Overnight oximetry for evaluating paediatric obstructive sleep apnoea: Technical specifications and interpretation guidelines

Abstract

The Australasian Sleep Association would like to draw readers' attention to new guidelines on the performance and interpretation of overnight oximetry for obstructive sleep apnoea (OSA) in children. OSA is a complex disorder comprising intermittent airflow obstruction during sleep, physiological abnormalities, sleep disturbance and a range of health consequences. It is estimated to affect 1–3% of otherwise healthy children and is far more common in at-risk populations. Despite its commonality and impact, non-specific symptoms, confinement to sleep and overlap with simple primary snoring make accurate clinical diagnosis challenging. The gold standard diagnostic test, polysomnography, is resource intensive limiting availability. As a result both under and over-diagnosis and therefore treatment are common. The overnight oximetry study, a high-resolution continuous recording of peripheral oxygen saturations, is a useful tool in the assessment of children suspected of OSA. It is simpler to perform, easier to achieve in the community, readily repeatable and relatively inexpensive. It can have roles in diagnosis, triaging and risk assessment. Equally it has significant limitations with lower sensitivity and specificity than polysomnography especially when used in contexts or populations it has not been validated for. Like all tools, users must understand when to use it, how to use it, and how to interpret the results. The Australasian Sleep Association has recently published a technical standard for the performance of overnight oximetry in this context together with clinical guidelines for their interpretation that may be found here: https://www.sleep.org.au/professional-resources/sleep-documents/overnight-oximetry-for-evaluating-paediatric-obstructive-sleep-apnoea---technical-specifications-and-interpretation-guidelines. Worked examples: The guideline includes multiple worked examples as an appendix. The Australasian Sleep Association expects that this standard will aid the consistent performance and interpretation of oximetry in the paediatric Australasian populace. While it represents a practical view of the state of the art, further progress is anticipated in terms of automated reporting and limited channel studies.