Comparison Between Oximetry and Polysomnography in Identifying Airway Obstruction in Infants with Robin Sequence
Rafael Galli, MD.
McGill University, Montreal, QC, Canada.
Polysomnography is the gold standard for the diagnosis of obstructive apnea in infants with Robin Sequence. However, its routine use is limited by cost and availability. The purpose of our study was to determine whether night-time pulse oximetry (oximetry), an inexpensive and widely available technology, could be used as a surrogate for polysomnography in identifying obstructive apnea in infants with Robin Sequence.
We reviewed all polysomnographies done in infants with Robin Sequence treated at the Montreal Children's Hospital. We extracted the following standard data: Central Apnea Index and Mixed Obstructive Apnea Hypopnea Index (MOAHI) from polysomnography data and Desaturation Index (drops≥4%/hour, DI4%) from the oximetry done at the time of polysomnography. Symptoms of obstructive apnea were assessed with a standard questionnaire. A MOAHI≤5 was used to separate infants with no/mild obstruction from those with moderate/severe obstruction (MOAHI>5).
We reviewed 39 polysomnographies (26 infants, age: 12.2±4.8 months). Central apnea with a mild decrease in oxygenation was a frequent occurrence. All infants with a DI4%<7 events/hour (22 studies) and no significant snoring had no or mild obstructive apnea on polysomnography. In patients with DI4%>7 events/hour, 53% had moderate or severe obstruction (Fig. 1). In the remaining infants, central events with desaturation predominated.
In Robin Sequence, oximetry can identify those infants with no or mild obstructive apnea thereby decreasing the demand for polysomnography. With a DI4%>7 events/hour, polysomnography is required to differentiate between obstructive and central events.
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