{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:58:24Z","timestamp":1777312704736,"version":"3.51.4"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000241","name":"Physician Services Incorporated Foundation","doi-asserted-by":"crossref","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100000241","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ottawa Hospital Academic Medical Organization","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/100001540","name":"CHEST Foundation","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100001540","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"ICES","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/501100025092","name":"Ontario Ministry of Health","doi-asserted-by":"crossref","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100025092","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100025090","name":"Ministry of Long-Term Care","doi-asserted-by":"crossref","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100025090","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Ontario Child Health Support Unit","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Obstructive sleep apnea (OSA) affects approximately 5% of children and requires polysomnography (PSG) for diagnosis. As such, population-based longitudinal studies of OSA in children are scarce. We aimed to validate pediatric case definitions of OSA using provincial health administrative datasets and establish a methodology for future longitudinal studies in this population. We performed a multicenter validation study, linking Ontario health administrative data with clinical data for children aged 0\u221218 years who underwent PSG between 2009\u20132016 at two tertiary care children\u2019s hospitals. We used various administrative case definitions to identify those with the highest sensitivity, specificity, positive and negative likelihood ratios for capturing children with moderate-severe OSA (apnea-hypopnea index \u22655), stratified by age groups (&lt;10 and age\u2009\u2265\u200910 years). The reference cohort included 1,254 children who underwent PSG, with 317 moderate-severe OSA. The overall mean age was 7.7\u2009\u00b1\u20094.8 years, with 64.8%\u2009&lt;\u200910 years of age and 44% female. The best-performing case definitions included combinations of PSG and adenotonsillectomy or initiation of positive airway pressure therapy within 0\u221218 months post PSG, or PSG and a diagnostic code for OSA within 6 months pre and 0\u221218 months post PSG. In children &lt;10 years, these definitions exhibited high specificity (0.80\u20130.88), with moderate sensitivity (0.62\u20130.79), positive (3.82\u20135.25) and negative likelihood ratios (0.27\u20130.43). However, the performance in children \u226510 was less robust with high specificity (0.85\u20130.92), moderate positive likelihood ratios (3.48\u20134.19) and low sensitivity (0.28\u20130.59), and negative likelihood ratios (0.48\u20130.78). We have identified case definitions within Ontario health administrative data that have good specificity, and moderate sensitivity, positive and negative likelihood ratios for identifying moderate-severe OSA in children &lt;10 years of age. These can be used in future studies to understand the natural history, predictors and outcomes of young children with OSA, while refined case definitions may still be needed for children \u226510.<\/jats:p>","DOI":"10.1371\/journal.pone.0347148","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:27:02Z","timestamp":1777310822000},"page":"e0347148","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Validation of a health administrative definition of obstructive sleep apnea in children in Ontario, Canada"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8637-1480","authenticated-orcid":true,"given":"Dhenuka","family":"Radhakrishnan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetyana","family":"Kendzerska","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherri","family":"Katz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrietta","family":"Blinder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2791-5836","authenticated-orcid":true,"given":"Saadoun","family":"Bin Hasan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanvi","family":"Naik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8855-3598","authenticated-orcid":true,"given":"Eric","family":"Benchimol","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indra","family":"Narang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suhail","family":"Al-Saleh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"issue":"2","key":"pone.0347148.ref001","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1513\/pats.200708-135MG","article-title":"Epidemiology of pediatric obstructive sleep apnea","volume":"5","author":"JC 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