Martino Pavone1, Nicola Ullmann2, Elisabetta Verrillo2, Giancarlo De Vincentiis3, Emanuela Sitzia3, Renato Cutrera2. 1. Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy. martino.pavone@opbg.net. 2. Respiratory Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy. 3. Otorhinolaryngology Unit, Bambino Gesù Children's Hospital, Piazza S.Onofrio 4, 00165, Rome, Italy.
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.
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.
Authors: Gillian M Nixon; Andrea S Kermack; G Michael Davis; John J Manoukian; Karen A Brown; Robert T Brouillette Journal: Pediatrics Date: 2004-01 Impact factor: 7.124
Authors: Jong Yong A Foo; Andrew P Bradley; Stephen J Wilson; Gordon R Williams; Carolyn Dakin; David M Cooper Journal: Acta Paediatr Date: 2006-05 Impact factor: 2.299
Authors: Linda Horwood; Robert T Brouillette; Christine D McGregor; John J Manoukian; Evelyn Constantin Journal: JAMA Otolaryngol Head Neck Surg Date: 2014-07 Impact factor: 6.223
Authors: S A McKenzie; A Bhattacharya; R Sureshkumar; B Joshi; A Franklin; R Pickering; I Dundas Journal: Respir Med Date: 2008-07-18 Impact factor: 3.415