Clinically significant night-to-night variability in overnight oximetry screening for obstructive sleep apnoea in children with Down syndrome: a retrospective review of screening data.

Authors

Alison J B Garde, Jonathan Wen Yi Ong, Zara Howarth, Jonathan James, Thomas L Wilkinson, Ho Ming Yuen, Catherine M Hill, Hazel J Evans

Published in

Archives of disease in childhood. Sep 08, 2026. Epub Sep 08, 2026.

Abstract

To understand the extent and implications of night-to-night variability (NTNV) in obstructive sleep apnoea (OSA) screening for children with Down syndrome (DS).
Retrospective review of outpatient OSA screening data, assessing NTNV across three consecutive nights of pulse oximetry (3NPO) studies and comparing results of screening oximetry and diagnostic polygraphy (PG). Two hundred and forty-six 3NPO studies in patients aged 1 to <18 years with DS at University Hospital Southampton NHS Foundation Trust between April 2020 and December 2024 were included. Clinically significant NTNV was defined as results above and below the published screening thresholds predictive of moderate-to-severe OSA in children with DS (3% oxygen desaturation index (ODI3) ≥6.15 and delta index (D12s) ≥0.555) on nights within the same 3NPO study. Receiver operating characteristic curve analysis was used to identify optimal lower reassurance threshold values to account for NTNV.
Fifty-three per cent of the 150 complete 3NPO studies showed clinically significant NTNV. Children with night 1 results below the reassurance thresholds ODI3 3.61 (n=19) and D12s 0.49 (n=64) had a low chance of abnormal result on subsequent nights (negative predictive value 79% and 81%, respectively). Eighty-seven per cent of night 1 oximetry data fell above these thresholds. Sixty per cent of PG studies showed OSA. Seventy-six per cent of moderate-to-severe OSA was in children aged >6 years.
Clinically significant NTNV was seen in the majority of 3NPO studies. Single-night screening may miss children who would screen positive on multiple-night testing. UK screening recommendations may need revision to reflect NTNV and significant OSA prevalence in older children.

PMID:
42711093
Bibliographic data and abstract were imported from PubMed on 09 Sep 2026.

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