Utility of overnight oximetry indices in the evaluation of children with snoring and suspected obstructive sleep apnea.

IF 3.5 3区医学 Q1 CLINICAL NEUROLOGY Journal of Clinical Sleep Medicine Pub Date : 2025-01-01 DOI:10.5664/jcsm.11344

Yu Qian Koh, Rehena Sultana, Arun Pugalenthi, Yi Hua Tan, Ooh Hoe Teoh, Zai Ru Cheng, Duo-Tong Cheng, Oh Moh Chay, John Carson Allen, Soh Gin Tan, M Lim, Jasmine Tan, Biju Thomas

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Abstract

Study objectives: Optimal cutoff values of oximetry indices that differentiate obstructive sleep apnea (OSA) from primary snoring (PS) are not well-established. Our study aimed to assess the utility of overnight oximetry indices in differentiating PS from OSA and assessing OSA severity, compared to polysomnography, in children with suspected OSA.

Methods: This was a retrospective study of children (1-18 years of age) with snoring who underwent polysomnography. Patients with Down syndrome, craniofacial anomalies, known genetic syndromes, neuromuscular conditions, or a central apnea index ≥ 5 were excluded. Demographic data, polysomnography variables, and oximetry indices (eg, oxygen desaturation index [ODI₃, defined as number of ≥ 3% desaturation episodes/h of artifact-free recording time, and SpO₂ nadir]) were collected.

Results: Of 1,203 children (mean age 9.1 ± 3.9 years, 67.7% males), 91.8% (847/923) ≤ 12 years and 84.3% (236/280) > 12 years of age had OSA. The optimal cutoff of ODI₃ for differentiating PS from OSA was 2.4 (sensitivity [Se]: 78.8% [75.9-81.6%]; specificity [Sp]: 80.5% [69.9-88.7%]) in children ≤ 12 years of age and 3.6 (Se: 71.1% [64.8-76.8%]; Sp: 91.1% [78.8-97.5%]) in children > 12 years of age. The optimal cutoffs of ODI₃ for differentiating PS from mild, moderate, and severe OSA categories were 2.0 (Se: 70.1% [65.3-74.5%]; Sp: 70.1% [58.6-80.0%]), 3.7 (Se: 82.3% [76.6-87.1%]; Sp: 94.8% [87.2-98.6%]), and 4.3 (Se: 99.1% [96.8-99.9%]; Sp: 98.7% [93.0-100.0%]) in children ≤ 12 years of age and 1.9 (Se: 78.8% [75.9-81.6%]; Sp: 80.5% [69.9-88.7%]), 4.1 (Se: 85.4% [72.2-93.9%]; Sp: 91.1% [78.8-97.5%]), and 6.9 (Se: 98.4% [91.2-100.0%]; Sp: 97.8% [88.2-99.9%]) in children > 12 years of age, respectively.

Conclusions: This study provides optimal cutoff values for ODI₃ in differentiating PS from OSA and assessing OSA severity in children. Because oximetry is cheaper and widely available, ODI₃ has the potential to be incorporated into cost-effective clinical decision-making algorithms, especially in resource-limited settings.

Citation: Koh YQ, Sultana R, Pugalenthi A, et al. Utility of overnight oximetry indices in the evaluation of children with snoring and suspected obstructive sleep apnea. J Clin Sleep Med. 2025;21(1):109-121.

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夜间血氧仪指数在评估打鼾和疑似阻塞性睡眠呼吸暂停儿童中的实用性。

研究目的：区分阻塞性睡眠呼吸暂停（OSA）和原发性打鼾（PS）的血氧指标最佳临界值尚未确定。我们的研究旨在评估与多导睡眠图（PSG）相比，隔夜血氧监测指标在区分原发性打鼾（PS）和阻塞性睡眠呼吸暂停（OSA）以及评估 OSA 严重程度方面对疑似 OSA 患儿的效用：这是一项回顾性研究，研究对象为接受 PSG 检查的打鼾儿童（1-18 岁）。排除了唐氏综合征、颅面畸形、已知遗传综合征、神经肌肉疾病和中心性呼吸暂停指数≥5的患者。收集了人口统计学数据、PSG 变量和血氧饱和度指数（如血氧饱和度指数[ODI3，定义为血氧饱和度下降次数≥3%/无伪影记录时间小时数和 SpO2 nadir]）：在 1,203 名儿童（平均年龄为 9.1±3.9岁，67.7% 为男性）中，91.8%（847/923）小于 12 岁，84.3%（236/280）大于 12 岁的儿童患有 OSA。区分 PS 和 OSA 的最佳 ODI3 临界值在 12 岁以下为 2.4 [Se：78.8% (75.9%-81.6%)，Sp：80.5% (69.9%-88.7%)]，在 12 岁以上为 3.6 [Se：71.1% (64.8%-76.8%)，Sp：91.1% (78.8%-97.5%)]。区分 PS 与轻度、中度和重度 OSA 类别的最佳 ODI3 临界值为 2.0 [Se：70.1%（65.3%-74.5%），Sp：70.1%（58.6%-80.0%）]；3.7 [Se：82.3%（76.6%-87.1%），Sp：94.8%（87.2%-98.6%）] 和 4.3 [Se：99.1%（96.8%-99.9%），Sp：98.7%（93.0%-100.0%）]；大于 12 岁时分别为 1.9[Se：78.8%（75.9%-81.6%），Sp：80.5%（69.9%-88.7%）]；4.1[Se：85.4%（72.2%-93.9%），Sp：91.1%（78.8%-97.5%）]和 6.9[Se：98.4%（91.2%-100.0%），Sp：97.8%（88.2%-99.9%）]：这项研究为区分 PS 和 OSA 以及评估儿童 OSA 严重程度提供了最佳的 ODI3 临界值。由于血氧仪成本较低且广泛可用，ODI3 有可能被纳入具有成本效益的临床决策算法中，尤其是在资源有限的情况下。

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来源期刊

Journal of Clinical Sleep Medicine CLINICAL NEUROLOGY-

CiteScore

6.20

自引率

7.00%

发文量

321

审稿时长

1 months

期刊介绍： Journal of Clinical Sleep Medicine focuses on clinical sleep medicine. Its emphasis is publication of papers with direct applicability and/or relevance to the clinical practice of sleep medicine. This includes clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports. In addition, the journal will publish proceedings from conferences, workshops and symposia sponsored by the American Academy of Sleep Medicine or other organizations related to improving the practice of sleep medicine.