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At-home pulse oximetry in children undergoing adenotonsillectomy for obstructive sleep apnea

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Abstract

Nocturnal pulse oximetry has a high positive predictive value for polysomnographically diagnosed obstructive sleep apnoea (OSA) in children. When significant adenotonsillar hypertrophy is diagnosed, adenotonsillectomy (T&A) represents a common treatment for OSA in children. We investigated the role of pulse oximetry in predicting those patients, referred for suspected OSA, who subsequently needed T&A. At-home nocturnal pulse oximetry was performed on 380 children (65.7% males), median age 4.1(IRQ 3.0–5.6) years, referred for suspected OSA, and data were retrospectively analysed. For each recording McGill Oximetry Score (MOS) was categorized. Mean pulse rate (PR) z-score and pulse rate variability (PRV)-corrected (PRSD/meanPR) were significantly higher in children with abnormal MOS. Both parameters were significantly higher in subjects who underwent T&A compared with those not surgically treated. Both DI4 and PRV corrected showed a negative correlation with the elapsed time between pulse oximetry recordings and T&A. The logistic regression model showed a strong effect of an abnormal MOS as a predicting factor for T&A (adjusted odds ratio 19.7).

Conclusions: In our study, children with OSA who subsequently needed T&A showed higher PRV compared to those without surgical indication. Children with abnormal MOS were nearly 20 times more likely to undergo T&A.

What is Known:

• Nocturnal pulse oximetry has a high positive predictive value for polysomnographically diagnosed obstructive sleep apnoea in children.

• When significant adenotonsillar hypertrophy is diagnosed, adenotonsillectomy represents a common treatment for OSA in children.

What is New:

• An abnormal pulse oximetry highly predict the indication for adenotonsillectomy.

• We suggest the use of at-home pulse oximetry as method to predict prescription of adenotonsillectomy, and this may be useful in contexts where polysomnography is not readily available.

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Abbreviations

AHI:

Apnea index

MOS:

McGill Oximetry Score

OSA:

Obstructive sleep apnoea

PR:

Pulse rate

PRV:

Pulse rate variability

PSG:

Polysomnography

T&A:

Adenotonsillectomy

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Authors and Affiliations

  1. Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children’s Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy

    Martino Pavone, Nicola Ullmann, Elisabetta Verrillo & Renato Cutrera

  2. Otorhinolaryngology Unit, Bambino Gesù Children’s Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy

    Giancarlo De Vincentiis & Emanuela Sitzia

Authors
  1. Martino Pavone
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  2. Nicola Ullmann
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  3. Elisabetta Verrillo
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  4. Giancarlo De Vincentiis
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  5. Emanuela Sitzia
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  6. Renato Cutrera
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Corresponding author

Correspondence to Martino Pavone.

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None.

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The study was approved by the Bambino Gesù Children’s Hospital Scientific Board (Rome, Italy); at the time of each recording, parents signed an informed consent.

Additional information

Communicated by Peter de Winter

Martino Pavone and Nicola Ullmann contributed equally as co-first authors.

Revisions received: 19 December 2016; 04 January 2017

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Pavone, M., Ullmann, N., Verrillo, E. et al. At-home pulse oximetry in children undergoing adenotonsillectomy for obstructive sleep apnea. Eur J Pediatr 176, 493–499 (2017). https://doi.org/10.1007/s00431-017-2868-1

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  • DOI: https://doi.org/10.1007/s00431-017-2868-1

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