{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T21:30:46Z","timestamp":1778621446872,"version":"3.51.4"},"reference-count":66,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,6,26]],"date-time":"2021-06-26T00:00:00Z","timestamp":1624665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chang Gung Medical Foundation,","award":["CMRPG3F1091\u20133 and CMRPG3J1701 (L.-A.L.)"],"award-info":[{"award-number":["CMRPG3F1091\u20133 and CMRPG3J1701 (L.-A.L.)"]}]},{"name":"Chang Gung Medical Foundation","award":["CMRPG3D0771 (H.-Y.L.)."],"award-info":[{"award-number":["CMRPG3D0771 (H.-Y.L.)."]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Efficient screening for severe obstructive sleep apnea (OSA) is important for children with snoring before time-consuming standard polysomnography. This retrospective cross-sectional study aimed to compare clinical variables, home snoring sound analysis, and home sleep pulse oximetry on their predictive performance in screening severe OSA among children who habitually snored. Study 1 included 9 (23%) girls and 30 (77%) boys (median age of 9 years). Using univariate logistic regression models, 3% oxygen desaturation index (ODI3) \u2265 6.0 events\/h, adenoidal-nasopharyngeal ratio (ANR) \u2265 0.78, tonsil size = 4, and snoring sound energy of 801\u20131000 Hz \u2265 22.0 dB significantly predicted severe OSA in descending order of odds ratio. Multivariate analysis showed that ODI3 \u2265 6.0 events\/h independently predicted severe pediatric OSA. Among several predictive models, the combination of ODI3, tonsil size, and ANR more optimally screened for severe OSA with a sensitivity of 91% and a specificity of 94%. In Study 2 (27 (27%) girls and 73 (73%) boys; median age, 7 years), this model was externally validated to predict severe OSA with an accuracy of 76%. Our results suggested that home sleep pulse oximetry, combined with ANR, can screen for severe OSA more optimally than ANR and tonsil size among children with snoring.<\/jats:p>","DOI":"10.3390\/diagnostics11071168","type":"journal-article","created":{"date-parts":[[2021,6,27]],"date-time":"2021-06-27T22:24:57Z","timestamp":1624832697000},"page":"1168","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Screening Severe Obstructive Sleep Apnea in Children with Snoring"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4181-9798","authenticated-orcid":false,"given":"Hui-Shan","family":"Hsieh","sequence":"first","affiliation":[{"name":"Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"},{"name":"Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen 361126, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chung-Jan","family":"Kang","sequence":"additional","affiliation":[{"name":"Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"},{"name":"Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen 361126, China"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7394-4016","authenticated-orcid":false,"given":"Hai-Hua","family":"Chuang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Department of Family Medicine, Chang Gung Memorial Hospital, Taipei Branch & Linkou Main Branch, Taoyuan 33305, Taiwan"},{"name":"Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 106344, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Ying","family":"Zhuo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen 361126, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guo-She","family":"Lee","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"},{"name":"Department of Otolaryngology, Taipei City Hospital, Ren-Ai Branch, Taipei 10629, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4015-5942","authenticated-orcid":false,"given":"Yu-Shu","family":"Huang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Sleep Center, Department of Child Psychiatry, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5466-8995","authenticated-orcid":false,"given":"Li-Pang","family":"Chuang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry B.-J.","family":"Kuo","sequence":"additional","affiliation":[{"name":"Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl C.-H.","family":"Yang","sequence":"additional","affiliation":[{"name":"Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-595X","authenticated-orcid":false,"given":"Li-Ang","family":"Lee","sequence":"additional","affiliation":[{"name":"Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"},{"name":"Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen 361126, China"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsueh-Yu","family":"Li","sequence":"additional","affiliation":[{"name":"Sleep Center, Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 33302, 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