RT Journal Article
SR Electronic
T1 Home oximetry to screen for obstructive sleep apnoea in Down syndrome
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 962
OP 967
DO 10.1136/archdischild-2017-314409
VO 103
IS 10
A1 Catherine M Hill
A1 Heather E Elphick
A1 Michael Farquhar
A1 Paul Gringras
A1 Ruth M Pickering
A1 Ruth N Kingshott
A1 Jane Martin
A1 Janine Reynolds
A1 Anna Joyce
A1 Johanna C Gavlak
A1 Hazel J Evans
YR 2018
UL http://adc.bmj.com/content/103/10/962.abstract
AB Objective Children with Down syndrome are at high risk of obstructive sleep apnoea (OSA) and screening is recommended. Diagnosis of OSA should be confirmed with multichannel sleep studies. We aimed to determine whether home pulse oximetry (HPO) discriminates children at high risk of OSA, who need further diagnostic multichannel sleep studies.Design Cross-sectional prospective study in a training sample recruited through three UK centres. Validation sample used single-centre retrospective analysis of clinical data.Patients Children with Down syndrome aged 0.5–6 years.Intervention Diagnostic multichannel sleep study and HPO.Main outcome measures Sensitivity and specificity of HPO to predict moderate-to-severe OSA.Results 161/202 children with Down syndrome met quality criteria for inclusion and 25 had OSA. In this training sample, the best HPO parameter predictors of OSA were the delta 12 s index >0.555 (sensitivity 92%, specificity 65%) and 3% oxyhaemoglobin (SpO2) desaturation index (3% ODI)>6.15 dips/hour (sensitivity 92%, specificity 63%). Combining variables (delta 12 s index, 3% ODI, mean and minimum SpO2) achieved sensitivity of 96% but reduced specificity to 52%. All predictors retained or improved sensitivity in a clinical validation sample of 50 children with variable loss of specificity, best overall was the delta 12 s index, a measure of baseline SpO2 variability (sensitivity 92%; specificity 63%).Conclusions HPO screening could halve the number of children with Down syndrome needing multichannel sleep studies and reduce the burden on children, families and health services alike. This approach offers a practical universal screening approach for OSA in Down syndrome that is accessible to the non-specialist paediatrician.