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Scott E. Brietzke, MD, MPH; Eliot S. Katz, MD; David W. Roberson, MD

Arch Otolaryngol Head Neck Surg. 2007;133(10):980-984.

Objectives  To evaluate a noninvasive measure of arousal, the pulse transit time (PTT), as a screening tool for obstructive sleep apnea/hypopnea syndrome (OSAHS) in an unselected population of symptomatic children, compared with overnight polysomnography (PSG). A secondary objective included comparing the diagnostic performance of PTT with continuous pulse oximetry recorded during PSG.

Design  Prospective, blinded diagnostic comparison study using the gold standard of overnight PSG.

Setting  Tertiary-care children's hospital sleep laboratory.

Patients  An unselected, volunteer sample of 59 patients (mean age, 7.8 years) with and without adenotonsillar tissue undergoing PSG and simultaneous PTT, including patients with obesity and craniofacial syndromes.

Main Outcome Measures  The relationship between the PTT and polysomnographic measures of OSAHS to include pulse oximetry using correlation coefficients and receiver operating characteristic curve analysis.

Results  The correlation coefficient between the PTT arousal index and PSG apnea-hypopnea index (AHI) was 0.70 (P < .001). Linear regression resulted in a good fit (R² = 0.73) between PTT arousal index and AHI. With the use of an AHI of 1 or greater (35.6% prevalence of OSAHS) as a criteria for OSAHS, the area under the receiver operating characteristic curve was 0.86 (95% confidence interval, 0.76-0.96). The optimal PTT arousal index threshold was 5.4 events per hour, which translated into a sensitivity of 81% and a specificity of 76%.

Conclusions  The PTT arousal index is highly correlated with the PSG-derived AHI and demonstrated excellent diagnostic utility for moderate and severe OSAHS. However, for mild OSAHS, PTT was barely adequate and did not significantly outperform pulse oximetry. Pulse transit time may be a useful tool to evaluate moderate to severe sleep-related breathing disorders in children.

Author Affiliations: Department of Otolaryngology, Walter Reed Army Medical Center, Washington, DC (Dr Brietzke); and Departments of Pediatric Pulmonology (Dr Katz) and Otolaryngology–Communication Disorders (Dr Roberson), Children's Hospital Boston, Boston, Massachusetts.