Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea
Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea
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DOI：
10.1542/peds.105.2.405
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发表时间：
2000-02-01
期刊：
影响因子：
8
通讯作者：
Ducharme, FM
中科院分区：
文献类型：
--
作者：
Brouillette, RT;Morielli, A;Ducharme, FM
目标。目的探讨脉搏血氧仪在儿童阻塞性睡眠呼吸暂停（OSA）诊断中的应用价值。我们对349名因可能的阻塞性睡眠呼吸暂停而转诊至儿科睡眠实验室的患者进行了横断面研究。夜间多导睡眠图（PSG）的混合/阻塞性呼吸暂停/低通气指数（MOAHI）大于或等于1定义为OSA。睡眠实验室医生阅读夜间血氧趋势和事件图，对临床和多导睡眠图结果不知情。使用似然比来确定氧饱和度测定结果已知前后OSA发生概率的变化。在349例患者中，210例（60%）经多导睡眠图诊断为OSA。血氧测定趋势图中93例为OSA阳性，256例为阴性或不确定。在93例血氧测定结果为阳性的患者中，PSG证实了90例OSA。血氧趋势图阳性的似然比为19.4，将OSA的概率从60%增加到97%。血氧测定阳性儿童的MOAHI中位数为16.4（7.5,30.2）。这3例血氧假阳性结果均来自92名儿童的亚组，这些儿童的诊断不包括可能影响睡眠呼吸的腺扁桃体肥大。氧饱和度阴性或不确定结果的似然比为。58，将阻塞性睡眠呼吸暂停的概率从60%降低到47%。血氧仪读数的观察者间信度非常好至极好（kappa = 0.80）。在怀疑患有阻塞性睡眠呼吸暂停的儿童中，阳性的夜间血氧趋势图至少有97%的阳性预测值。血氧测定可以：1)作为12个月以上儿童由腺扁桃体肥大引起的直接阻塞性睡眠呼吸障碍的明确诊断试验，或2)快速、廉价地识别有睡眠呼吸障碍病史的儿童，这些儿童需要PSG来阐明其类型和严重程度。血氧饱和度阴性不能排除阻塞性呼吸暂停。
Objective. To determine the utility of pulse oximetry for diagnosis of obstructive sleep apnea (OSA) in children.Methods. We performed a cross-sectional study of 349 patients referred to a pediatric sleep laboratory for possible OSA. A mixed/obstructive apnea/hypopnea index (MOAHI) greater than or equal to 1 on nocturnal polysomnography (PSG) defined OSA. A sleep laboratory physician read nocturnal oximetry trend and event graphs, blinded to clinical and polysomnographic results. Likelihood ratios were used to determine the change in probability of having OSA before and after oximetry results were known.Results. Of 349 patients, 210 (60%) had OSA as defined polysomnographically. Oximetry trend graphs were classified as positive for OSA in 93 and negative or inconclusive in 256 patients. Of the 93 oximetry results read as positive, PSG confirmed OSA in 90 patients. A positive oximetry trend graph had a likelihood ratio of 19.4, increasing the probability of having OSA from 60% to 97%. The median MOAHI of children with a positive oximetry result was 16.4 (7.5, 30.2). The 3 false-positive oximetry results were all in the subgroup of 92 children who had diagnoses other than adenotonsillar hypertrophy that might have affected breathing during sleep. A negative or inconclusive oximetry result had a likelihood ratio of .58, decreasing the probability of having OSA from 60% to 47%. Interobserver reliability for oximetry readings was very good to excellent (kappa = .80).Conclusions. In the setting of a child suspected of having OSA, a positive nocturnal oximetry trend graph has at least a 97% positive predictive value. Oximetry could: 1) be the definitive diagnostic test for straightforward OSA attributable to adenotonsillar hypertrophy in children older than 12 months of age, or 2) quickly and inexpensively identify children with a history suggesting sleep-disordered breathing who would require PSG to elucidate the type and severity. A negative oximetry result cannot be used to rule out OSA.