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Nocturnal Pulse Oximetry as an Abbreviated Testing Modality for Pediatric Obstructive Sleep Apnea, Brouillette, R.T. et al. Pediatrics 2000;105:405–412. 2.
Usefulness of Pulse Transit Time in the assessment of children with Obstructive Sleep Apnoea N. J. Rowbotham, M. P. Yanney Department of Paediatrics, Sherwood Forest Hospitals Foundation Trust, Sutton in Ashfield, Nottinghamshire

Introduction Pulse oximetry is widely used to identify children with obstructive sleep apnoea (OSA) but it lacks the sensitivity of polysomnography (PSG) and fails to assess sleep disruption associated with frequent arousals.1 PSG is used for arousal detection but availability is restricted to a limited number of tertiary centres due to the high level of training and skill required to perform and interpret the test. Pulse transit time (PTT) is the time taken for the pulse pressure wave to travel from the aortic valve to the periphery and is a non-invasive marker of blood pressure which is computed from the ECG and oximetry outputs of a sleep study. It provides a quantitative measurement of arousals and inspiratory effort in patients with sleep disordered breathing. Previous studies have shown the utility of PTT to detect arousals in children with OSA but values likely to be indicative of disease have not been 2 established. Aim: to investigate if there is a correlation between PTT indices (PTT arousals, respiratory swing) and oximetry results to ascertain its usefulness or otherwise in the assessment of children with suspected OSA.

Methods A retrospective review was carried out of 176 paediatric inpatient sleep studies undertaken at a district general hospital between December 2013 and December 2014. Data was obtained from a database and patient notes. Sleep studies were carried out using Stowood Scientific Instruments Visi-3 sleep system incorporating ECG, audio, video, PTT and oximetry data. Statistical analysis was performed using an unpaired, 1-tailed students t test.

Results Our data showed an upward trend in average PTT arousals when OSA severity was determined using pulse oximetry criteria or by sleep study based diagnosis. Positive studies had an average PTT over 49/hour (Figures 1, 3 and 4). This upward trend is also the case for respiratory swing (Figures 2, 5 and 6), with positive studies having a mean respiratory swing over 24ms. There is a highly significant difference in mean PTT and respiratory swing between normal/ borderline and abnormal oximetry categories (p

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