Home video clips compared to polygraphy for obstructive sleep apnea diagnosis in children with autism spectrum disorder: A pilot study.

INTRODUCTION

Children with autism spectrum disorder (ASD) have higher prevalence of obstructive sleep apnea (OSA) than typically developing children. Polysomnography (PSG), the gold standard test is challenging for children with ASD. Polygraphy (PG) may be better tolerated, but more accessible screening tools are needed. We evaluated diagnostic characteristics of video clips for OSA in this pilot study.

METHODS

Children 4-18 years with ASD referred for PSG for suspected OSA were recruited. Parents recorded 3 2-min home videos, scored for OSA presence using Monash score (MS, positive if ≥ 3). Participants completed the Pediatric Sleep Questionnaire (PSQ; positive if ≥ 0.33) and underwent home PG, scored by obstructive apnea hypopnea index (oAHI), oxygen desaturation index 3 % (ODI3; ≥4.3 and > 7 thresholds) and McGill Oximetry Score (MOS; positive if ≥ 2). Receiver-operator curves were used to compare diagnostic performance across tools for moderate-severe OSA (oAHI ≥5 events/hour).

RESULTS

26 children participated; 15 (median age 7.1) provided video clips. Median oAHI was 2.4/hr; 26.7 % had moderate-severe OSA. Fourteen (93.3 %) had PSQ ≥0.33, three had MOS ≥2. ODI3 was ≥4.3 in 7 and > 7 in 6 children. Median MS was 3.0. MS had 100 % sensitivity, 63.6 % specificity and AUC 78.4 for detecting moderate-severe OSA; average AUC increased when MS was combined with oximetry metrics.

CONCLUSION

MS showed high sensitivity but low specificity in detecting moderate-severe OSA. MS outperformed PSQ and MOS, but not ODI3. MS may be a viable alternative screening tool to identify OSA in children with ASD but requires further validation.