Van Someren V H, Hibbert J, Stothers J K, Kyme M C, Morrison G A
Department of Paediatrics, United Medical School, Guy's Hospital, London.
Clin Otolaryngol Allied Sci. 1990 Jun;15(3):263-71. doi: 10.1111/j.1365-2273.1990.tb00784.x.
A series of children having tonsillectomy and adenoidectomy was investigated for hypoxaemia during sleep and to assess the value of signs and symptoms as predictors of hypoxaemia. Forty-four children were studied the night before surgery. Oxygen saturation (SaO2) was measured whilst the child was awake using a pulse oximeter and when the child was asleep oxygen saturation. ECG and chest impedance were continuously monitored and recorded. In addition, 20 control children having urological surgery were studied in the same way. All the measures of hypoxaemia (awake SaO2, baseline asleep SaO2, number of hypoxaemic episodes) differed significantly between patients and controls (P less than 0.01). When significant hypoxaemia was defined as a baseline sleeping SaO2 below 90% or one dip in SaO2 of at least 10% below the baseline per hour 15 children were found to have abnormal studies. These children could not be identified from history or clinical examination but using the criteria of mouth breathing, audible respiration at rest and an awake SaO2 of less than 96%, 14 of the 15 children were accurately identified (93% sensitivity, 86% specificity). Thus a combination of the physical signs of mouth breathing and measurement of oxygen saturation whilst awake may provide a useful clinic screening test for children suspected of suffering from sleep apnoea.
