Investigations
After referral, the ENT surgeon will take a sleep history with reference to presenting symptoms and carry out a full ear, nose, and throat examination with a hearing assessment if indicated.
Although majority of cases are diagnosed on clinical grounds alone some patients may need additional investigations (1,2).
Investigations carried out in the secondary care include:
- overnight pulse oximetry
- can be carried out at home using a portable pulse oximetry equipment
- heart rate and oxygen saturations are monitored overnight
- it has a high positive predictive value (97%) for diagnosis of obstructive sleep apnoea but the negative predictive value is low (53%) (since not all apnoeas result in a drop in saturations)
- polysomnography (a sleep study)
- currently the optimal mode of investigation for paediatric OSA
- measures apnoeas and hypopnoeas which is often combined and used as the apnoea-hpopnoea index (AHI) (the total number of apnoeas and hypopnoeas per hour of sleep) to determine the severity of the condition
- additionally electroencephalography, electro-oculography, or electromyography measurements are also included
The UK Royal College of Paediatrics and Child Health's working group states that oximetry is useful as a screening tool while polysomnography is required reliably differentiate primary snoring from obstructive sleep apnoea
Reference:
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