Oximetry and carbon dioxide screening for ventilatory requirements in children with spinal muscular atrophy type 1-3.

INTRODUCTION

Despite disease modifying treatments (DMT), assisted ventilation is commonly required in children with Spinal Muscular Atrophy (SMA). Guidelines suggest screening with oximetry and transcutaneous carbon dioxide (TcCO) for sleep disordered breathing (SDB).

AIM

To determine the utility of pulse oximetry and TcCO as a screen for SDB and the need for Non-Invasive Ventilation (NIV) in children with SMA type 1-3.

METHODS

A prospective cohort study was conducted in Queensland, Australia. Full diagnostic PSG was completed in DMT naïve children with SMA. Pulse oximetry and TcCO were extracted from PSG. Apnoea-hypopnoea indices (AHI) criteria were applied to PSG results to define the need for NIV. Abnormal was defined as: ≤3 months of age [mo] AHI≥10 events/hour; >3mo AHI ≥5 events/hour. Receiver operating characteristic curves were calculated for abnormal PSG and pulse oximetry/TcCO variables, and diagnostic statistics were calculated.

RESULTS

Forty-seven untreated children with SMA were recruited (type 1 n = 13; 2 n = 21; 3 n = 13) ranging from 0.2 to 18.8 years old (median 4.9 years). Oxygen desaturation index ≥4 % (ODI4) ≥20events/hour had sensitivity 82.6 % (95 % CI 61.2-95.0) and specificity of 58.3 % (95 % CI 36.6-77.9). TcCO alone and combinations of oximetry/TcCO had low diagnostic ability. The same methodology was applied to 36 children who were treated (type 1 n = 7; type 2 n = 17; type n = 12) and oximetry±TcCO2 had low diagnostic ability.

CONCLUSION

ODI4 ≥20events/hour can predict the need for NIV in untreated children with SMA. TcCO2 monitoring does not improve the PPV. If normal however, children may still require a diagnostic PSG. Neither oximetry nor TcCO monitoring were useful screening tests in the children treated with DMT.