title: Model for prediction of pediatric OSA: Proposal for a clinical decision rule.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) is a syndrome frequently diagnosed in children; however, it lacks optimal diagnostic methods. This study aimed to provide a clinical decision rule for predicting pediatric OSA using commonly available clinical information.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Children between the ages of 3 to 6 years-old, referred for an otorhinolaryngology consultation due to clinical suspicion of OSA, were recruited from January to June 2014. At baseline age, weight, height, gender, body mass index, Pediatric Sleep Questionnaire (PSQ) scores, tonsil size, and oxygen desaturation index (ODI) were assessed. A logistic regression modeling was used with backward stepwise elimination to develop a prediction model.
  
  
  RESULTS
  Sixty-seven children were included with a mean age of 4.51 years. Of the 67 children included in this study, 25 (37.3%) subjects were diagnosed with pediatric OSA. Significant predictors of pediatric OSA in the final model (odds ratio, 95% confidence interval) included PSQ score (5.12; 3.3-6.5), ODI (1.34; 1.0-1.79) and tonsil size (6.7; 3.22-9.75). The final decision rule had a sensitivity of 88% and a specificity of 86%. The area under the receiver operating characteristic curve was 0.897.
  
  
  CONCLUSIONS
  The proposed clinical decision rule, based on three readily available variables, is a promising discriminating instrument for prediction of OSA among children between 3 and 6 years.
  
  
  METHODS
  2b.
authors.affiliation: Department of Otorhinolarygology/Sleep Medicine Centre-Hospital CUF, Porto.|Department of Otorhinolarygology, Hospital São Sebastião, Sta Maria da Feira, Portugal.
authors.forename: Victor
authors.initials: V
authors.lastname: Certal
authors.affiliation: Department of Otorhinolarygology, Hospital São Sebastião, Sta Maria da Feira, Portugal.
authors.forename: Hélder
authors.initials: H
authors.lastname: Silva
authors.affiliation: Department of Otorhinolarygology, Hospital São Sebastião, Sta Maria da Feira, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Carvalho
authors.affiliation: Centre for Research in Health Technologies and Information Systems.
authors.forename: Altamiro
authors.initials: A
authors.lastname: Costa-Pereira
authors.affiliation: Department of Pediatrics, Faculty of Medicine.
authors.forename: Inês
authors.initials: I
authors.lastname: Azevedo
authors.affiliation: Department of Pulmonology, Faculty of Medicine, University of Porto.
authors.forename: João
authors.initials: J
authors.lastname: Winck
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, California.
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
authors.affiliation: Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
mesh_terms: D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010372:Pediatrics; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D011795:Surveys and Questionnaires
keywords: Clinical decision rule; diagnosis; pediatric OSA