Can Nocturnal Oximetry Parameters Differentiate Infants Without and With Upper Airway Obstruction?

Nocturnal oximetry results represent one of 3 facets describing sleep-disordered breathing (SDB) severity in infancy, the other 2 being exam/DISE findings and caregiver sleep concerns. We speculated that oxygen desaturation (>=3%) index (ODI3) and/or McGill oximetry score (MOS) can discriminate infants with clinically apparent upper airway obstruction (UAO) from those without (controls). <bold>Methods:</bold> ODI3 values in 1-12 m.o. infants with UAO or controls were compared to published age-adjusted, upper reference ODI3 values <italic>(Kaditis and Gozal. Children 2022)</italic>. Sensitivity, specificity, PPV and NPV of abnormal ODI3 and MOS>1 for UAO were calculated. <bold>Results:</bold> Data from 20 infants with UAO (Apert syndrome;choanal atresia; hypoplastic mandible/Robin sequence; laryngomalacia), median age 2.2 m (1.1-7.3) and median ODI3 13.3/h (0.9-38.8) and from 88 controls (age 3.5 m;1-12.2) (Table 1) were analyzed. <bold>TABLE 1.</bold> <table-wrap><object-id>erj;64/suppl_68/PA1361/TB1</object-id><object-id>T1</object-id><object-id>TB1</object-id><table><colgroup><col></col><col></col><col></col><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td> <bold>Controls:Age subgroups</bold> </td><td> <bold>1-2 mo</bold> <bold>(n=39)</bold> </td><td> <bold>3-4 mo</bold> <bold>(n=15)</bold> </td><td> <bold>5-6 m</bold> <bold>(n=16)</bold> </td><td> <bold>7-8 m</bold> <bold>(n=6)</bold> </td><td> <bold>9-10 m</bold> <bold>(n=7)</bold> </td><td> <bold>11-12 m</bold> <bold>(n=5)</bold> </td></tr><tr><td> <bold>ODI3 values in controls: median (10th-90th percentile)</bold> </td><td> 6.7 (1.9-14.4) </td><td> 5.3 (2.7-15.3) </td><td> 4.2 (2-10.8) </td><td> 6 (0.9-7) </td><td> 4.2 (1.1-6.9) </td><td> 4.3 (0.9-5.8) </td></tr></tbody></table></table-wrap> 5 of 20 (25%) infants with UAO had abnormal ODI3, 15 of 20 (75%) MOS>1 and 5 of 20 (25%) both abnormal ODI3 and MOS (kappa 0.158-weak). MOS>1 but not abnormal ODI3 has modest sensitivity and adequate NPV for detecting UAO (Table 2). <bold>TABLE 2.</bold> <table-wrap><object-id>erj;64/suppl_68/PA1361/TB2</object-id><object-id>T2</object-id><object-id>TB2</object-id><table><colgroup><col></col><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td></td><td><bold>Sensitivity</bold></td><td><bold>Specificity</bold></td><td><bold>PPV</bold></td><td><bold>NPV</bold></td></tr><tr><td><bold>Abnormal ODI3</bold></td><td>5/20 (25%)</td><td>88/88 (100%)</td><td>5/5 (100%)</td><td>88/103 (85.4%)</td></tr><tr><td><bold>Abnormal MOS</bold></td><td>15/20 (75%)</td><td>64/88 (72.7%)</td><td>15/39 (38.5%)</td><td>64/69 (92.8%)</td></tr></tbody></table></table-wrap> <bold>Conclusion:</bold> To assess UAO severity in infancy, oximetry results should be interpreted in the context of exam/DISE findings and caregiver reported sleep concerns.