Oxygen Desaturation Index as Predictor of Moderate-to-Severe OSAS in Children with Snoring

Abstract

Polysomnography (PSG) is the gold standard method for evaluating severity of Obstructive Sleep Apnea Syndrome (OSAS), but it is not available in all settings. We hypothesized that Oxygen Desaturation (≥3%) Index (ODI3) ≥3.5/h from nocturnal oximetry predicts moderate-to-severe OSAS (apnea-hypopnea index-AHI &gt;5/h) in children with snoring (Papadakis et al. Pediatrics 2018:142: e20173382). <b>Methods:</b> PSGs from 1-17 year-old, otherwise healthy children with snoring &gt;3 nights/week and tonsillar hypertrophy with or without obesity were analyzed retrospectively. Logistic regression analysis was applied to assess the association of ODI3 ≥3.5/h (explanatory variable) with AHI&gt;5/h (primary outcome) adjusted for obesity and age. <b>Results:</b> PSGs of 112 children with snoring (median age 6.1 years; range 1.2-17 years; 35.7% obese) were analyzed. Prevalence of moderate-to-severe OSAS was 49.1% and frequency of ODI3 ≥3.5/h was 60.7%. ODI3 ≥3.5/h was a significant predictor of moderate-to-severe OSAS (OR 33.7; 95% CI 9.8-115.5; p&lt;0.001). ODI3 ≥3.5/h had Sensitivity 92.7%, Specificity 70.2%, Positive Predictive Value 75%, and Negative Predictive Value 90.9% for predicting moderate-to-severe OSAS. <b>Conclusion:</b> In otherwise healthy children with snoring and tonsillar hypertrophy with or without obesity, ODI3 ≥3.5/h has high sensitivity for moderate-to-severe OSAS, but its false positive rate is 25%. Thus, when only nocturnal oximetry is available, decisions for adenotonsillectomy should also be based on OSAS-related morbidity and affected quality of life.