Abstract
Objectives/background: Sleep laboratory polysomnography (PSG) is the
gold standard for obstructive sleep apnea (OSA) diagnosis in infants,
but its access remains limited. Another simple and widely used tool,
oximetry-capnography can provide information on the presence of
desaturations and alveolar hypoventilation. However, its reliability is
debated. This study aimed at examining its use in determining OSA
severity in infants. Patients/methods: This retrospective study was
conducted in a sleep unit in a tertiary hospital, in infants <
4 months old with clinical signs of OSA or Pierre Robin Sequence (PRS)
who underwent a one-night PSG coupled with oximetry-capnography.
Results: Among the 78 infants included (median [IQR] age: 61
[45-89] days at PSG), 44 presented with PRS, and 34 presented with
isolated airway obstruction. The clinical, sleep and respiratory
characteristics were not significantly different between the two
subgroups. In the entire cohort, 63.5% had severe OSA. Median OAHI was
14.5/h [7.4-5.9], Spo2 was 97.4% [96.5-98.1], and PtCO2 was
41.1 mmHg [38.3-44.9]. The optimal threshold to predict OAHI
> 10/h was 6/h for OD3% (sensitivity 95.7%, specificity
51.9%) and 2/h for OD4% (sensitivity 95.7%, specificity 48.1%).
Conclusion: Whereas transcutaneous capnography does not appear to be
sufficient in predicting severe OSA in infants < 4 months old
with PRS or clinical signs of OSA, oximetry may be a useful alternative
for the screening of severe OSA in infants in the absence of PSG.