title: Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings.
abstract: OBJECTIVE
  Nocturnal oximetry has become known as a simple, readily available, and potentially useful diagnostic tool of childhood obstructive sleep apnea (OSA). However, at-home respiratory polygraphy (HRP) remains the preferred alternative to polysomnography (PSG) in unattended settings. The aim of this study was twofold: (1) to design and assess a novel methodology for pediatric OSA screening based on automated analysis of at-home oxyhemoglobin saturation (SpO2), and (2) to compare its diagnostic performance with HRP.
  
  
  METHODS
  SpO2recordings were parameterized by means of time, frequency, and conventional oximetric measures. Logistic regression models were optimized using genetic algorithms (GAs) for three cutoffs for OSA: 1, 3, and 5 events/h. The diagnostic performance of logistic regression models, manual obstructive apnea-hypopnea index (OAHI) from HRP, and the conventional oxygen desaturation index ≥ 3% (ODI3) were assessed.
  
  
  RESULTS
  For a cutoff of 1 event/h, the optimal logistic regression model significantly outperformed both conventional HRP-derived ODI3 and OAHI: 85.5% accuracy (HRP 74.6%; ODI3 65.9%) and 0.97 area under the receiver operating characteristics curve (AUC) (HRP 0.78; ODI3 0.75) were reached. For a cutoff of 3 events/h, the logistic regression model achieved 83.4% accuracy (HRP 85.0%; ODI3 74.5%) and 0.96 AUC (HRP 0.93; ODI3 0.85) whereas using a cutoff of 5 events/h, oximetry reached 82.8% accuracy (HRP 85.1%; ODI3 76.7) and 0.97 AUC (HRP 0.95; ODI3 0.84).
  
  
  CONCLUSIONS
  Automated analysis of at-home SpO2recordings provide accurate detection of children with high pretest probability of OSA. Thus, unsupervised nocturnal oximetry may enable a simple and effective alternative to HRP and PSG in unattended settings.
authors.affiliation: Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.|Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Álvarez
authors.affiliation: Unidad Multidisciplinar de Sueño, CIBER Respiratorio, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: María L
authors.initials: ML
authors.lastname: Alonso-Álvarez
authors.affiliation: Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.
authors.forename: Gonzalo C
authors.initials: GC
authors.lastname: Gutiérrez-Tobal
authors.affiliation: Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.|Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Crespo
authors.affiliation: Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois.
authors.forename: Leila
authors.initials: L
authors.lastname: Kheirandish-Gozal
authors.affiliation: Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Hornero
authors.affiliation: Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois.
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.affiliation: Unidad Multidisciplinar de Sueño, CIBER Respiratorio, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Terán-Santos
authors.affiliation: Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.|Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Del Campo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods; D010092:Oximetry / Q000379:methods*; D017286:Polysomnography; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*
keywords: at-home respiratory polygraphy; automated pattern recognition; blood oxygen saturation; genetic algorithms; nocturnal oximetry