting abnormal overnight polysomnograms, but most had good specificity and positive predictive value.

Conclusions

We conclude that individual nap study parameters are not very sensitive in predicting abnormal ONP findings. However, when nap study parameters are abnormal, the chance of obstructive sleep apnea syndrome is high.

Section snippets

Patients

All patients were referred for polysomnography by their physicians for the evaluation of OSAS secondary to adenotonsillar hypertrophy. The study was confined to children with adenotonsillar hypertrophy because they comprise the majority of children undergoing polysomnography in pediatric sleep laboratories, and they were otherwise healthy, and did not have complicating medical conditions. All the subjects had a nap study with either normal or mildly abnormal findings, and were referred back for

Results

One hundred forty-three children had normal or mildly abnormal findings on nap PSGs from 1991 to 1998. Their mean age was 5.6 ± 3.1 years, and 52 were girls (36%). The mean interval between nap and overnight PSGs was 5.9 ± 4.8 months. Total sleep time during nap studies was 1 h, while mean sleep time during the overnight studies was 5.1 ± 1.3 h.

One hundred thirty-eight patients (96%) were sedated with chloral hydrate during nap studies. The remaining patients did not receive chloral hydrate

Discussion

We found that no individual nap study parameter was very sensitive in predicting the presence of obstructive sleep apnea in an overnight sleep study. However, many of them had good specificity and positive predictive values. We also found that if nap studies are even mildly abnormal, there is a high chance of having an abnormal overnight sleep study. This study also suggests that nap studies underestimate the abnormalities detected by ONP, even when children were sedated with chloral hydrate.

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