title: The impact of recent changes to the respiratory scoring rules in pediatrics.
abstract: OBJECTIVE
  In 2007 the American Academy of Sleep Medicine (AASM) published polysomnography (PSG) scoring guidelines, which were updated in 2012. A key change in terms of scoring respiratory events in children was the threshold for reduction in airflow (50% vs 30%) for the definition of hypopnea. This study aimed to determine the impact of different scoring rules on the assessment of severity of obstructive sleep apnea (OSA) in children.
  
  
  METHODS
  Forty-two children (mean age 4.3 y, 16 F) underwent PSG. An obstructive apnea-hypopnea index (OAHI) was determined using three scoring rules: (1) ATS 1996 rules with minor modifications (modified ATS 1996); (2) AASM 2007 rules (AASM 2007); and (3) AASM 2007 rules with respiratory event related arousals included in the OAHI (AASM+RERA).
  
  
  RESULTS
  The AASM 2007 OAHI (median 0.4 events/h, range 0, 14) was lower than the modified ATS 1996 OAHI (median 0.8 range 0, 26.1, p < 0.001), underestimating severity of disease in 24% of cases. The AASM+RERA OAHI (median 0.8, range 0, 19.1) was also lower than the modified ATS 1996 OAHI (p = 0.02), but the difference was not clinically significant except at very high OAHIs.
  
  
  CONCLUSIONS
  The AASM 2007 rules lead to a lower OAHI and lesser OSA severity when compared to the previous standard. Inclusion of RERAs in the AASM 2007 OAHI leads to a comparable OAHI to the previous rules. Given that morbidity has been demonstrated even in mild OSA, these results support the inclusion of events with a reduction in airflow of less than 50% as included in the updated AASM rules in 2012.
authors.affiliation: The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Victoria, Australia and Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Nixon
authors.affiliation: Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hyde
authors.affiliation: The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Victoria, Australia and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Biggs
authors.affiliation: The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Victoria, Australia and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Walter
authors.affiliation: The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Victoria, Australia and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
authors.forename: Rosemary S C
authors.initials: RS
authors.lastname: Horne
authors.affiliation: The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Victoria, Australia and Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
authors.forename: Margot J
authors.initials: MJ
authors.lastname: Davey
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000592:standards; D017286:Polysomnography / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*; D012955:Societies, Medical / Q000592:standards; D014481:United States
keywords: Polysomnography; apnea hypopnea index; obstructive sleep apnea; scoring