Abstract
Background: Pulse transit time (PTT) is a non-invasive measure of arousals and respiratory effort for which we aim to identify threshold values that detect sleep disordered breathing (SDB) in children. We also compare the sensitivity and specificity of oximetry with the findings of a multi-channel study.Methods: We performed a cross-sectional observational study of 521 children with SDB admitted for multi-channel sleep studies (pulse oximetry, ECG, video, sound, movement, PTT) in a secondary care centre. PTT data was available in 368 children. Studies were categorised as normal; primary snoring; upper airway resistance syndrome (UARS); obstructive sleep apnoea (OSA), and “abnormal other.” Receiver operator characteristic curves were constructed for different PTT (Respiratory swing; Arousal index) thresholds using a random sample of 50% of children studied (training set); calculated thresholds of interest were validated against the other 50% (test set). Study findings were compared with oximetry categories (normal, inconclusive, abnormal) using data (mean and minimum oxygen saturations; oxygen desaturations > 4%) obtained during the study.Results: Respiratory swing of 17.92 ms identified SDB (OSA/UARS) with sensitivity: 0.80 (C.I. 0.62–0.90) and specificity 0.79 (C.I. 0.49–0.87). PTT arousal index of 16.06/ hour identified SDB (OSA/UARS) with sensitivity: 0.85 (95% C.I. 0.67–0.92) and specificity 0.37 (95% C.I. 0.17–0.48). Oximetry identified SDB (OSA) with sensitivity: 0.38 (C.I. 0.31–0.46) and specificity 0.98 (C.I. 0.97–1.00).Conclusions: PTT is more sensitive but less specific than oximetry at detecting SDB in children. The additional use of video and sound enabled detection of SDB in twice as many children as oximetry alone.
Highlights
Obstructive sleep disordered breathing (SDB) is a syndrome of upper airway dysfunction characterized by snoring and/or increased respiratory effort during sleep [1,2,3]
Use of a multi-channel study resulted in the detection of obstructive sleep apnoea (OSA) or upper airway resistance syndrome (UARS) in 182 children
That within the limitation of studies incorporating oximetry, video and sound, there is a need for distinction between the range of categories we have identified to aid clinical management decisions and to identify children with OSA who are missed by the use of oximetry alone
Summary
Obstructive sleep disordered breathing (SDB) is a syndrome of upper airway dysfunction characterized by snoring and/or increased respiratory effort during sleep [1,2,3]. There is strong evidence of PTT in Children With SDB adverse neurocognitive, behavioral and cardiovascular outcomes in children with SDB, underlining the importance of diagnosis and management [4,5,6,7]. The mechanisms behind these adverse outcomes are being elucidated [8]. Oximetry is widely used in both secondary and tertiary care centers and has been shown to have good specificity for detecting OSA in children but is much less sensitive. Pulse transit time (PTT) is a non-invasive measure of arousals and respiratory effort for which we aim to identify threshold values that detect sleep disordered breathing (SDB) in children. We compare the sensitivity and specificity of oximetry with the findings of a multi-channel study
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