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Home oximetry to screen for obstructive sleep apnoea in Down syndrome

Home oximetry to screen for obstructive sleep apnoea in Down syndrome
Home oximetry to screen for obstructive sleep apnoea in Down syndrome

Objective Children with Down syndrome are at high risk of obstructive sleep apnoea (OSA) and screening is recommended. Diagnosis of OSA should be confirmed with multichannel sleep studies. We aimed to determine whether home pulse oximetry (HPO) discriminates children at high risk of OSA, who need further diagnostic multichannel sleep studies.

Design Cross-sectional prospective study in a training sample recruited through three UK centres. Validation sample used single-centre retrospective analysis of clinical data.

Patients Children with Down syndrome aged 0.5–6 years.

Intervention Diagnostic multichannel sleep study and HPO.

Main outcome measures Sensitivity and specificity of HPO to predict moderate-to-severe OSA.

Results 161/202 children with Down syndrome met quality criteria for inclusion and 25 had OSA. In this training sample, the best HPO parameter predictors of OSA were the delta 12 s index >0.555 (sensitivity 92%, specificity 65%) and 3% oxyhaemoglobin (SpO2) desaturation index (3% ODI)>6.15 dips/hour (sensitivity 92%, specificity 63%). Combining variables (delta 12 s index, 3% ODI, mean and minimum SpO2) achieved sensitivity of 96% but reduced specificity to 52%. All predictors retained or improved sensitivity in a clinical validation sample of 50 children with variable loss of specificity, best overall was the delta 12 s index, a measure of baseline SpO2 variability (sensitivity 92%; specificity 63%).

Conclusions HPO screening could halve the number of children with Down syndrome needing multichannel sleep studies and reduce the burden on children, families and health services alike. This approach offers a practical universal screening approach for OSA in Down syndrome that is accessible to the non-specialist paediatrician.

Down syndrome, obstructive sleep apnoea, screening methods
0003-9888
1-6
Hill, Catherine
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Elphick, Heather
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Farquhar, Michael
ec24a05e-22e9-4e6e-81b1-6a85e6c0ccef
Gringras, Paul
c6762f07-b124-4136-8cc1-a517044ae7ef
Pickering, Ruth
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Kingshott, Ruth
d832ca93-ead4-40f4-bfe6-eef0a5580208
Evans, Hazel
7bcf2df5-0362-4456-9976-eb99f71b172f
Hill, Catherine
867cd0a0-dabc-4152-b4bf-8e9fbc0edf8d
Elphick, Heather
b52520b9-6580-4ef9-8038-2d8a07baae9a
Farquhar, Michael
ec24a05e-22e9-4e6e-81b1-6a85e6c0ccef
Gringras, Paul
c6762f07-b124-4136-8cc1-a517044ae7ef
Pickering, Ruth
4a828314-7ddf-4f96-abed-3407017d4c90
Kingshott, Ruth
d832ca93-ead4-40f4-bfe6-eef0a5580208
Evans, Hazel
7bcf2df5-0362-4456-9976-eb99f71b172f

Hill, Catherine, Elphick, Heather, Farquhar, Michael, Gringras, Paul, Pickering, Ruth, Kingshott, Ruth and Evans, Hazel (2018) Home oximetry to screen for obstructive sleep apnoea in Down syndrome. Archives of Disease in Childhood, 1-6. (doi:10.1136/archdischild-2017-314409).

Record type: Article

Abstract

Objective Children with Down syndrome are at high risk of obstructive sleep apnoea (OSA) and screening is recommended. Diagnosis of OSA should be confirmed with multichannel sleep studies. We aimed to determine whether home pulse oximetry (HPO) discriminates children at high risk of OSA, who need further diagnostic multichannel sleep studies.

Design Cross-sectional prospective study in a training sample recruited through three UK centres. Validation sample used single-centre retrospective analysis of clinical data.

Patients Children with Down syndrome aged 0.5–6 years.

Intervention Diagnostic multichannel sleep study and HPO.

Main outcome measures Sensitivity and specificity of HPO to predict moderate-to-severe OSA.

Results 161/202 children with Down syndrome met quality criteria for inclusion and 25 had OSA. In this training sample, the best HPO parameter predictors of OSA were the delta 12 s index >0.555 (sensitivity 92%, specificity 65%) and 3% oxyhaemoglobin (SpO2) desaturation index (3% ODI)>6.15 dips/hour (sensitivity 92%, specificity 63%). Combining variables (delta 12 s index, 3% ODI, mean and minimum SpO2) achieved sensitivity of 96% but reduced specificity to 52%. All predictors retained or improved sensitivity in a clinical validation sample of 50 children with variable loss of specificity, best overall was the delta 12 s index, a measure of baseline SpO2 variability (sensitivity 92%; specificity 63%).

Conclusions HPO screening could halve the number of children with Down syndrome needing multichannel sleep studies and reduce the burden on children, families and health services alike. This approach offers a practical universal screening approach for OSA in Down syndrome that is accessible to the non-specialist paediatrician.

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More information

Accepted/In Press date: 3 April 2018
e-pub ahead of print date: 14 May 2018
Keywords: Down syndrome, obstructive sleep apnoea, screening methods

Identifiers

Local EPrints ID: 419439
URI: http://eprints.soton.ac.uk/id/eprint/419439
ISSN: 0003-9888
PURE UUID: 2d7a27ad-23d6-4fb5-a899-5c2a4f09598b
ORCID for Catherine Hill: ORCID iD orcid.org/0000-0003-2372-5904

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Date deposited: 12 Apr 2018 16:30
Last modified: 17 Dec 2019 05:30

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Contributors

Author: Catherine Hill ORCID iD
Author: Heather Elphick
Author: Michael Farquhar
Author: Paul Gringras
Author: Ruth Pickering
Author: Ruth Kingshott
Author: Hazel Evans

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