The role of nocturnal pulse oximetry in the screening for obstructive sleep apnea in obese children and adolescents.
OBJECTIVE
Obesity is a known risk factor for the development of obstructive sleep apnea (OSA) in children. Early screening is essential because of the possible complications associated with OSA. At present, the gold standard for diagnosing OSA is polysomnography, which however has multiple limitations. The aim of this study is to examine the role of nocturnal oximetry as a screening tool for OSA in obese children and adolescents.


METHODS
This retrospective study included obese children who underwent a polysomnography at the Antwerp University Hospital between November 2010 and May 2014. Their oximetries were scored manually, blinded for the polysomnography results, according to Brouilette et al. OSA was defined as an obstructive apnea-hypopnea index (oAHI) ≥ 2 on polysomnography.


RESULTS
This study included 130 obese patients (38% boys, mean age 12 years). Polysomnography results determined 44 patients (34%) with a diagnosis of OSA. Oximetry results classified 16 patients as positive, 43 as negative, and 71 as inconclusive. Further analysis of the positive and negative oximetry results showed a sensitivity and specificity of 58% and 88%, respectively, with a negative and positive predictive value of 81% and 69%, respectively. A second analysis, using the oxygen desaturation index, showed inferior results in comparison to the score attained by Brouillette (sensitivity 57%, specificity 73%).


CONCLUSIONS
These results suggest that oximetry alone is insufficient as a screening tool for OSA in obese children. Other screening methods need to be explored in the future.
Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium. Electronic address: annelies.vaneyck@uantwerpen.be.
Annelies
A
Van Eyck
Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
Chinouk
C
Lambrechts
Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
Liesbeth
L
Vanheeswijck
Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
Kim
K
Van Hoorenbeeck
Department of Pediatrics, AZ Monica, Antwerp, Belgium.
Dominique
D
Haentjens
Department of ENT, Antwerp University Hospital, Edegem, Belgium.
An
A
Boudewyns
Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
Benedicte Y
BY
De Winter
Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Endocrinology, Diabetology, and Metabolism, Antwerp University Hospital, Edegem, Belgium.
Luc
L
Van Gaal
Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium.
Wilfried
W
De Backer
Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
Stijn L
SL
Verhulst
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009765:Obesity / Q000150:complications*; D010092:Oximetry / Q000379:methods*; D017286:Polysomnography / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis*; D011795:Surveys and Questionnaires
Adolescents; Children; Obesity; Obstructive Sleep apnea; Oximetry; Sleep-disordered breathing