Constantin醫師表示接受Fonds de la recherche en sante du Quebec、Montreal兒童醫院研究機構以及加拿大兒童健康臨床醫師科學計畫的獎學金。她目前由Fonds de la recherche en sante du Quebec研究職業獎助資助。
OSA-18 Quality-of-Life Questionnaire Does Not Detect Obstructive Sleep Apnea in Children
By Fran Lowry
Medscape Medical News
December 23, 2009 — The OSA-18 Quality-of-Life Questionnaire does not accurately detect obstructive sleep apnea in children and should not be used in place of polysomnography, according to new research published online December 21 in Pediatrics.
"Polysomnography is the best tool available for diagnosing obstructive sleep apnea...in children. However, polysomnography is relatively inaccessible and costly, and studies are needed to evaluate other diagnostic approaches," writes Evelyn Constantin, MD, from the Montreal Children's Hospital, Quebec, Canada. "It has been suggested that the [OSA-18] is a useful measure that could replace polysomnography."
In this study, Dr. Constantin sought to determine whether the OSA-18 questionnaire was an accurate measure for the detection of moderate to severe obstructive sleep apnea, as indicated by an abnormal McGill oximetry score, in children.
The OSA-18 is an 18-item questionnaire that uses a Likert-type scoring system that includes 5 subscales of sleep quality, including sleep disturbance, physical symptoms, emotional symptoms, daytime function, and caregiver concerns. Scores can range from 18, meaning no effect on quality of life, to 126, meaning major negative effect. A value of 60 or more is considered abnormal.
Dr. Constantin performed a cross-sectional study using a database that contained information on 334 children aged 2 to 10 years, including demographics, medical history, comorbidities, sleep habits, sleep symptoms, responses to questions from the OSA-18, and oximetry metrics. All children had been tested with overnight home pulse oximetry between April 2005 and March 2006.
She found that the mean OSA-18 score was 52.9 ± 19.0. In all, 99 children had an abnormal McGill oximetry score, and 40 of these children had an OSA-18 score equal to or greater than 60. The sensitivity of the OSA-18 was 40%.
Of the 217 participants who had an OSA-score less than 60, 158 had an inconclusive McGill oximetry score, which resulted in a negative predictive value of 73%.
Dr. Constantin also performed a posthoc analysis for sensitivity and negative predictive value after stratifying the study population into 3 age groups of similar size as follows: 2 to 3 years old, 4 to 5 years old, and 6 to 10 years old. She reports that the sensitivity and negative predictive value for each of these age groups were equally poor.
An important limitation to the study is the use of a nocturnal pulse oximetry–based test as the reference standard, the authors write. "It is instructive to consider how accuracy measures could have changed had the OSA-18 been judged against a more sensitive standard: in-laboratory, attended polysomnography."
She also adds that the study population consisted of patients who had been referred mostly by otolaryngologists and to a lesser extent by family physicians and subspecialists, and as a result cannot be considered to be representative of the general pediatric population.
Although the OSA-18 is not useful for detecting moderate-to-severe obstructive sleep apnea in children, it may useful in determining how the condition affects the child's life and the family environment and may play a role "in addressing dimensions that certainly cannot be addressed by polysomnography alone," Dr. Constantin writes.
The study findings should give pause to physicians and surgeons "who would rely on subjective testing for children with OSA. Because of the obstacles of obtaining polysomnography, additional studies are needed to develop and validate measures that would simply and accurately detect OSA in children," she concludes.
Dr. Constantin has reported that she was supported by a fellowship from the Fonds de la recherche en sante du Quebec, the Montreal Children's Hospital Research Institute, and the Canadian Child Health Clinician Scientist Program. She is currently funded by a research career award from the Fonds de la recherche en sante du Quebec.
