Pulse oximetry recording in children with adenotonsillar hypertrophy: usefulness in the diagnosis of obstructive sleep apnea syndrome

Introduction. Obstructive sleep apnea syndrome (OSAS) is the most serious consequence of adenotonsillar hypertrophy (ATH). The gold standard diagnostic method is polysomnography (PSG) with nocturnal oximetry, but it requires expensive equipment, the presence of a technician and a specialized doctor, and is very time consuming, making the procedure difficult. The recording of pulse oximetry monitoring during sleep may serve as a diagnostic approach. In pediatrics, few studies have been published, and their results have been controversial. Objective. To establish the diagnostic value of the visual analysis of the recorded nocturnal oximetry monitoring vs. the PSG. Population. Children with clinical suspicion of OSAS secondary to ATH referred to PSG. Children with other associated diagnoses (myopathy, craniofacial malformations, etc.) were excluded. Methods. 1) A visual analysis (using our own algorithm) of the oximetry recorded simultaneously with the PSG was performed; 2) the diagnostic value of the pulse oximetry vs. the PSG was established. Both tests were conducted in a blinded and random fashion by two doctors. Results. A total of 167 PSGs were included; the PSG showed OSAS in 75 children and simple snoring in 92; 65 oximetries were considered pathological and in agreement with the PSG in relation to OSAS; 10 children with mild OSAS in the PSGs had normal oximetries. The recorded pulse oximetry showed a sensitivity of 86.6% and a specificity of 98.9% for detecting OSAS. Conclusions. The visual analysis of recorded pulse oximetry monitoring during sleep is highly useful for the diagnosis and management of these patients.