Pediatric snoring, enlarged tonsils: oximetry identifies surgical candidates

  • Papadakis CE & al.
  • Pediatrics
  • 7 Aug 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Overnight oximetry for children with sleep-disordered breathing (SDB) can predict ability of adenotonsillectomy (T/A) to resolve hypoxemia.

Why this matters

  • For evaluating children with SDB, oximetry is cheaper, easier, and more widely available than gold-standard polysomnography.

Study design

  • CHANIA: prospective randomized controlled single-blind parallel-group trial.
  • Participants: 140 children aged 4-10 years with snoring, adenotonsillar hypertrophy.
  • All were T/A candidates at a Greek regional hospital. 
  • Participants randomly assigned to overnight oximetry:
    • Just before and 3 months after T/A; or
    • At baseline and after 3 months awaiting surgery (control).
  • Outcomes were proportions of patients:
    • With baseline McGill Oximetry Score (MOS; proxy for apnea-hypopnea index) >1 achieving 1 at follow-up; and
    • With baseline ≥3.5 episodes/hour of oxygen desaturation of Hb index (ODI) achieving
  • Funding: None.

Key results

  • With MOS >1 at baseline: 
    • MOS of 1 achieved in 12/17 (70.6%) in the T/A group vs
    • 10/21 (47.6%) in control group (P=.14).
  • Among children with ODI ≥3.5 at baseline:
    • ODI
    • OR, 14.0 (95% CI, 2.9-68.4; P<.001>
  • Number needed to treat to prevent abnormal follow-up ODI: 3.

Limitations

  • Small single-center study.
  • Many unsatisfactory oximetry readings.

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