Use of oximetry to screen for paediatric obstructive sleep apnoea: is one night enough and is 6 hours too much?

Abstract

IntroductionNocturnal pulse oximetry can be used to screen for obstructive sleep apnoea (OSA) using the McGill Oximetry Score (MOS). The MOS has a time threshold for a technically adequate study of 6 hours. It has been suggested that one night of oximetry is sufficient to screen for OSA using the MOS.Aims(1) To evaluate night-to-night variation of the MOS. (2) To determine the impact of recording three nights of oximetry on the screening yield for OSA. (3) To explore whether useful MOS data are discarded when a threshold of 6 hours of oximetry recording is used.MethodsA retrospective study of nocturnal pulse oximetry done at home over three consecutive nights in paediatric patients with suspected OSA. Studies were scored (MOS) using thresholds of ≥6 and ≥4 hours of recording.ResultsA total of 329 patients were studied. MOS scores over three nights showed only fair to moderate agreement. On the first night 126 patients (38%) screened positive for OSA. When three nights of oximetry were done 195 patients (59%) screened positive on at least one of the nights. There were 48 patients with studies of between 4 and 6 hours duration on one or more nights. If these studies are scored 20 patients (42%) would screen positive for OSA on at least one night based on scoring these studies alone.ConclusionOne night of oximetry screening may not be sufficient to screen for OSA. Lowering the time threshold to ≥4 hours may increase the screening capability of nocturnal oximetry.

Paediatric sleep diagnostics in the 21st century: the era of “sleep-omics”?

“…Increasing the number of nights studied from one to three in a cohort of 329 paediatric patients undergoing nocturnal oximetry, including children with Down syndrome (n=34), typically developing children (n=204) and children with other predisposing factors to OSA (n=82), increased the diagnostic yield from 38% (n=126) on night one to 59% (n=195) by night three. There was a reduction in the number of patients without adequate data for analysis from 16% on night one to 6% following night three [ 86 ].…”

Use of pulse oximetry as an investigative test for paediatric respiratory sleep disorders

“…Recent British Thoracic Society consensus recommends a single night of pulse oximetry monitoring to diagnose severe OSA in TD children 2. Children with complex medical conditions demonstrate night-to-night variability in saturation indices, and multiple nights of monitoring requires consideration 8 9. Future research is necessary to determine the most consistent saturation indices for diagnostic reporting.…”

Recent advances in paediatric sleep disordered breathing

“…PAVONE et al [35] have provided evidence that between-night pulse oximetry metric variations are limited in children without comorbidities. However, GALWAY et al [36] showed that there is likely to be night-to-night variability for children with comorbidities. Further research is required to determine which oxygen saturation indices demonstrate least night-to-night variability and thus might prove most useful diagnostically.…”