Chest
Volume 123, Issue 1, January 2003, Pages 96-101
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Clinical Investigations
Sleep and Breathing
Reference Values for Nocturnal Home Pulse Oximetry During Sleep in Primary School Children

https://doi.org/10.1378/chest.123.1.96Get rights and content

Objective

To provide reference values for pulse oximeter saturation (Spo2) in primary school children, measured at home during sleep.

Methods

Recordings of Spo2 and signal quality from 100 children were randomly selected from a larger population-based sample intended to study the prevalence of sleep-disordered breathing. Recordings were analyzed for the duration of artifact-free recording time (AFRT), minimum Spo2 (SATmin) and median Spo2 (SAT50), the Spo2 below which the child spent 5% of AFRT (SAT5), and the Spo2 below which the child spent 10% of AFRT (SAT10). In addition, the time in seconds with Spo2 ≤ 90% per hour of AFRT (TI90) was calculated, as were the number of falls in Spo2 by ≥ 4% per hour of AFRT (DI4), the number of falls in Spo2 to ≤ 90% per hour of AFRT (DI90), and the number of falls in Spo2 to ≤ 92% per hour of AFRT (DI92).

Results

Ten recordings had to be excluded because of insufficient AFRT (< 5 h). Mean age of the remaining 90 children (54 girls) was 9.3 years (SD, 0.6). Median (range; fifth centile) values for SATmin, SAT5, SAT10, and SAT50 were 93% (76 to 97; 87.5), 97% (88 to 99; 95), 97% (89 to 99; 96), and 98% (94 to 100; 97). Median values (range; 95th centile) for Ti90, DI4, DI90, and DI92 were 0.0 s (0.0 to 5.8; 1.6), 0.8 (0.0 to 6.1; 3.9), 0.0 (0.0 to 1.2; 0.2), and 0.0 (0.0 to 2.0; 0.6).

Conclusion

Baseline Spo2 values < 97% were uncommon in these children, as were intermittent desaturations to ≤ 90%. These data may serve as a basis for the interpretation of clinical recordings of Spo2 in children referred for sleep-related breathing disorders.

Section snippets

Subject Recruitment

Twenty-seven of the 59 regular primary schools located within the city limits of Hannover, Germany, were selected at random within strata of socioeconomic status (ie, the percentage of pupils from low-income families). Eleven of the selected schools were contacted between February 2001 and May 2001, and all children attending third grade were identified. With institutional review board approval, parental informed consent and child assent were obtained. Of the 739 children attending third grade,

Results

All recordings contained analyzable data, but 10 recordings (10%; seven of these were from boys) had to be excluded because of insufficient (< 5 h) recording time. The remaining recordings were from 54 girls and 36 boys studied at a mean age of 9.3 years (SD, 0.6). Mean height was 137.5 cm (SD, 6.6), mean weight was 31.8 kg (SD, 5.9), and mean body mass index was 16.7 (SD, 2.3). Mean TRT was 591.2 min (SD, 61.3), with an AFRT of 578.3 min (SD, 63.8), ie, 97.4% (SD, 6.1) of recording time was

Discussion

Using new-generation, motion-resistant pulse oximetry and sophisticated methods to exclude spuriously low Spo2 values without having to analyze the pulse waveform signal throughout, we determined baseline Spo2 and the frequency of intermittent falls in Spo2 (desaturations) in a group of primary school children. Our subject recruitment and selection procedures enabled us to establish population-based reference values for NHPO recordings in this age group. We found that average Spo2 was

ACKNOWLEDGMENT

The authors thank Dr. Ehrhardt (Department of Public Health, City Council, Hannover, Germany), Mrs. Martinsen (Supervisory School Authority, Hannover, Germany), Mr. Hegemann (District Government, Hannover, Germany), and the headmasters and teachers of the participating schools for their support and cooperation. Our thanks also go to E. Fiege and A. Guenther for their help with obtaining the recordings, R. Downes (Getemed AG; Teltow, Germany) for technical assistance, and particularly to the

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Mrs. Urschitz-Duprat was supported by a research grant from the Hans Meineke Foundation, Hannover, Germany.

Oximeter sensors were provided by Masimo Corporation, Irvine, CA.

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