Sleep studies in obese children with obstructive sleep apnea: Pulse oximetry as a diagnostic tool

Obstructive sleep apnea is associated with many co-morbidities in children and young people. Obesity has long been recognised as an important risk factor associated with obstructive sleep apnea. Currently, polysomnography is regarded as the gold-standard diagnostic tool for obstructive sleep apnea. The validity of oximetry as a screening and diagnostic tool for obstructive sleep apnea has been the subject of several studies in the literature. There is little published evidence on the use of oximetry in children with obesity. This study assesses whether oximetry is a reliable diagnostic tool for obstructive sleep apnea in obese children. We reviewed the medical records of obese children with a suspected diagnosis of obstructive sleep apnea who underwent oximetry and cardiorespiratory polygraphy or full polysomnography at Sheffield Children's Hospital between January 2010 and March 2022. We compared oximetry results with the apnea-hypopnea index from cardiorespiratory polygraphy or full polysomnography for each patient. A total of 60 patient records were included in the analysis. The sensitivity of oximetry in diagnosing obstructive sleep apnea was 70.9%, with a specificity of 65.5% and a positive predictive value of 68.75%. In the subgroup of subjects with severe obstructive sleep apnea (apnea-hypopnea index > 10), oximetry had a sensitivity of 87.5%. We concluded that oximetry could be a helpful initial diagnostic tool for obstructive sleep apnea in obese children, but is not entirely reliable. A negative oximetry result in a symptomatic individual should prompt a referral for more detailed investigations, while a positive result can help in treatment decisions without needing a polysomnography.