Comparison of home oximetry monitoring with laboratory polysomnography in children.

Abstract

STUDY OBJECTIVES: To measure the accuracy and reliability of a portable home oximetry monitor with an automated analysis for the diagnosis of obstructive sleep apnea (OSA) in children. DESIGN: Prospective cohort study. SETTING: Alberta Lung Association Sleep Center, Alberta Children's Hospital Sleep Clinic. STUDY SUBJECTS: Consecutive, otherwise healthy children, aged 4 to 18 years, presenting to the Pediatric Sleep Service at the Alberta Children's Hospital for assessment of possible OSA. INTERVENTIONS: All subjects underwent 2 nights of monitoring in the home with an oximetry-based portable monitor with an automatic internal scoring algorithm. A third night of monitoring was done simultaneously with computerized laboratory polysomnography according to American Thoracic Society guidelines. MEASUREMENTS AND RESULTS: Both test-retest reliability of the portable monitor-based desaturation index (DI) between 2 nights at home and between laboratory and home were high using the Bland and Altman analysis (mean agreement, 0.32 and 0.64; limits of agreement, - 8.00 to 8.64 and - 0.75 to 6.50, respectively). The polysomnographic apnea-hypopnea index (AHI) agreed poorly with the portable monitor DI (mean difference, 1.27; limits of agreement, - 12.02 to 15.02). The sensitivity and specificity of the monitor for the identification of moderate sleep apnea (polysomnography AHI > 5/h) were 67% and 60%, respectively. CONCLUSION: Portable monitoring based only on oximetry alone is not adequate for the identification of OSA in otherwise healthy children.