Pulse transit time as a screening test for pediatric sleep-related breathing disorders.
OBJECTIVE
To evaluate a noninvasive measure of arousal, the pulse transit time (PTT), as a screening tool for obstructive sleep apnea/hypopnea syndrome (OSAHS) in an unselected population of symptomatic children, compared with overnight polysomnography (PSG). A secondary objective included comparing the diagnostic performance of PTT with continuous pulse oximetry recorded during PSG.


METHODS
Prospective, blinded diagnostic comparison study using the gold standard of overnight PSG.


METHODS
Tertiary-care children's hospital sleep laboratory.


METHODS
An unselected, volunteer sample of 59 patients (mean age, 7.8 years) with and without adenotonsillar tissue undergoing PSG and simultaneous PTT, including patients with obesity and craniofacial syndromes.


METHODS
The relationship between the PTT and polysomnographic measures of OSAHS to include pulse oximetry using correlation coefficients and receiver operating characteristic curve analysis.


RESULTS
The correlation coefficient between the PTT arousal index and PSG apnea-hypopnea index (AHI) was 0.70 (P<.001). Linear regression resulted in a good fit (R2=0.73) between PTT arousal index and AHI. With the use of an AHI of 1 or greater (35.6% prevalence of OSAHS) as a criteria for OSAHS, the area under the receiver operating characteristic curve was 0.86 (95% confidence interval, 0.76-0.96). The optimal PTT arousal index threshold was 5.4 events per hour, which translated into a sensitivity of 81% and a specificity of 76%.


CONCLUSIONS
The PTT arousal index is highly correlated with the PSG-derived AHI and demonstrated excellent diagnostic utility for moderate and severe OSAHS. However, for mild OSAHS, PTT was barely adequate and did not significantly outperform pulse oximetry. Pulse transit time may be a useful tool to evaluate moderate to severe sleep-related breathing disorders in children.
Brietzke
Scott E
SE
Department of Otolaryngology, Walter Reed Army Medical Center, 6900 Georgia Ave, Washington, DC 20307, USA. SEBrietzke@msn.com
Katz
Eliot S
ES
Roberson
David W
DW
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010045:Outpatients; D010092:Oximetry; D017286:Polysomnography; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D011795:Surveys and Questionnaires