What would you say if you heard about a new test for a common yet serious and largely underdiagnosed medical disorder which can accurately identify children in need of treatment at a fraction of the cost of the existing test, and can be done on a urine sample instead of requiring an overnight stay at a laboratory as currently required? If you are like me, the answer is probably: great, tell me more!

In a groundbreaking study published today, Dr. David Gozal of the University of Chicago (who is perhaps the leading pediatric sleep researcher in the world) described a new test which can accurately distinguish children who snore, but are otherwise well, from children with obstructive sleep apnea by measuring the levels of certain proteins in the urine.

Obstructive sleep apnea is a condition present in 2-3% of otherwise healthy children in which the throat collapses inwards during sleep, leading to either a partial or complete blockage of airflow to the lungs. This causes drops in blood oxygen levels and to fragmented and interrupted sleep. Obstructive sleep apnea can cause high blood pressure, heart disease, developmental delay, poor school performance, and behavioral impairment. While snoring is the most common symptom, it is not very specific, since anywhere from 9-20% of all children snore. Currently, the only way to distinguish between primary (benign) snoring and obstructive sleep apnea is by doing an overnight sleep study. This entails spending a night in a sleep lab wired up to a whole battery of monitors, and is not only a hassle, but can be very difficult for some children with special needs, who may not understand what is going on. Sleep studies are also fairly costly, and because there are relatively few sleep labs in which children can have them done, the wait time can be as long as several months.

There are still several questions remaining before this test can be widely used. This study was done on a small group of children, and compared primary snorers to children with significant obstruction (an average of 10 obstructions/hour, or one every 6 minutes of sleep). It is not clear whether this test will be as sensitive in identifying children with a lesser, yet still significant, degree of obstruction. It is also not clear whether taking medications, or the presence of other medical conditions, will affect the outcome of the test.

Still, I think that this is a really exciting development, as it opens a novel approach to both diagnosing and screening for a common disorder with many complications which may enable physicians caring for children at risk for to accurately and quickly diagnose (and then treat) them even if located far from a sleep lab which studies kids, while reducing inconvenience for children and their families, and costs for the healthcare system as a whole. This is exactly the kind of innovation we are so in need of.




Dennis Rosen, M.D.




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