title: Clinical screening of school children for polysomnography to detect sleep-disordered breathing--the Tucson Children's Assessment of Sleep Apnea study (TuCASA).
abstract: OBJECTIVE
  This report describes the associations, specificities, sensitivities, and positive likelihood ratios of clinical symptoms to a finding of sleep-disordered breathing (SDB) on polysomnography in children.
  
  
  METHODS
  Four hundred eighty unattended home polysomnograms were completed in a community-based cohort of children 6 to 11 years of age (50% boys, 42.3% Hispanic, and 52.9% between the ages of 6 and 8 years). SDB was present if the child had a respiratory disturbance index of > or = 1 event per hour.
  
  
  RESULTS
  Boys were twice as likely as girls to have SDB (p < .01); however, witnessed apnea, ethnicity, age, obesity, and airway size (based on clinical evaluation) were not significantly different between those with SDB and without SDB. The sensitivity of any individual or combined clinical symptoms was poor, with male sex (60%) and snoring (29.5%) having the greatest proportion of SDB children. However, high specificities for snoring (89.5%), excessive daytime sleepiness (86.3%), and learning problems (95.9%) were noted. Combinations of symptoms such as snoring+male sex (95.1%), snoring+excessive daytime sleepiness (97.0%), and snoring+learning problems (98.9%) had specificities approaching 1. Positive likelihood ratios for snoring (2.8), learning (2.8), and symptoms combined with snoring such as snoring+male sex (3.9), snoring+learning problems (4.0), and snoring+excessive daytime sleepiness (2.9) were observed.
  
  
  CONCLUSIONS
  Snoring, excessive daytime sleepiness, and learning problems are each highly specific, but not sensitive, for SDB in 6- to 11-year old children. However, specificities and positive likelihood ratios for the combination of some of these symptoms is sufficiently high to suggest that some children may not require a polysomnogram for the diagnosis of SDB.
authors.affiliation: University of Arizona College of Medicine, Arizona Respiratory Center, Box 245030, 1501 N. Campbell, Room 2329, Tucson, AZ 85724, USA. jamieg@arc.arizona.edu
authors.forename: James L
authors.initials: JL
authors.lastname: Goodwin
authors.forename: Kris L
authors.initials: KL
authors.lastname: Kaemingk
authors.forename: Shelagh A
authors.initials: SA
authors.lastname: Mulvaney
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Morgan
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan
mesh_terms: D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D017286:Polysomnography / Q000379:methods*; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000453:epidemiology*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology; D012913:Snoring / Q000175:diagnosis / Q000453:epidemiology; D011795:Surveys and Questionnaires