Brouillette R T, Morielli A, Leimanis A, Waters K A, Luciano R, Ducharme F M
Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada.
Pediatrics. 2000 Feb;105(2):405-12. doi: 10.1542/peds.105.2.405.
To determine the utility of pulse oximetry for diagnosis of obstructive sleep apnea (OSA) in children.
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.
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).
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.
确定脉搏血氧饱和度测定法在儿童阻塞性睡眠呼吸暂停（OSA）诊断中的效用。
我们对349名因可能患有OSA而被转诊至儿科睡眠实验室的患者进行了一项横断面研究。夜间多导睡眠图（PSG）显示混合/阻塞性呼吸暂停/低通气指数（MOAHI）大于或等于1定义为OSA。一名睡眠实验室医生在不知晓临床和多导睡眠图结果的情况下阅读夜间血氧饱和度测定趋势图和事件图。似然比用于确定在知晓血氧饱和度测定结果前后患OSA概率的变化。
在349名患者中，210名（60%）经多导睡眠图定义患有OSA。血氧饱和度测定趋势图在93名患者中被分类为OSA阳性，在256名患者中为阴性或不确定。在93名血氧饱和度测定结果为阳性的患者中，PSG证实90名患者患有OSA。血氧饱和度测定趋势图阳性的似然比为19.4，将患OSA的概率从60%提高到97%。血氧饱和度测定结果为阳性的儿童的MOAHI中位数为16.4（7.5，30.2）。3例假阳性的血氧饱和度测定结果均在92名患有除腺样体扁桃体肥大以外可能影响睡眠期间呼吸的其他疾病的儿童亚组中。血氧饱和度测定结果为阴性或不确定的似然比为0.58，将患OSA的概率从60%降低到47%。血氧饱和度测定读数的观察者间可靠性非常好至极好（kappa = 0.80）。
在怀疑患有OSA的儿童中，夜间血氧饱和度测定趋势图阳性的阳性预测值至少为97%。血氧饱和度测定法可以：1）作为12个月以上儿童因腺样体扁桃体肥大导致的单纯性OSA的确定性诊断测试，或者2）快速且低成本地识别有睡眠呼吸障碍病史的儿童，这些儿童需要PSG来阐明类型和严重程度。血氧饱和度测定结果为阴性不能用于排除OSA。
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