Can parents predict obstructive sleep apnea in children with syndromic or complex craniosynostosis?

Obstructive sleep apnea (OSA) is a clinical syndrome characterized by snoring, apneas and difficulty in breathing. These symptoms can be rated and a risk score (Brouillette score) can be calculated to estimate the likelihood of OSA. This study aimed at establishing the predictive value of the Brouillette score and observation by parents at home in children with syndromic or complex craniosynostosis, compared with ambulatory polysomnography. This prospective study included 78 patients (37 boys, mean age 7.3 years). Sensitivity and negative predictive values were calculated. Polysomnography showed clinically significant OSA in 11 children. The Brouillette score had a negative predictive value of 90% and a sensitivity of 55% in comparison with polysomnography. More than three-quarters of all patients snored. The single question 'Is there difficulty with breathing during sleep?' showed a sensitivity of 64% and a high negative predictive value of 91%. Thus, asking parents whether the child has difficulty in breathing during sleep can exclude the presence of clinical significant OSA and avoid polysomnography in children with syndromic and complex craniosynostosis.