Predicting night to night variability (NTNV) in obstructive sleep apnea (OSA) screening in trisomy 21 (T21)

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Background: 3-night home pulse oximetry (3NHPO) is used for OSA screening in T21 due to presumed NTNV. Aim: To establish if threshold values can be used to predict variability across 3NHPO. Methods: All children ≥12 months with T21 undergoing OSA-screening 3NHPO from April 2020-December 2024 at our centre were included. Studies with <4 hours artefact-free recording time on any night were excluded. Clinically-relevant cut-off (CRCO) values predictive of obstructive apnea hypopnea index (OAHI) ≥5 are: Oxygen Desaturation Index 3% (ODI3) ≥6.150, delta 12s index (D12) ≥0.555, calculated combined score ≥-0.5537 (Hill, C.M. et al. Arch Dis Child 2018;103(10):962-967). Combined score = -20.988+(1.408xD12)+(0.066xODI3)+(0.178xmeanSpO2)+(0.023xminimumSpO2). Cases of change (COC) were where indices fluctuated above and below these CRCO across 3 nights. Receiver-Operator Curve analysis determined threshold values either side of CRCO with optimum sensitivity and specificity to predict COC on subsequent nights. Negative (NPV) and positive predictive values (PPV) were calculated for the threshold values. Results Of 230 eligible 3NHPO, 80 had insufficient data. 150 studies were analysed from 97 patients age 1.0-17.3 years (median 6.6). NTNV was present (for each parameter, COC in 1/3). NPV for threshold values of ODI3 <3.605, D12 <0.485 and combined score <-0.8616 were 79%, 81% and 94% respectively – children below these thresholds on night 1 are unlikely to have indices predictive of OAHI ≥5 on subsequent nights. Conclusion Where only one night of oximetry data for OSA screening in a child with T21 is available, lower threshold values than established CRCO may be used to make allowance for NTNV.

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