PEDIATRICS Vol. 105 No. 2 February 2000, pp. 405-412
Nocturnal Pulse Oximetry as an Abbreviated Testing Modality for Pediatric Obstructive Sleep Apnea
Received Mar 19, 1999; accepted Jul 22, 1999.
,
From the * Department of Pediatrics, Montreal Children's
Hospital, McGill University, Montreal, Canada; and the
Department of Respiratory Medicine, New Children's Hospital,
University of Sydney, Sydney, Australia.
Objective. To determine the utility of pulse oximetry for diagnosis of obstructive sleep apnea (OSA) in children.
Methods. We performed a cross-sectional study of 349 patients referred to a pediatric sleep laboratory for possible OSA. A mixed/obstructive apnea/hypopnea index (MOAHI) greater than or equal to 1 on nocturnal polysomnography (PSG) defined OSA. A sleep laboratory physician read nocturnal oximetry trend and event graphs, blinded to clinical and polysomnographic results. Likelihood ratios were used to determine the change in probability of having OSA before and after oximetry results were known.
Results. Of 349 patients, 210 (60%) had OSA as defined
polysomnographically. Oximetry trend graphs were classified as positive
for OSA in 93 and negative or inconclusive in 256 patients. Of the 93 oximetry results read as positive, PSG confirmed OSA in 90 patients. A
positive oximetry trend graph had a likelihood ratio of 19.4, increasing the probability of having OSA from 60% to 97%. The median
MOAHI of children with a positive oximetry result was 16.4 (7.5, 30.2).
The 3 false-positive oximetry results were all in the subgroup of 92 children who had diagnoses other than adenotonsillar hypertrophy that
might have affected breathing during sleep. A negative or inconclusive
oximetry result had a likelihood ratio of .58, decreasing the
probability of having OSA from 60% to 47%. Interobserver reliability
for oximetry readings was very good to excellent (
= .80).
Conclusions. In the setting of a child suspected of having OSA, a positive nocturnal oximetry trend graph has at least a 97% positive predictive value. Oximetry could: 1) be the definitive diagnostic test for straightforward OSA attributable to adenotonsillar hypertrophy in children older than 12 months of age, or 2) quickly and inexpensively identify children with a history suggesting sleep-disordered breathing who would require PSG to elucidate the type and severity. A negative oximetry result cannot be used to rule out OSA. Key words: predictive value of tests, polysomnography, likelihood ratio, sleep apnea syndromes, questionnaire, sleep.
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