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Night-to-night variation of pulse oximetry in children with sleep-disordered breathing
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  • Published on:
    Single night oximetry may be inadequate
    • Michael D Shields, Respiratory paediatrician Queen's University Belfast
    • Other Contributors:
      • Dara O'Donoghue, Respiratory paediatrician

    We would like to thank the authors of the Pavone paper for their interest in our paper (1,2). We are sorry for not quoting their paper in our study report but do confirm that we were aware of it (2). In our introduction we selected several papers to quote in order to introduce the uncertainty with respect to the need to record 1, 2 or 3 nights of overnight oximetry and the Pavone paper was not one we selected. The Pavone paper claims excellent night to night consistency in oximetry and that only one night of oximetry measurement is necessary while our study did not find this to be the case (2).
    While we agree that the Pavone study used a pulsed oximeter with some superior properties (Radical Masimo) compared to that which we used (Nonin 9600) we do not believe that this is one of the most important reasons why our results differ from the Pavone study.
    We believe the main reasons for differences between the two papers include;
    1] Different primary aims - our study was aimed to determine whether doing 2 or 3 nights oximetry would increase the chances of getting adequate traces to make a report. We therefore included all studies (whether satisfactory or not). In the Pavone study only those with 2 nights each with > 6 hours satisfactory tracing were included and about one third of the children initially identified were therefore excluded. We do not know what then happened to these children – i.e. whether further studies had to be rescheduled. Clearly selec...

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    Conflict of Interest:
    None declared.
  • Published on:
    Pulse oximetry in children under the magnifying glass
    • Martino Pavone, Pediatric Pulmonologist Pediatric Pulmonology & Respiratory Intermediate Care Unit Sleep and Long Term Ventilation Unit Academic Department of Pediatri
    • Other Contributors:
      • Elisabetta Verrillo, Pediatric Pulmonologist
      • Renato Cutrera, Pediatric Pulmonologist

    Dear Authors.

    In your paper [1], you did not mention a previous prospective study performed by our group [2], on 148 otherwise healthy children referred to a Sleep Center for suspected OSA. In our study, pulse oximetry metrics were similar on the two consecutive nights. The McGill Oximery Score (MOS) on the two nights showed excellent night-to-night consistency when analyzed as positive for OSA versus inconclusive. We highlighted that the findings may not apply to younger infants, to adolescents, or to children with complex comorbidities.

    Our conclusions were different from yours for at least two main reasons.

    Firstly, you accepted oximetry recording lasting ≥ 4 hrs. On our opinion, this cut off is too low and it cannot be sufficiently representative of an overnight study. In our study [2], we accepted recordings lasting ≥ 6 hrs according to the ATS guidelines for sleep study.

    Secondly, you used a Nonin 9600 Pulse Oximeter with Nellcor neonatal-adult SpO2 sensor. In our study [2], we used a motion-resistant Radical 5 Masimo Pulse Oximeter. Previous studies [3,4], demonstrated the superiority of the Radical Masimo technology.

    We believe that your study was performed using suboptimal technology and the criteria for minimum acceptable recording time didn’t respect the ATS guidelines. Therefore, your results should be considered with caution.

    Convincing data already exist on pulse oximetry and the analysis of MOS as a useful tool for...

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    Conflict of Interest:
    None declared.