The Diagnostic Accuracy of Overnight Oximetry for Pediatric Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis  
[PERSON]  
1  
1 Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, via San Vitale 59, 40125 Bologna, Italy; [EMAIL_ADDRESS] (M.L.B. ); [EMAIL_ADDRESS] (G.A.-B.) 2 School of Dentistry, University of Brescia, Spedali Civilli 1, 25121 Brescia, Italy; [PERSON].G. ); [EMAIL_ADDRESS] (C.P.) 3  
[PERSON]  
1 Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, via San Vitale 59, 40125 Bologna, Italy; [EMAIL_ADDRESS] (M.L.B. ); [EMAIL_ADDRESS] (G.A.-B.) 2 School of Dentistry, University of Brescia, Spedali Civilli 1, 25121 Brescia, Italy; [EMAIL_ADDRESS] (P.G. ); [EMAIL_ADDRESS] (C.P.) 3  
[PERSON]  
2 School of Dentistry, University of Brescia, Spedali Civilli 1, 25121 Brescia, Italy; [EMAIL_ADDRESS] (P.G. ); [EMAIL_ADDRESS] (C.P.) 3  
[PERSON]  
2 School of Dentistry, University of Brescia, Spedali Civilli 1, 25121 Brescia, Italy; [EMAIL_ADDRESS] (P.G. ); [EMAIL_ADDRESS] (C.P.) 3  
[PERSON]  
2 School of Dentistry, University of Brescia, Spedali Civilli 1, 25121 Brescia, Italy; [EMAIL_ADDRESS] (P.G. ); [EMAIL_ADDRESS] (C.P.) 3  
[PERSON]  
1 Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, via San Vitale 59, 40125 Bologna, Italy; [EMAIL_ADDRESS] (M.L.B. ); [EMAIL_ADDRESS] (G.A.-B.) 3  
Footnote 1: email: c.g.i.d. use of screening tools for pediatricic OSA when PSG is not available [3]. So far, the use of validated questionnaires [5; 6; 7; 8], single-channel recordings [9], biomarkers [10], and artificial intelligence-based methods [11] have been discussed. The sleep-related breathing disorder scale of the pediatric sleep questionnaire (SRBD-PSQ) proved to perform well as a screening method for OSA, but the diagnostic accuracy was not good enough to replace PSG [5; 6; 7]. The SRBD-PSQ has also been recommended together with overnight oximetry when PSG is not available [8]. To date, studies on biomarkers are relatively small in number and show a limited reproducibility. Thus, their overall validity for the diagnosis of pediatric OSA remains unclear [10]. Much emphasis has recently been given to the adoption of machine learning approaches to diagnose pediatric OSA, but greater efforts and larger databases are still needed to optimize their accuracy [11]. Already part of the PSG, overnight oximetry has emerged as a potential standalone method that may quickly and inexpensively suggest the presence of pediatric OSA [4; 12; 13; 14; 15; 16], thus supporting the risk stratification, identification, and appropriate management of children potentially affected by OSA. However, it is worthy to note that, at present, no consensus exists on which oximetry parameter is the most accurate. Various parameters have been adopted to classify oximetry recordings as abnormal, with additional variability arising from the different cut-offs used to define pediatric OSA [17]. A previous systematic review and meta-analysis has been focused on the diagnostic accuracy of single- or double-channel portable sleep monitors for the screening of pediatric OSA [9]. The study reported a pooled sensitivity of 74% (95% confidence interval [CI]: 66-80%) and a pooled specificity of 90% (95% CI: 85-94%) for oximetry-based statistical classifiers at a PSG-derived apnea-hypopnea index (AHI), cut-off of 5 events/h, concluding that oximetry may provide a simple and effective alternative to PSG for the diagnosis of moderate-severe pediatric OSA [9]. However, there is no systematic review and meta-analysis investigating oximetry compared with PSG for diagnosing mild to severe OSA in children in an attempt to identify a consistent criterion for detecting OSA.