Utility of overnight oximetry indices in the evaluation of children with snoring and suspected obstructive sleep apnea.

Study Objectives: Optimal cutoff values of oximetry indices that differentiate obstructive sleep apnea (OSA) from primary snoring (PS) are not well-established. Our study aimed to assess the utility of overnight oximetry indices in differentiating PS from OSA and assessing OSA severity, compared to polysomnography, in children with suspected OSA.
Methods: This was a retrospective study of children (1-18 years of age) with snoring who underwent polysomnography. Patients with Down syndrome, craniofacial anomalies, known genetic syndromes, neuromuscular conditions, or a central apnea index ≥ 5 were excluded. Demographic data, polysomnography variables, and oximetry indices (eg, oxygen desaturation index [ODI ₃ , defined as number of ≥ 3% desaturation episodes/h of artifact-free recording time, and SpO ₂ nadir]) were collected.
Results: Of 1,203 children (mean age 9.1 ± 3.9 years, 67.7% males), 91.8% (847/923) ≤ 12 years and 84.3% (236/280) > 12 years of age had OSA. The optimal cutoff of ODI ₃ for differentiating PS from OSA was 2.4 (sensitivity [Se]: 78.8% [75.9-81.6%]; specificity [Sp]: 80.5% [69.9-88.7%]) in children ≤ 12 years of age and 3.6 (Se: 71.1% [64.8-76.8%]; Sp: 91.1% [78.8-97.5%]) in children > 12 years of age. The optimal cutoffs of ODI ₃ for differentiating PS from mild, moderate, and severe OSA categories were 2.0 (Se: 70.1% [65.3-74.5%]; Sp: 70.1% [58.6-80.0%]), 3.7 (Se: 82.3% [76.6-87.1%]; Sp: 94.8% [87.2-98.6%]), and 4.3 (Se: 99.1% [96.8-99.9%]; Sp: 98.7% [93.0-100.0%]) in children ≤ 12 years of age and 1.9 (Se: 78.8% [75.9-81.6%]; Sp: 80.5% [69.9-88.7%]), 4.1 (Se: 85.4% [72.2-93.9%]; Sp: 91.1% [78.8-97.5%]), and 6.9 (Se: 98.4% [91.2-100.0%]; Sp: 97.8% [88.2-99.9%]) in children > 12 years of age, respectively.
Conclusions: This study provides optimal cutoff values for ODI ₃ in differentiating PS from OSA and assessing OSA severity in children. Because oximetry is cheaper and widely available, ODI ₃ has the potential to be incorporated into cost-effective clinical decision-making algorithms, especially in resource-limited settings.
Citation: Koh YQ, Sultana R, Pugalenthi A, et al. Utility of overnight oximetry indices in the evaluation of children with snoring and suspected obstructive sleep apnea. J Clin Sleep Med. 2025;21(1):109-121.
(© 2025 American Academy of Sleep Medicine.)