At-home pulse oximetry in children undergoing adenotonsillectomy for obstructive sleep apnea.
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 DI4and 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.
Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy. martino.pavone@opbg.net.
Martino
M
Pavone
Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy.
Nicola
N
Ullmann
Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy.
Elisabetta
E
Verrillo
Otorhinolaryngology Unit, Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy.
Giancarlo
G
De Vincentiis
Otorhinolaryngology Unit, Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy.
Emanuela
E
Sitzia
Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy.
Renato
R
Cutrera
D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010092:Oximetry / Q000379:methods*; D017286:Polysomnography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy / Q000706:statistics & numerical data*
Adenotonsillectomy; McGill Oximetry Score; Obstructive sleep apnoea; Pulse oximetry; Pulse rate variability