Warapongmanupong Siriporn, Preutthipan Aroonwan
Division of Pediatric Pulmonology, Department of Pediatrics, and Ramathibodi Hospital Sleep Disorder Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Pediatric Pulmonology, Department of Pediatrics, and Ramathibodi Hospital Sleep Disorder Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Int J Pediatr Otorhinolaryngol. 2019 Apr;119:27-31. doi: 10.1016/j.ijporl.2019.01.003. Epub 2019 Jan 7.
Pulse oximetry (PO) has been frequently used as an alternative test to polysomnography (PSG) in children. We conducted this study to determine which statistical parameters obtained from overnight PO monitoring would be most suitable and to evaluate its diagnostic performance.
We prospectively recruited children with snoring referred for PSG. Subjects were monitored with PO while performing PSG. Eight statistical parameters of SpO data were analyzed to identify which had the best diagnostic performance as assessed by the area under the receiver-operating characteristic curve (AUC). To validate this parameter (which was found to be the standard deviation, SD) in a larger population, we retrospectively extracted raw data of SpO from our previous PSG records, calculated the SD of each patient, and assessed its AUC.
A total of 166 children were recruited in the first phase. SD of SpO was found to have the largest AUC. In the second phase, raw data of 457 patients were extracted. SD of SpO correlated well with the apnea/hypopnea index (AHI) (r = 0.6, P < 0.001). For diagnosis of moderate to severe obstructive sleep apnea (OSA) (AHI ≥5 events/h), AUC was 0.74. SD of SpO ≥1.06 representing mean + 2SD of normal to mild OSA (AHI <5) provided 97% specificity and 92% positive predictive value. The positive likelihood ratio was 11.
Calculating the SD of SpO, which quantifies the amount of dispersion of SpO values, is a useful initial investigation in childhood OSA. An SD ≥ 1.06 can predict moderate to severe OSA with confidence. This parameter is simple, practical, and readily accessible.
脉搏血氧饱和度测定法（PO）在儿童中常被用作多导睡眠图（PSG）的替代检测方法。我们开展这项研究以确定从夜间PO监测中获得的哪些统计参数最为合适，并评估其诊断性能。
我们前瞻性招募了因打鼾而接受PSG检查的儿童。在进行PSG检查时，对受试者进行PO监测。分析SpO₂数据的八个统计参数，以确定通过受试者工作特征曲线下面积（AUC）评估时哪个参数具有最佳诊断性能。为了在更大的人群中验证该参数（发现为标准差，SD），我们回顾性地从我们之前的PSG记录中提取SpO₂的原始数据，计算每位患者的SD，并评估其AUC。
第一阶段共招募了166名儿童。发现SpO₂的SD具有最大的AUC。在第二阶段，提取了457名患者的原始数据。SpO₂的SD与呼吸暂停/低通气指数（AHI）相关性良好（r = 0.6，P < 0.001）。对于中度至重度阻塞性睡眠呼吸暂停（OSA）（AHI≥5次/小时）的诊断，AUC为0.74。SpO₂的SD≥1.06代表正常至轻度OSA（AHI < 5）的均值 + 2SD，其特异性为97%，阳性预测值为92%。阳性似然比为11。
计算SpO₂的SD，其量化了SpO₂值的离散程度，是儿童OSA的一种有用的初步检查方法。SD≥1.06可以可靠地预测中度至重度OSA。该参数简单、实用且易于获得。
