Pulse oximetry can be used to monitor a child with obstructive sleep apnea associated with hypertrophic tonsils and adenoids. The McGill Oximetry Scoring System can be used to grade he severity of the apnea and to recommend the optimum therapy for the child. The authors are from Montreal, Canada.
Procedure: The child is connected to a pulse oximeter that monitors the child's oxygen saturation during sleep, looking for episodes with desaturation events.
Baseline: stable oxygen saturation > 95%
Parameters:
(1) number of episodes with oxygen saturation dropping to 85-89% (A)
(2) number of episodes with oxygen saturation dropping to 80-84% (B)
(3) number of episodes with oxygen saturation dropping to < 80% (C)
Drops in Oxygen Saturation
Oximetry Score
Oximetry Grade
AND(1-2 A, 0 B, 0 C)
1
inconclusive
AND(A + B >= 3, 0-3 B, 0 C)
2
mild OSA
OR(1-3 C, B > 3)
3
moderate OSA
> 3 C
4
severe OSA
Oximetry Grade
Management Recommendations
inconclusive
additional evaluation of breathing during sleep required to rule out obstructive sleep apnea
mild OSA
adenotonsillectomy as elective procedure
moderate OSA
adenotonsillectomy within 2 weeks
severe OSA
adenotonsillectomy as urgent surgery (within 1-2 days)
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