Home oximetry to screen for obstructive sleep apnoea in Down syndrome.

Abstract:

OBJECTIVE:Children with Down syndrome are at high risk of obstructive sleep apnoea (OSA) and screening is recommended. Diagnosis of OSA should be confirmed with multichannel sleep studies. We aimed to determine whether home pulse oximetry (HPO) discriminates children at high risk of OSA, who need further diagnostic multichannel sleep studies. DESIGN:Cross-sectional prospective study in a training sample recruited through three UK centres. Validation sample used single-centre retrospective analysis of clinical data. PATIENTS:Children with Down syndrome aged 0.5-6 years. INTERVENTION:Diagnostic multichannel sleep study and HPO. MAIN OUTCOME MEASURES:Sensitivity and specificity of HPO to predict moderate-to-severe OSA. RESULTS:161/202 children with Down syndrome met quality criteria for inclusion and 25 had OSA. In this training sample, the best HPO parameter predictors of OSA were the delta 12 s index >0.555 (sensitivity 92%, specificity 65%) and 3% oxyhaemoglobin (SpO2) desaturation index (3% ODI)>6.15 dips/hour (sensitivity 92%, specificity 63%). Combining variables (delta 12 s index, 3% ODI, mean and minimum SpO2) achieved sensitivity of 96% but reduced specificity to 52%. All predictors retained or improved sensitivity in a clinical validation sample of 50 children with variable loss of specificity, best overall was the delta 12 s index, a measure of baseline SpO2 variability (sensitivity 92%; specificity 63%). CONCLUSIONS:HPO screening could halve the number of children with Down syndrome needing multichannel sleep studies and reduce the burden on children, families and health services alike. This approach offers a practical universal screening approach for OSA in Down syndrome that is accessible to the non-specialist paediatrician.

journal_name

Arch Dis Child

authors

Hill CM,Elphick HE,Farquhar M,Gringras P,Pickering RM,Kingshott RN,Martin J,Reynolds J,Joyce A,Gavlak JC,Evans HJ

doi

10.1136/archdischild-2017-314409

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

962-967

issue

10

eissn

0003-9888

issn

1468-2044

pii

archdischild-2017-314409

journal_volume

103

pub_type

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