Home Diagnosis of Obstructive Sleep Apnea in Children

According to an American study, 2 to 3% of children have obstructive sleep apnea (OSA), a condition characterized by upper airway obstruction during sleep. Its main health impacts are neurocognitive deficits, behavioural disorders, growth retardation, and pulmonary and systemic hypertension.

In a report of an investigation into the death of a young child following complications of an adenotonsillectomy, the coroner looked at the need to carry out a diagnostic exploration of OSA in children with respiratory obstruction due to tonsillar hypertrophy and, more specifically, at the diagnostic performance of portable devices that can be used at home. It was in this context that he asked the Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS), now the Institut national d’excellence en santé et en services sociaux (INESSS), to evaluate the home diagnostic modalities that could serve as possible alternatives to laboratory polysomnography (PSG) testing for adults and children with obstructive sleep apnea.

INESSS concludes that presently, none of the portable devices for the home diagnosis of OSA can be considered an alternative to the reference standard test, polysomnography, but in terms of overcoming the difficulty in accessing laboratory PSG, nocturnal oximetry is the best alternative for the initial evaluation for detecting the most severe cases. However, the patient intake capacity of sleep laboratories is limited and the offer of service at university hospitals varies from region to region. The experts consulted brought up the need to ensure the regular maintenance and replacement of oximetry devices, which are used mainly in the regions (outside of hospitals with a sleep laboratory), and to improve the sleep laboratories’ patient intake capacity by increasing human and physical resources.