title: Diagnosis of obstructive sleep apnea in children: a systematic review.
abstract: OBJECTIVE
  To investigate diagnostic test accuracy (DTA) of different tests for obstructive sleep apnea (OSA) compared to polysomnography (PSG) in children.
  
  
  METHODS
  We performed a systematic review according to DTA criteria published by the Cochrane Collaboration. Studies that compared any possible diagnostic test with PSG for diagnosing OSA were considered. Study quality assessment was conducted in each selected study and DTA measures recalculated by hand whenever possible. Excellent DTA was defined as positive likelihood ratio (PLR) > 10 and negative likelihood ratio (NLR) < 0.1.
  
  
  RESULTS
  We identified 1064 potentially relevant studies, of which 33 met inclusion criteria. Study quality was generally low; 5 studies fulfilled all quality criteria and 11 studies included >100 subjects. Included studies compared 40 different tests to PSG. Only 13 studies used the currently accepted definition for OSA (i.e., apnea hypopnea index ≥1). In these studies, PLR ranged from 1.017 to ∞, NLR from 0 to 1.089. Sleep lab-based polygraphy, urinary biomarkers, and rhinomanometry (one study each) showed excellent DTA.
  
  
  CONCLUSIONS
  There is limited evidence concerning diagnostic alternatives to PSG for identifying OSA in children. However, polygraphy, urinary biomarkers, and rhinomanometry may be valid tests if their apparently high DTA is confirmed by subsequent studies.
authors: Working Group on Pediatric Sleep Medicine, Department of Neonatology, University Children's Hospital Tuebingen, Calwer Str. 7, 72076 Tuebingen, Germany.
authors: Pablo E
authors: PE
authors: Brockmann
authors: Christine
authors: C
authors: Schaefer
authors: Anette
authors: A
authors: Poets
authors: Christian F
authors: CF
authors: Poets
authors: Michael S
authors: MS
authors: Urschitz
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*
keywords: Pediatric; Polysomnography; Sleep disordered breathing; Snoring