• Justine Bradley, Barbara C Galland, Jessie P Bakker, Evan Tan, Andrew Gray, Barry J Taylor, and Patrick J D Dawes.
• Division of Surgical Sciences, Department of Otorhinolaryngology–Head and Neck Surgery, University of Otago, Dunedin, New Zealand.
• Arch. Otolaryngol. Head Neck Surg. 2012 Apr 1;138(4):398-403.

ObjectivesTo compare nocturnal polysomnography (PSG) with pulse transit time (PTT) recordings and structured clinical assessments and assess the reliability of these methods as a surrogate for the apnea-hypopnea index (AHI; calculated as the number of apneas/hypopneas per hour of total sleep time) and to test the associations between the clinical assessments and sleep disordered breathing (SDB).DesignProspective observational study. The parents of 51 children and adolescents filled out a questionnaire on SDB and the participants underwent examination. Scores from questionnaire and examination items were weighted according to their association with SDB. A total clinical score was assigned combining questionnaire and examination scores.SettingHospital pediatrics department.PatientsChildren and adolescents aged 5 to 17 years undergoing standard PSG with the addition of PTT as part of a clinical investigation for SDB.Main Outcome MeasuresThe AHI and associations between the AHI and PTT arousal index (PTT-AI) and questionnaire, examination, and total clinical scores.ResultsWe found a significant correlation between the AHI and PTT-AI (r = 0.55; P < .001). The relationship between the AHI and PTT-AI was stronger when the AHI was greater than 3. We also found significant correlations between the PTT-AI and the total clinical score (r = 0.38; P = .008) and the examination score (r = 0.44; P = .002) but not the questionnaire score (r = 0.23; P = .12). There was an association between the AHI and examination score in particular when the AHI was greater than 3.ConclusionsPulse transit time shows promise as a screening test for SDB associated with an AHI greater than 3. For less severe SDB, the validity of using the PTT to separate these conditions from primary snoring has not been demonstrated in a clinical setting.

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