Screening severe obstructive sleep apnea in children with snoring

Hui Shan Hsieh, Chung Jan Kang, Hai Hua Chuang, Ming Ying Zhuo, Guo She Lee, Yu Shu Huang, Li Pang Chuang, Terry B.J. Kuo, Cheryl C.H. Yang, Li Ang Lee*, Hsueh Yu Li*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

8 Scopus citations


Efficient screening for severe obstructive sleep apnea (OSA) is important for children with snoring before time-consuming standard polysomnography. This retrospective cross-sectional study aimed to compare clinical variables, home snoring sound analysis, and home sleep pulse oximetry on their predictive performance in screening severe OSA among children who habitually snored. Study 1 included 9 (23%) girls and 30 (77%) boys (median age of 9 years). Using univariate logistic regression models, 3% oxygen desaturation index (ODI3) ≥ 6.0 events/h, adenoidal-nasopharyngeal ratio (ANR) ≥ 0.78, tonsil size = 4, and snoring sound energy of 801–1000 Hz ≥ 22.0 dB significantly predicted severe OSA in descending order of odds ratio. Multivariate analysis showed that ODI3 ≥ 6.0 events/h independently predicted severe pediatric OSA. Among several predictive models, the combination of ODI3, tonsil size, and ANR more optimally screened for severe OSA with a sensitivity of 91% and a specificity of 94%. In Study 2 (27 (27%) girls and 73 (73%) boys; median age, 7 years), this model was externally validated to predict severe OSA with an accuracy of 76%. Our results suggested that home sleep pulse oximetry, combined with ANR, can screen for severe OSA more optimally than ANR and tonsil size among children with snoring.

Original languageEnglish
Article number1168
Issue number7
StatePublished - 07 2021

Bibliographical note

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • Adenoidal-nasopharyngeal ratio
  • Children
  • Obstructive sleep apnea
  • Oxygen desaturation index
  • Snoring sound energy
  • Tonsil size


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