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Updated: May 16, 2026
A Model to Simulate Clinically Relevant Hypoxia in Humans
Published on: December 22, 2016
Mean desaturation nadir values in children with sleep disordered breathing
Omemine Kokoricha1, Nicola Jane Rowbotham2, Andrew Prayle2,3
1Department of Paediatrics, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK.
Insights
Mean desaturation nadir (MDN) can help identify children with severe obstructive sleep apnoea (OSA). Lower MDN values, particularly below 90%, indicate increased perioperative risk in pediatric patients with sleep disordered breathing (SDB).
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Critical Care
Background:
- Obstructive sleep apnoea (OSA) diagnosis in children requires sleep studies for risk stratification before surgery.
- Mean desaturation nadir (MDN) is a key metric for assessing hypoxic burden in sleep disordered breathing (SDB).
- Limited data exists on MDN values in pediatric patients with severe OSA or other SDB categories.
Purpose of the Study:
- To determine Mean Desaturation Nadir (MDN) values in children with varying severities of sleep disordered breathing (SDB).
- To evaluate the utility of MDN in identifying pediatric patients with severe OSA and associated perioperative risks.
Main Methods:
- A cross-sectional observational study analyzed data from 889 children undergoing multichannel sleep studies (MCSS).
- MCSS included oximetry, video, sound, movement, heart rate, and pulse transit time, excluding airflow and AHI.
- Sleep disordered breathing (SDB) categories were established using oximetry and video criteria.
Main Results:
- Mean Desaturation Nadir (MDN) decreased with increasing SDB severity, particularly in moderate and severe OSA.
- Severe OSA (n=37) was associated with a mean MDN of 88% (95% CI 87%–89%).
Conclusions:
- MDN values below 90% may effectively identify children with severe OSA.
- This finding aids in stratifying perioperative risk for pediatric patients with severe OSA.
Introduction:
Sleep studies are recommended in children suspected to have severe obstructive sleep apnoea (OSA) to stratify perioperative risk before adenotonsillectomy and to avoid unscheduled high-dependency unit admission. The mean desaturation nadir (MDN) is thought to be a useful measure of the overall hypoxic burden from sleep disordered breathing (SDB) events. MDN values have been reported in healthy children but not in those with severe OSA or other categories of SDB.
Methods:
We report the findings of a cross-sectional observational study in children with SDB assessed with multichannel sleep studies (MCSS) in a UK secondary care centre between July 2022 and November 2024. We evaluated data from 1031 children recorded in a sleep study database, which is maintained for audit and service evaluation purposes. Following exclusions, the data of 889 children were analysed for MDN values according to SDB categories. The parameters measured with MCSS include oximetry, video, sound, movement, heart rate and pulse transit time but do not include airflow or an Apnoea-Hypopnoea Index (AHI) which is reported with cardiorespiratory studies or polysomnography. SDB categories were determined using oximetry and video criteria.
Results:
We found that MDN falls with increasing severity of SDB, most notably in children with moderate and severe OSA. Approximately 4% of the cohort (n=37) had severe OSA (defined using McGill's criteria) and had a mean MDN of 88% (95% CI 87% to 89%).
Conclusion:
Our findings suggest that MDN values <90% can identify children with severe OSA who may have increased perioperative risk.
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