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. 2025 Aug-Sep:245:108200.
doi: 10.1016/j.rmed.2025.108200. Epub 2025 Jun 5.

Nocturnal oximetry in infants: Reference values and diagnostic accuracy for upper airway obstruction

Anastasios-Panagiotis Chantzaras  1 , Maria Eleni Liagkaki  1 , Angeliki Moudaki  1 , Anna Del Colle  2 , Sanae Makhout  3 , Alexa R Leitman  4 , Renato Cutrera  2 , Refika Ersu  5 , Annelies Van Eyck  3 , Sherri L Katz  5 , Stijn Verhulst  3 , Elisabetta Verrillo  2 , Athanasios G Kaditis  6
Affiliations

Nocturnal oximetry in infants: Reference values and diagnostic accuracy for upper airway obstruction

Anastasios-Panagiotis Chantzaras et al. Respir Med. 2025 Aug-Sep.

Abstract

Objective: To present reference data for nocturnal oximetry (NOx) in infants without respiratory disorders and evaluate their diagnostic accuracy for distinguishing moderate-to-severe upper airway obstruction (UAO) from mild/no UAO.

Materials and methods: Infants (aged 1-12 months) without respiratory disease hospitalized for common disorders (e.g. gastroenteritis) underwent NOx (reference). Infants with and without UAO who had NOx were included as validation group. Abnormal basal SpO2 (<10th percentile for age), oxygen desaturation (≥3 %) index (ODI3) (>90th percentile), cumulative nocturnal hypoxemia score (>90th percentile) and McGill oximetry score (MOS) (>1) were assessed as predictors of UAO requiring intervention (moderate-to-severe UAO).

Results: Of 187 infants without respiratory disorder and with NOx, 138 (73.8 %) had acceptable tracings. Basal SpO2 was not age-related (P = .877; 10th percentile >95 %), while ODI3 and cumulative nocturnal hypoxemia score decreased with age (P < .001). MOS>1 likelihood diminished with age (OR 0.72 [0.59-0.86]; P < .001). For reference validation, 20 infants without respiratory disorder underwent NOx, and NOx of 77 infants with UAO were analyzed retrospectively (32.5 % required intervention post-NOx). Although NOx parameters values in UAO and reference groups partially overlapped, abnormal ODI3, cumulative nocturnal hypoxemia score and MOS were associated with increased odds of moderate-to-severe UAO (OR [95 %CI]: 5.33 [1.93-14.71] for ODI3-10s (≥10s desaturation duration); 3.57 [1.27-9.99]; and 5.98 [1.82-19.69], respectively). MOS>1 outweighed ODI3-10s in sensitivity for moderate-to-severe UAO detection (80.0 % [95 %CI: 60.9 %-91.1 %) vs. 52.0 % [95 %CI: 32.4 %-71.6 %]; P = .040).

Conclusion: Frequent desaturations are common in infants with UAO, but also in those without respiratory disorder. Clusters of desaturations (MOS>1) represent an acceptable index of moderate-to-severe UAO.

Keywords: Central sleep apnea; Nocturnal hypoxemia; Obstructive sleep apnea; Sleep-disordered breathing.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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