Can overnight portable pulse oximetry be used to stratify obstructive sleep apnea risk in infants? A correlation analysis

Introduction There is limited evidence on the accuracy of oximetry in the evaluation of infant obstructive sleep apnea (OSA). We aimed to determine the utility of overnight oximetry to stratify infants at risk for OSA, to determine urgency for definitive screening with an overnight in‐laboratory polysomnogram (PSG). Methods Retrospective single‐institution cohort study of infants undergoing PSG and a separate overnight oximetry over an 8‐year period. Correlations, using oximetry in both in‐hospital (attended) or at‐home (unattended) settings, for ODI4 10 (decrease in oxygen saturation ≥ 4% from baseline, duration ≥ 10 seconds) and ODI4 0 (duration > 0 second) with the obstructive apnea‐hypopnea index (AHIo) were obtained. The area under the curve was calculated, and sensitivity and specificity values have been presented as receiver operating characteristic curves. Results Thirty‐eight infants were included. The mean (SD) age (months) was 5.7 (3.9) at diagnostic PSG and 5.5 (3.7) at the time of oximetry. The mean AHIo for the entire cohort was 6.7 (6.2). The mean (SD) ODI4 0 was 8.6 (9.0) and the mean (SD) ODI4 10 was 5.4 (5.1).The correlation between ODI and AHIo was statistically significant for the cohort (ODI4 0 vs. AHIo [ r = .59, P < .001] and ODI4 10 vs AHIo [ r = .55, P = .0003]). Using an ODI4 0 cutoff of 3, the sensitivity, specificity, negative predictive value and positive predictive value for diagnosing OSA was: 86%, 40%, 50%, and 80% respectively for an AHIo greater than 2, and 100%, 35%, 100%, and 58% respectively for an AHIo greater than or equal to 5. Conclusion There is a significant positive correlation between the ODI 4 obtained from oximetry and the AHIo obtained from PSG in infants at risk for OSA. An ODI4 0 greater than 3 may be useful to stratify infants at risk for moderate to severe OSA when used in attended (in‐hospital) or unattended (in‐home) settings.