1. Date of download: 6/21/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Testing for Pediatric Obstructive Sleep Apnea When Health Care Resources Are Rationed JAMA Otolaryngol Head Neck Surg. 2014;140(7):616-623. doi:10.1001/jamaoto.2014.778 Representative Pulse Oximetry Tracings From Children in Our Study Cohort Illustrating McGill Oximetry Scores (MOS) 1 Through 4Representative overnight pulse oximetry trend graphs from children in our study cohort evaluated for suspected obstructive sleep apnea (OSA). MOS 1 is inconclusive, neither ruling in nor ruling out OSA. MOS 2, 3, and 4 indicate abnormal oximetry, with progressively more severe OSA associated with clusters of desaturation and repetitive dips in oxyhemoglobin saturation (oxygen saturation) measured by pulse oximetry to less than 90%, 85%, and 80%, respectively. (See the Pulse Oximetry subsection and Nixon et al for additional details about grading oximetry using the MOS.) Figure Legend:

2. Date of download: 6/21/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Testing for Pediatric Obstructive Sleep Apnea When Health Care Resources Are Rationed JAMA Otolaryngol Head Neck Surg. 2014;140(7):616-623. doi:10.1001/jamaoto.2014.778 Clinical Course of a Cohort of Children Evaluated for Suspected Obstructive Sleep Apnea (OSA) Following the Montreal Children’s Hospital’s McGill Oximetry Score (MOS)-Based Diagnostic ApproachThe clinical pathway followed by patients in our study cohort, starting with the results of initial oximetry testing, and subsequent medical testing and/or surgical intervention. PSG indicates polysomnography; TA, adenotonsillectomy. Figure Legend:

3. Date of download: 6/21/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Testing for Pediatric Obstructive Sleep Apnea When Health Care Resources Are Rationed JAMA Otolaryngol Head Neck Surg. 2014;140(7):616-623. doi:10.1001/jamaoto.2014.778 Theoretical Estimated Costs to Evaluate 1000 Children for Possible Obstructive Sleep Apnea (OSA) Using 4 Different Diagnostic ApproachesThe estimated cost to evaluate 1000 children for OSA using oximetry and/or polysomnography (PSG) assuming $100 and $1000 for oximetry and PSG, respectively. The horizontal line indicates the cost to evaluate all children with PSG alone ($1 000 000); point A, the cost to evaluate all children with oximetry alone ($100 000); point B, the cost to evaluate all children with oximetry and 9.1% with PSG, as in the current series ($191 000); point C, the cost would be less than that for the PSG-for-all option if less than 90% of children proceed to PSG; point D, cost to evaluate if all children with inconclusive oximetry results in a proportion similar to the current series (73%) proceed to PSG ($830 000). Figure Legend: