title: Can history and physical examination reliably diagnose pediatric obstructive sleep apnea/hypopnea syndrome? A systematic review of the literature.
abstract: OBJECTIVE
  Using an evidence-based technique, systematically review the literature to evaluate the accuracy of routine clinical history and physical examination in the diagnosis of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the pediatric patient.
  
  
  METHODS
  The biomedical literature was systematically reviewed. Articles comparing the results of clinical evaluation to polysomnography (PSG) were selected. The level of evidence was assessed using established evidence-based medicine (EBM) guidelines.
  
  
  RESULTS
  Twelve articles were identified using the search criteria. Eleven of 12 articles concluded that clinical evaluation is inaccurate in the diagnosis of OSAHS. The level of evidence was good to very good (Grade B/B+).
  
  
  CONCLUSIONS
  Clinical history and physical examination are not reliable for diagnosing OSAHS compared with overnight PSG. Complicating the interpretation of this work is the lack of a validated PSG threshold of clinically significant disease. There is an urgent need for the development of adequate screening tests with validated clinical outcomes.
  
  
  METHODS
  B-3.
authors.affiliation: Department of Otolaryngology, Boston Children's Hospital, Massachusetts, USA. SEBritzke@msn.com
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brietzke
authors.forename: Eliot S
authors.initials: ES
authors.lastname: Katz
authors.forename: David W
authors.initials: DW
authors.lastname: Roberson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008487:Medical History Taking; D010808:Physical Examination; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*