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  1. R Mark Beattie, Editor in Chief

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Night to night variation of pulse oximetry in children with sleep disordered breathing

Sleep disordered breathing is common, particularly in Down syndrome. Overnight polysomnography is the gold standard to diagnose but is difficult to access routinely. Overnight pulse oximetry is recommended for screening although there is little data on how best to interpret the results. Burke et al report data on night to night variation using statistical measures of repeatability in 214 children referred to a sleep clinic who required overnight oximetry. 123/214 had three technically adequate nights oximetry. The following measures were made—length of adequate trace, basal SpO2, number of desaturations (>4% drop for >10s) per hour 'adjusted index' and time with SpO2 <90%. There was substantial night to night variation in all clinical groups. Intraclass correlation coefficient for adjusted index was 0.54 (95% confidence interval 0.2–0.81) among children with Down Syndrome and 0.88 (95% confidence interval 0.84–0.91) for other diagnosis. Many children with one normal night of oximetry (39 out of 84) went on to have abnormal oximetry on subsequent nights. This data has significant implications for the assessment of sleep disordered breathing with the challenge being if the test is negative shouldn't I just repeat it? …

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