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Accuracy of nocturnal pulse oximetry (NPO) is paramount to the diagnosis of paediatric sleep disordered breathing (SDB). Oxygen saturation (SpO2) measurements can vary depending on the device and sensor type. Masimo device SpO2 values are within +/-2% of arterial blood gas measurements (McDermott, 2023) and demonstrate improved accuracy in cases of severe hypoxia or motion artifacts compared to Nonin (Elron et al., 2023). Radiometer devices, such as the TCM5 utilise reflectance sensors and rarely outperform Masimo or Nonin in terms of accuracy, such as during sleep or in the presence of motion (Emdin et al., 2015). We aimed to compare SpO2 measures (mean, ≥3% desaturation index (ODI), Nadir) from the three NPO devices in our heterogenous paediatric population.We recorded NPO in children (4 months – 18 years) referred to Great Ormond Street Hospital for a diagnostic cardiorespiratory sleep study between 10/2020 – 09/2021, using three devices simultaneously. Masimo Rad-97® with Masimo single-use wrap sensor (applied to toe), Nonin PureLight® reusable FlexSensor as part of the Natus® Embla® NDx system (applied to toe), and Radiometer Ltd TCM5 with Sensor 92 reflectance sensor (applied to forehead) were used. Stowood Ltd Visi-Download software was used to analyse Masimo and Radiometer data. Natus® Embla® Remlogic was used for Nonin. An estimated total sleep time with ≥6 hours of recording with good signal quality was required.Simultaneous NPO was achieved in 57 children. Mean±SD age was 7.4±4.5 years, 33 (58%) were male, and 33 (58%) had comorbidity. Friedman test revealed a significant difference between the three devices for mean SpO2 (X2 =16.7, p<0.05), ODI (X2 =17.4, p<0.05) and SpO2nadir (X2 =28, p<0.05). Masimo ODI was lower than Nonin ODI (median (IQR) 2.4(4.1) vs 3.6(2.1), p<0.05) and Radiometer ODI (2.4 (4.1) vs 5.9 (13.25), p<0.05). Masimo nadir SpO2 was higher than Nonin nadir SpO2 (91(7.25) vs 89(7.0), p<0.05) and Radiometer nadir SpO2 (91(7.25) vs 84.5(13.5). No difference was seen with Nonin and Radiometer for ODI or nadir SpO2. (Table 1)NPO SpO2 measurements vary between the three devices in our heterogenous paediatric population. Further research is required to determine whether using different devices leads to different diagnostic outcomes.Abstract P37 Table 1