Nocturnal Pulse Oximetry Is Better than Snoring Sound Analysis for
Screening Severe Pediatric Obstructive Sleep Apnea
Abstract
Abstract: Introduction: Efficacious screening of severe obstructive
sleep apnea (OSA) is important for children with sleep-disordered
breathing before time-consuming nocturnal polysomnography. However, the
predictive performance of clinical variables, nocturnal unattended pulse
oximetry, and snoring sound analysis to screen for severe pediatric OSA
has not been comprehensively investigated. Methods: Forty-two
consecutive children (11 [26%] girls and 31 [74%] boys; median
age, 9 years; median body-mass index of 19.0 kg/m2) with loud snoring
were prospectively recruited to undergo standard polysomnography,
nocturnal pulse oximetry, and snoring sound analysis. Results: Binary
logistic regression models showed that oxygen desaturation index ≥ 3%
(> 5.9 events/h), adenoidal‐nasopharyngeal ratio
(> 0.782), snoring sound energy of 801-1000 Hz
(> 22.1 dB), and tonsil size (> 3)
significantly predicted severe OSA, in descending order of odds ratio.
Multivariate analysis showed that oxygen desaturation index ≥ 3%,
adenoidal‐nasopharyngeal ratio, and tonsil size independently predicted
severe OSA, and that their combination best predicted severe OSA
(sensitivity = 91%; specificity = 84%; area under the curve = 0.92; p
< 0.001). Conclusions: Our results suggested that pulse
oximetry is better than snoring sound analysis to screen for severe OSA
in children with loud snoring. A combination of oxygen desaturation
index ≥ 3%, adenoidal‐nasopharyngeal ratio, and tonsil size can be used
to efficiently screen for severe pediatric OSA.