Screening for obstructive sleep apnea in the resource-limited setting of the COVID-19 pandemic (SPARE study).

INTRODUCTION

Obstructive sleep apnea (OSA) significantly impacts children's health, but diagnosing OSA is challenging, especially during the COVID-19 pandemic with limited access to polysomnography (PSG). A recent study used 1-2-min sleep videos to assess OSA, developing the Monash score, which demonstrated 100 % sensitivity and 36 % specificity for moderate to severe OSA diagnosis with a score of 3 or higher.

HYPOTHESIS: We hypothesized that home video recordings using mobile technology could help clinicians identify children at risk of moderate to severe OSA.

METHODS

This study included children 3-18 years referred for OSA evaluation. Parents recorded 3-min sleep videos over three nights. Sleep physicians, blinded to polygraphy (PG) results scored videos using the Monash score. PG with the Nox T3 device served as the reference standard, measuring airflow, respiratory patterns, and oxygen saturation. OSA was defined as mild-to-severe with obstructive apnea hypopnea index (oAHI) ≥1.5 events/hour, moderate-to-severe with oAHI ≥5, and severe with oAHI >10. Oximetry metrics (oxygen desaturation index 3 % (ODI3) ≥4.3 or >7, and McGill Oximetry Score (MOS) ≥2) indicated OSA presence.

RESULTS

Among 51 children (45 % female) included in the study, the Monash score showed 91.7 % sensitivity and 70.4 % specificity for mild-to-severe OSA, and 100 % sensitivity with 29.6 % specificity for moderate-to-severe OSA. ODI ≥4.3 had the highest diagnostic accuracy (AUC 98.5, 95 %CI 96-100), while the Monash score had an AUC of 84.5 (95 %CI 73.1-96.3).

CONCLUSION

Home-recorded videos offer high sensitivity for pediatric OSA screening and could prioritize at-risk children in resource-limited settings, enabling earlier diagnosis and intervention.