Diagnostic capability of questionnaires and clinical examinations to assess sleep-disordered breathing in children: a systematic review and meta-analysis.
BACKGROUND
The reference standard for the diagnosis of pediatric sleep-disorder breathing (SDB) is a full polysomnography (PSG) (an overnight sleep study). There are many obstacles to children being able to undergo a full PSG; therefore, the authors evaluated the diagnostic value of alternative diagnostic methods (clinical history and physical examination) for pediatric SDB.


METHODS
The authors selected articles in which the investigators' primary objective was to evaluate the diagnostic capability of physical evaluations and questionnaires compared with the current reference standard (that is, a full PSG) to diagnose SDB in children younger than 18 years. The authors searched several electronic databases without limitations.


RESULTS
Using a two-step selection process, the authors identified 24 articles and used them to conduct a qualitative analysis. They conducted a meta-analysis on 11 of these articles. Among these articles, only one involved a test that had diagnostic accuracy good enough to warrant its use as a screening method for pediatric SDB, but its diagnostic accuracy was not sufficient to be considered a true diagnostic tool (that is, a replacement for full PSG) for pediatric SDB. Practical Implications. The involvement of dentists in the screening process for pediatric SDB can contribute significantly to children's health. The identified questionnaire could be considered an acceptable screening test to determine which children to refer to a sleep medicine specialist.
Dr. Canto is an adjunct professor, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil, and a postdoctoral fellow, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Address correspondence to Dr. Canto at Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, 5-83 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada T6G1C9, delucaca@ualberta.ca or graziela.canto@ufsc.br.
Graziela
G
De Luca Canto
Vandana
V
Singh
Michael P
MP
Major
Manisha
M
Witmans
Hamdy
H
El-Hakim
Paul W
PW
Major
Carlos
C
Flores-Mir
D002648:Child; D003937:Diagnosis, Differential; D006801:Humans; D008487:Medical History Taking; D010808:Physical Examination; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*; D011795:Surveys and Questionnaires
Obstructive sleep apnea; decision making; evidence-based dentistry; sleep apnea syndrome