Aims The neuropsychological impact of sleep disordered breathing (SDB) is well recognised but identifying which children require intervention is a challenge due to the poor specificity of history and examination findings. Polysomnography is the gold standard but availability is limited. Oximetry is commonly used to screen for SDB but, despite good specificity, it lacks sensitivity. This study aims to assess the impact of using a multi-channel sleep system (MCSS) on detection and outcomes in SDB.
Methods Data was collected prospectively on children with symptoms of SDB undergoing sleep studies between 08/2015–08/ 2016, following assessment in ENT or paediatric clinics at a district general hospital. Studies were performed using Stowood Scientific Instruments Visi-3 sleep systems incorporating audio, video, pulse transit time and oximetry data.
Study findings were categorised as normal; primary snoring; upper airway resistance syndrome (UARS); obstructive sleep apnoea or ‘abnormal other’ and compared with standard oximetry criteria.
Results (Figure 1 here)
The use of MCSS identified 69 more children with abnormalities than oximetry alone. Seven children with abnormal oximetry were found to have normal studies. There were 3 oximetry failures who were categorised normal; primary snoring and UARS using MCSS. The median age of children with positive studies was 4.78 years (range 0–17 years).
(Figure 2 here)
Data published by the Royal College of Surgeons show directly standardised tonsillectomy rates (SDB), for the 2 Clinical Commissioning Groups served by the Trust, of 12.56/1 00 000 and 17.76/1 00 000 population (mean 26.03/1 00 000 population; England).1
Conclusions Twice as many children with SDB were identified using MCSS compared with oximetry. Its use was associated with low adenotonsillectomy rates due to surgeons managing most children with normal studies conservatively. The need for inpatient stay increases the cost of MCSS but this is offset by fewer children undergoing surgery. Forty children with symptoms of SDB and recurrent tonsillitis, who had studies to stratify perioperative risk before tonsillectomy, could have been evaluated more cost-effectively with oximetry. If validated for use at home, MCSS would further reduce costs while detecting SDB with increased sensitivity and specificity.
Royal College of Surgeons, Procedure Explorer Tool http://rcs.methods.co.uk/pet.html
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