The specificities of diagnostic examination of childhood Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

The diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children depends both on daytime and nighttime symptoms which vary subjectively between individuals and on the results of nocturnal monitoring, intended to supply an objective basis and precision for diagnosis and assessment of severity. Nocturnal monitoring measures the apnea and hypopnea index (AHI): if the score is >1.5 per hour of sleep, diagnosis is confirmed and the score is a key to determining management. Simple respiratory polygraphy can confirm OSAHS is 77% of cases, but cannot identify upper airway resistance syndrome (UARS), where apnea and desaturating hypopnea are often absent but in which restricted inspiration leads to cortical micro-arousal. UARS is relatively frequent in children and requires full polysomnography, although this tool is not readily available. The clinician can provide critical interpretation of the results of nocturnal monitoring if he or she is aware of the various techniques and their respective diagnostic sensitivity; in the light of the individual clinical context, a patient-centered approach can thus be adopted, improving management of sleep disordered breathing