RT Journal Article
SR Electronic
T1 Pulse rate and pulse rate variability help to identify children with obstructive sleep apnea needing adenotonsillectomy
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P4045
VO 42
IS Suppl 57
A1 Nicola Ullmann
A1 Martino Pavone
A1 Elisabetta Verrillo
A1 Antonio Di Marco
A1 Vincenzo Fierimonte
A1 Maria Cecilia Graziani
A1 Serena Soldini
A1 Renato Cutrera
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/P4045.abstract
AB Indroduction: nocturnal pulse oximetry has a high positive predictive value for polysomnographically-diagnosed obstructive sleep apnea(OSA) in children. When significant adenotonsillar hypertrophy is present, adenotonsillectomy(T&A) represents a common treatment for OSA in children. After T&A a reduction of pulse rate(PR) and pulse rate variability(PRV) is expected.Objective: We hypothesised that PR and PRV could help to predict those patients, referred for suspected OSA, who need surgical treatment.Methods: at-home nocturnal pulse oximetry recording was performed on 251 children(162 males), aged 4.5 yrs ± 2.5(mean ± SD), referred consecutively from February 2009 and November 2012 for suspected OSA and data were retrospectively analysed. Patients with significant comorbidities were excluded. For each analysis McGill Oximetry Score(MOS) was also categorized.Results: mean and maximum PR and PR variability were progressively higher as MOS increased. Moreover all PR values(lowest, mean, maximum, and PRV) were significantly higher in subjects who underwent T&A compared with those not surgically treated(p<0.01). Interestingly a negative correlation was found between PRV and the time spent between pulse oximetry recordings and T&A(p=0.03, rho spearman=-0.30). Children with a PRV ≥10 were significantly more likely to undergo a surgical treatment indication(Positive likelihood ratio=4.1). Importantly when both MOS and PRV were used, NPO could better predict those patients who underwent T&A.Conclusions: our data suggest that in children with OSA, PR and PRV, as measured by nocturnal pulse oximetry, complement MOS system as a useful parameter to guide clinical decisions.