Zarmina Ehsan1,2, Shan He3, Guixia Huang4, Md M Hossain4,5, Narong Simakajornboon5,6. 1. Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO. 2. University of Missouri-Kansas City School of Medicine, Kansas City, MO. 3. Department of Otolaryngology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China. 4. Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 5. Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 6. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Abstract
INTRODUCTION: There is limited evidence on the accuracy of oximetry in the evaluation of infant obstructive sleep apnea (OSA). We aimed to determine the utility of overnight oximetry to stratify infants at risk for OSA, in order to determine urgency for definitive screening with an overnight in-laboratory polysomnogram (PSG). METHODS: Retrospective single-institution cohort study of infants undergoing PSG and separate overnight oximetry over an eight-year period. Correlations, using oximetry in both in-hospital (attended) or at-home (unattended) settings, for ODI410 (decrease in oxygen saturation ≥ 4% from baseline, duration ≥ 10 seconds) and ODI40 (duration>0 seconds) with AHIo were obtained. The AUC was calculated, and sensitivity and specificity values were presented as ROC curves. RESULTS: Thirty-eight infants were included. The mean(SD) age (months) 5.7(3.9) at diagnostic PSG and 5.5(3.7) at the time of oximetry. The mean AHIo for the entire cohort was 6.7(6.2). The mean(SD) ODI40 was 8.6(9.0) and the mean(SD) ODI410 was 5.4(5.1).The correlation between ODI and AHIo was statistically significant for the cohort [ODI40 vs. AHIo(r= 0.59,p<0.001) and ODI410 vs. AHIo (r=0.55,p=0.0003)]. Using an ODI40 cutoff of 3, the sensitivity, specificity, NPV and PPV for diagnosing OSA were: 86%, 40%, 50%, 80% for AHIo>2, and 100%, 35%, 100%, 58% for AHIo≥5. CONCLUSION: There is a significant positive correlation between the ODI4 obtained from oximetry and AHIo obtained from PSG in infants at risk for OSA. An ODI40 >3 may be useful to stratify infants at risk for moderate to severe OSA when used in attended (in-hospital) and unattended (in-home) settings. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
INTRODUCTION: There is limited evidence on the accuracy of oximetry in the evaluation of infant obstructive sleep apnea (OSA). We aimed to determine the utility of overnight oximetry to stratify infants at risk for OSA, in order to determine urgency for definitive screening with an overnight in-laboratory polysomnogram (PSG). METHODS: Retrospective single-institution cohort study of infants undergoing PSG and separate overnight oximetry over an eight-year period. Correlations, using oximetry in both in-hospital (attended) or at-home (unattended) settings, for ODI410 (decrease in oxygen saturation ≥ 4% from baseline, duration ≥ 10 seconds) and ODI40 (duration>0 seconds) with AHIo were obtained. The AUC was calculated, and sensitivity and specificity values were presented as ROC curves. RESULTS: Thirty-eight infants were included. The mean(SD) age (months) 5.7(3.9) at diagnostic PSG and 5.5(3.7) at the time of oximetry. The mean AHIo for the entire cohort was 6.7(6.2). The mean(SD) ODI40 was 8.6(9.0) and the mean(SD) ODI410 was 5.4(5.1).The correlation between ODI and AHIo was statistically significant for the cohort [ODI40 vs. AHIo(r= 0.59,p<0.001) and ODI410 vs. AHIo (r=0.55,p=0.0003)]. Using an ODI40 cutoff of 3, the sensitivity, specificity, NPV and PPV for diagnosing OSA were: 86%, 40%, 50%, 80% for AHIo>2, and 100%, 35%, 100%, 58% for AHIo≥5. CONCLUSION: There is a significant positive correlation between the ODI4 obtained from oximetry and AHIo obtained from PSG in infants at risk for OSA. An ODI40 >3 may be useful to stratify infants at risk for moderate to severe OSA when used in attended (in-hospital) and unattended (in-home) settings. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.