Diagnostic potential of biomarkers in the assessment of pediatric obstructive sleep apnea-A systematic review and meta- analysis.

UNLABELLED: PURPOSE  : Periodic hypopnea or apnea during sleep, along with episodes of hypoxia and sleep fragmentation caused by frequent awakenings to restore the upper airway are the characteristics of Pediatric obstructive sleep apnea (P-OSA). While extensive literature evaluates biomarkers in the diagnosis of OSA in adults, no systematic review summaries their diagnostic accuracy in P-OSA. This systematic review evaluates the diagnostic accuracy of biomarkers in assessing the P-OSA compared to Polysomnography in children.

METHOD: The research question was established in PECO format. The study protocol was registered in PROSPERO. A literature search was conducted in various database upto January 2025, including studies that assessed various biomarkers in comparison with polysomnography. Screening was done with Distiller SR and the risk of bias was assessed with Newcastle-Ottawa Scale. Meta-analysis was performed with the pooled sensitivity and specificity values using RevMan software.

RESULTS

Eighteen studies were included, that assessed transfer-ribonucleic acid, C-reactive protein, inflammatory markers, leukotrienes, salivary amylase, salivary cortisol, isoprostane and hydrogen peroxide. Meta-analysis revealed that urine-based biomarkers had highest diagnostic accuracy with a sensitivity of 89.75%, compared to 77.87% for serum-based biomarkers. The pooled Odds ratio was 10.31 (95% CI: 8.48-12.54), indicating a strong diagnostic association.

CONCLUSION

Biomarkers offer a non- invasive and reliable diagnostic tool for P-OSA. Urine-based leukotriene biomarkers are a promising biomarkers for screening P-OSA in conjunction with other diagnostic aids, due to its high sensitivity. However, the diagnostic accuracy can be influenced by various factors, necessitating further studies to identify biomarkers with high precision in the diagnosis of P-OSA.