Diagnosing OSA in Children: Are Single Night Sleep Studies Accurate?

Little girl sleeping child sleeping
Little girl sleeping child sleeping
In children, does night-to-night variability in sleep parameters affect the accuracy of single-night sleep tests in diagnosing OSA?

The use of single night sleep studies may misdiagnose children with obstructive sleep apnea (OSA), according to systemic review and meta-analysis published in International Journal of Pediatric Otorhinolaryngology.

Currently available guidelines posit that a single night of polysomnography is sufficient to establish the presence and severity of OSA, even though researchers have found that sleep structure can change due to night-to-night variability (NtNV) in sleep parameters. Researchers therefore conducted a systematic review and meta-analysis to assess NtNV in sleep parameters among children and to assess the accuracy of single-night sleep testing in children with suspected OSA.

Researchers searched PubMed, EMBASE, and Cochrane Library databases for articles until March 8, 2021. The search included studies that: involved patients 18 years of age or younger; evaluated respiratory sleep parameters using polysomnography or home sleep apnea testing; included respiratory sleep parameter data for at least 2 sleep studies; involved no intervention between at least 2 sleep studies; and were cross-sectional studies, observational epidemiological studies, case-control studies, cohort studies, or clinical trials.

Researchers identified 5 studies representing 395 patients for meta-analysis. The mean age of participants was 11.78 (standard deviation 4.05) years. An apnea-hypopnea index (AHI) score was reported for 325 participants from 4 studies and the mean change in events per hour between 2 consecutive nights was -0.13 (95% CI, -0.40 to 0.14). An obstructive apnea index (OAI) score was reported for 187 participants from 3 studies, with a mean change in events per hour of -0.07 (95% CI, -0.27 to 0.12) between nights. According to 3 of the studies, the diagnostic rates of OSA in patients from a single-night study were 83%, 84.6%, and 91%, suggesting that 9% to 17% of children may not be diagnosed by a single-night sleep study, noted the investigators.

The NtNV in AHI for children with moderate or severe OSA was 3.35 (95% CI, 0.07-6.62) events per hour. This was greater than in children with mild OSA, where NtNV was -0.15 (95% CI, -0.42 to 0.12) events per hour. Additionally, children with more severe OSA sometimes showed a higher AHI on the first night.

Study limitations include the small number of included studies, subgroup analysis of age, sex, BMI, and sleeping posture as well as statistical analysis of false positive rates, false negative rates, and changes in the severity of OSA were not performed.

Overall, said researchers, although NtNV in AHI was not statistically significant in the group sample of children analyzed, there were significant differences in nightly variation in AHI between children with mild vs moderate to severe OSA. “Individual NtNV in respiratory sleep parameters may cause children to be misdiagnosed by single night diagnostic sleep studies,” the researchers concluded.


Qin H, Huang G, Zong X, et al. Night-to-night variability in respiratory sleep parameters to diagnose obstructive sleep apnea in children: a systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol. Published online August 19, 2022. doi:10.1016/j.ijporl.2022.111285