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Nocturnal Pulse Oximetry Is Better than Snoring Sound Analysis for Screening Severe Pediatric Obstructive Sleep Apnea
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  • Hui-Shan Hsieh,
  • Chung-Jan Kang,
  • Hai-Hua Chuang,
  • Ming-Ying Zhuo,
  • Chung-Guei Huang,
  • Gui-She Lee,
  • Yu-Shu Huang,
  • Li-Pang Chuang,
  • Ning-Hung Chen,
  • Jen Fu Hsu,
  • Terry B.J. Kuo,
  • Cheryl C.H. Yang,
  • Li-Ang Lee,
  • Hsueh-Yu Li
Hui-Shan Hsieh
Chang Gung Memorial Hospital Linkou Main Branch
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Chung-Jan Kang
Chang Gung Memorial Hospital Linkou Main Branch
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Hai-Hua Chuang
Chang Gung Memorial Hospital
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Ming-Ying Zhuo
Xiamen Chang Gung Hospital
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Chung-Guei Huang
Chang Gung Memorial Hospital Linkou Main Branch
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Gui-She Lee
National Yang-Ming University
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Yu-Shu Huang
Chang Gung Memorial Hospital Linkou Main Branch
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Li-Pang Chuang
Chang Gung Memorial Hospital Linkou Main Branch
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Ning-Hung Chen
Chang Gung Memorial Hospital Linkou Main Branch
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Jen Fu Hsu
Chang Gung Memorial Hospital Linkou Main Branch
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Terry B.J. Kuo
National Yang-Ming Medical College
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Cheryl C.H. Yang
National Yang-Ming University
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Li-Ang Lee
Chang Gung Memorial Hospital Linkou Main Branch
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Hsueh-Yu Li
Chang Gung Memorial Hospital Linkou Main Branch
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Abstract

Abstract: Introduction: Efficacious screening of severe obstructive sleep apnea (OSA) is important for children with sleep-disordered breathing before time-consuming nocturnal polysomnography. However, the predictive performance of clinical variables, nocturnal unattended pulse oximetry, and snoring sound analysis to screen for severe pediatric OSA has not been comprehensively investigated. Methods: Forty-two consecutive children (11 [26%] girls and 31 [74%] boys; median age, 9 years; median body-mass index of 19.0 kg/m2) with loud snoring were prospectively recruited to undergo standard polysomnography, nocturnal pulse oximetry, and snoring sound analysis. Results: Binary logistic regression models showed that oxygen desaturation index ≥ 3% (> 5.9 events/h), adenoidal‐nasopharyngeal ratio (> 0.782), snoring sound energy of 801-1000 Hz (> 22.1 dB), and tonsil size (> 3) significantly predicted severe OSA, in descending order of odds ratio. Multivariate analysis showed that oxygen desaturation index ≥ 3%, adenoidal‐nasopharyngeal ratio, and tonsil size independently predicted severe OSA, and that their combination best predicted severe OSA (sensitivity = 91%; specificity = 84%; area under the curve = 0.92; p < 0.001). Conclusions: Our results suggested that pulse oximetry is better than snoring sound analysis to screen for severe OSA in children with loud snoring. A combination of oxygen desaturation index ≥ 3%, adenoidal‐nasopharyngeal ratio, and tonsil size can be used to efficiently screen for severe pediatric OSA.