Smartphone video clips could aid providers in diagnosing OSA in children
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Key takeaways:
- Polysomnography use is often limited for children, leaving a need for alternative diagnostic OSA tests.
- Short video clips taken by parents were similarly effective to other diagnostics in provider screening.
HONOLULU — Video clips of children could assist in screening for obstructive sleep apnea, as this method was nearly as effective in detecting OSA compared with other tools, according to two studies presented at the CHEST Annual Meeting.
“There’s a real shortage for diagnostic tests that are available, particularly polysomnography, for children with obstructive sleep apnea,” Sherri L. Katz, MDCM, MSc, FRCPC, FCCP, chief of pediatric respirology at Children’s Hospital of Eastern Ontario, told Healio. “We need to do better at identifying which children really need a sleep study and making sure that those who have OSA get early and quick access to diagnostic tests.”
Katz and Refika Ersu, MD, director of the sleep laboratory and home ventilation program at Children’s Hospital of Eastern Ontario, presented two complementary studies regarding the use of short video clips, recorded by parents, to determine which children need polysomnography to diagnose OSA.
In the first study, which included 50 children (mean age, 7.6 years; 46% boys) aged 3 to 18 years, parents were instructed to record three short video clips using their smartphones, which were then reviewed by two independent clinicians for signs of OSA using both the Monash Obstructive Sleep Apnea Video Score and overall clinician impression of presence and severity of OSA. Interrater agreement and agreement between the two scores were then estimated using weighted Cohen’s kappa.
With scores of 3 or higher indicating OSA, the mean Monash score was 3.25 and 32% of patients had a positive clinical impression of OSA.
Agreement between clinicians for the Monash score was 0.911 for the presence of OSA and 0.955 for severity (P < .001 for both). Agreement for clinical impression was 0.908 for presence and 0.812 for severity (P < .001 for both).
“The inter-relatability was excellent. Two raters came up with the same conclusions about whether a child is likely to have OSA or not based on the video clips,” Katz said. “The next step was to then compare it to other diagnostic tests that exist for sleep apnea.”
The second study, presented by Ersu, evaluated how the video clips compared with polygraphy measures, oximetry and the Pediatric Sleep Questionnaire (PSQ).
Researchers considered the patient to have OSA with scores of more than 1.5 on the obstructive apnea-hypopnea index (oAHI), 4.3 or higher per hour on the oxygen duration index 3% (ODI3%), 2 or higher on McGill oximetry score, 3 or higher using Monash score, and/or greater than 0.33 on the PSQ.
Of the 38 patients (mean age, 6.8 years; 17 girls) included, OSA was indicated in 35 (92.1%) using PSQ score, 18 (47.4%) using Monash score, 14 (36.8%) using ODI3% and six (15.8%) using the McGill score.
Thus, with a sensitivity of 75% and specificity of 85% at a 1.5 oAHI threshold, the video clips showed better diagnostic characteristics than PSQ and similar characteristics compared with oximetry.
“It was successful in diagnosing obstructive sleep apnea, more so than just a simple questionnaire,” Ersu told Healio. “It performed less than oximetry but requires less resource in limited settings.”
The use of smartphone videos needs additional study for this capacity, but such an approach could be beneficial when more tested methods are unavailable.
“Because of the limitations for what’s out there, it’s hard for people to access [sleep studies] and there are geographic and other disparities that limit access to testing, so we need something that’s simple, that parents can do at home and that is available for everybody,” Katz said.
It is “rather common” to see OSA in otherwise healthy children, according to Ersu.
“[It’s] more common if they have obesity or medical complexity and in children who live in low socioeconomic status and some minority children,” Ersu added. “There are adverse consequences, so if it’s diagnosed timely and treated timely, there may be a lot of health benefits.”