Pulse oximetric thresholds for tonsillectomy and adenotomy in children: significance of 1-2% decline in oxyhemoglobin saturation
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Updated: Jun 24, 2026
A Model to Simulate Clinically Relevant Hypoxia in Humans
Published on: December 22, 2016
Yoshikazu Miyamoto1, Keiko Kinouchi, Mitsuhito Sano
1Department of Anesthesiology and Intensive care medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. miyamoto@anes.med.osaka-u.ac.jp
Insights
Defining desaturation as a 1-2% SpO2 change helps identify children likely to benefit from tonsillectomy and adenotomy (TA). This revised pulse oximetry threshold improves detection accuracy for pediatric obstructive sleep apnea.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Oximetry
Background:
- Adenotonsillar hypertrophy is a common cause of pediatric obstructive sleep apnea.
- Current diagnostic criteria for tonsillectomy and adenotomy (TA) may not optimally identify all children who would benefit.
- Overnight pulse oximetry is a non-invasive tool used in evaluating sleep-disordered breathing.
Purpose of the Study:
- To establish optimal overnight pulse oximetric thresholds for determining the indication of tonsillectomy and adenotomy (TA) in children.
- To revise the definition of 'desaturation' for improved diagnostic accuracy.
Main Methods:
- Prospective study enrolling 134 children scheduled for TA and 112 healthy controls.
- Overnight pulse oximetry data recorded every 10 seconds.
- Desaturation/resaturation events defined as 1-4% SpO2 change in 10 seconds; indices calculated as events per hour.
- Optimal thresholds determined by maximizing sensitivity, specificity, and control group index values.
Main Results:
- Optimal thresholds were determined for various desaturation definitions (1-4% SpO2 change).
- Using 1-2% SpO2 change as the threshold approximately doubled the identification of TA patients whose preoperative indices improved post-surgery.
- Weighted averages for sensitivity and specificity ranged from 84.3-92.3% with the 1-2% threshold.
Conclusions:
- Defining desaturation/resaturation as a 1-2% change in SpO2 improves the detection of children with adenotonsillar hypertrophy who are likely to benefit from TA.
- This revised pulse oximetry approach offers relatively high sensitivity and specificity for identifying surgical candidates.
Objectives:
We aimed to establish optimal overnight pulse oximetric thresholds for determining the indication of tonsillectomy and adenotomy (TA) in children by revising the definition of 'desaturation'.
Methods:
One hundred and thirty four children scheduled for TA (TA group, 5.3 +/- 1.4 years old) and 112 otherwise healthy children scheduled for elective minor surgery (control group, 5.4 +/- 1.5 years old) were enrolled into this prospective study. Data were recorded and stored every 10 s using Nellcor N-395. Desaturation/resaturation events were defined as x% change (x = 1-4) of SpO2 (oxyhemoglobin saturation by pulse oximetry) in 10 s. The desaturation/resaturation indices were calculated as events per hour of total sleeping time. For each index, a wide range of temporary thresholds was set. The optimal thresholds for TA were the ones that maximized the weighted average for sensitivity, specificity (based on whether the index improved or not after TA), and the percentage of the control children whose indices were below the threshold.
Results:
For all the indices, the optimal thresholds that fulfilled the above condition were determined. Compared with the x = 3-4% results, the application of x = 1-2% approximately doubled the TA patients whose preoperative 'positive' indices improved after TA, with the weighted averages of 84.3-92.3% as described above.
Conclusions:
By defining desaturation/resaturation as a 1-2% change in SpO2 from the preceding value, children with adenotonsillar hypertrophy whose pulse oximetric indices are expected to improve after TA can be detected by pulse oximetry with relatively high sensitivity and specificity.
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