Faculty of Medicine, University of Southampton, Southampton, UK.
Southampton Children's Hospital, Southampton, UK.
Arch Dis Child. 2018 Oct;103(10):962-967. doi: 10.1136/archdischild-2017-314409. Epub 2018 May 14.
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.
Cross-sectional prospective study in a training sample recruited through three UK centres. Validation sample used single-centre retrospective analysis of clinical data.
Children with Down syndrome aged 0.5-6 years.
Diagnostic multichannel sleep study and HPO.
Sensitivity and specificity of HPO to predict moderate-to-severe OSA.
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 (SpO) desaturation index (3% ODI)>6.15 dips/hour (sensitivity 92%, specificity 63%). Combining variables (delta 12 s index, 3% ODI, mean and minimum SpO) 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 SpO variability (sensitivity 92%; specificity 63%).
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.
唐氏综合征患儿患阻塞性睡眠呼吸暂停（OSA）的风险较高，建议进行筛查。OSA 的诊断应通过多导睡眠研究来确认。我们旨在确定家庭脉搏血氧仪（HPO）是否能区分需要进一步进行多导睡眠研究的高危 OSA 患儿。
在英国三个中心招募的培训样本中进行的横断面前瞻性研究。验证样本使用单一中心的临床数据回顾性分析。
年龄在 0.5-6 岁的唐氏综合征患儿。
多导睡眠研究和 HPO。
HPO 预测中重度 OSA 的敏感性和特异性。
202 名唐氏综合征患儿中有 161 名符合纳入质量标准，25 名患儿患有 OSA。在这个培训样本中，预测 OSA 的最佳 HPO 参数指标是 delta 12 s 指数>0.555（敏感性 92%，特异性 65%）和 3%氧合血红蛋白（SpO）下降指数（3%ODI）>6.15 次/小时（敏感性 92%，特异性 63%）。联合变量（delta 12 s 指数、3%ODI、平均 SpO 和最低 SpO）的敏感性为 96%，但特异性降至 52%。所有预测指标在 50 名具有不同特异性损失的患儿的临床验证样本中保留或提高了敏感性，最佳的预测指标是 delta 12 s 指数，这是一种基线 SpO 变异性的衡量指标（敏感性 92%；特异性 63%）。
HPO 筛查可以将需要多导睡眠研究的唐氏综合征患儿数量减少一半，并减轻患儿、家庭和卫生服务机构的负担。这种方法为唐氏综合征的 OSA 提供了一种实用的、适用于非专业儿科医生的通用筛查方法。
