0516 Evaluating the Reliability of Pulse Oximetry for Detecting Respiratory Events in Pediatric Obstructive Sleep Apnea

Abstract Introduction Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder in children, characterized by recurrent upper-airway obstruction, intermittent hypoxemia, and disrupted sleep architecture. Pulse oximetry is widely used as a noninvasive tool to detect oxygen desaturation events associated with OSA, but its reliability varies across devices, signal quality, and patient populations. Understanding its performance in pediatric cohorts is particularly important, as children demonstrate distinct respiratory patterns and physiologic responses compared to adults. Methods To evaluate the reliability of pulse oximetry, we are conducting a clinical sleep study enrolling children aged 3–12 years with and without OSA. Participants undergo overnight, attended polysomnography (PSG) using a full montage that includes electroencephalography (EEG), electrooculography (EOG), electromyography (EMG), airflow measurement via nasal pressure transducer and thermistor, thoracoabdominal respiratory effort belts placed at the chest and abdomen, electrocardiography (ECG), a snoring microphone, body position sensors, and continuous pulse oximetry for oxygen saturation (SpO₂) and plethysmographic signal monitoring. In this ongoing study, we are examining the relationship between deoxygenation events and the magnitude and duration of decreased respiratory effort throughout the night. Results We have consented 84 children (mean age = 8.4 ± 2.4 years) and have completed sleep studies on 75 of them. Among these participants, 38 children have OSA. The mean apnea–hypopnea index (AHI) for all 75 children is 4.4 ± 3.4 events per hour. Our preliminary analysis shows that there are multiple events during the night with substantial decreases in respiratory effort, yet no corresponding change is observed in SpO₂. Conclusion Our preliminary findings suggest that significant reductions in respiratory effort may occur without corresponding oxygen desaturation in many pediatric sleep events. These results highlight limitations of relying solely on pulse oximetry to detect clinically relevant respiratory disturbances in children. Support (if any) This research was supported by the Intramural Research Program of the National Institutes of Health (NIH), including the NICHD and NIMH