Oximetry as an Accurate Tool for Identifying Moderate to Severe Sleep Apnea in Patients With Acute Stroke

Abstract

Study Objectives: Sleep-disordered breathing (SDB) is highly prevalent in patients with acute stroke. SDB is often underdiagnosed and associated with neurological deterioration and stroke recurrence. Polysomnography or home sleep apnea testing (HSAT) is typically used as the diagnostic modality; however, it may not be feasible to use regularly in patients with acute stroke. We investigated the predictive performance of pulse oximetry, a simpler alternative, to identify SDB. Methods: The records of 254 patients, who were admitted to Boston Medical Center for acute stroke and underwent HSAT, were retrospectively reviewed. Oxygen desaturation index (ODI) from pulse oximetry channel were compared to respiratory event index (REI) obtained from HSAT devices. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ODI were calculated, and different ODI cutoff values to predict SDB were proposed. Results: ODI had a strong correlation (r = .902) and agreement with REI. ODI was accurate in predicting SDB at different REI thresholds (REI ≥ 5, REI ≥ 15, and REI ≥ 30 events/h) with the area under the curve (AUC) of .965, .974, and .951, respectively. An ODI ≥ 5 events/h rules in the presence of SDB (specificity 91.7%, PPV 96.3%). An ODI ≥ 15 events/h rules in moderate to severe SDB (specificity 96.4%, PPV 95%) and an ODI < 5 events/h rules out moderate to severe SDB (sensitivity 100%, NPV 100%). Conclusions: Nocturnal pulse oximetry has a high diagnostic accuracy in predicting moderate to severe SDB in patients with acute stroke. Oximetry can be a simple modality to rapidly recognize patients with more severe SDB and facilitate the referral to the confirmation sleep study.

Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late‐onset gestational hypertension

“…In contrast, pulse oximeters are simple and useful screening tools. 18 Overnight pulse oximetry is generally satisfactory in detecting moderate to severe OSA, 28,29 but it has limited sensitivity for detecting mild OSA. The ODI is usually the most effective measure for a diagnosis of OSA, and cutoffs of 5.0, 10.0 or 15.0 are applied on a case-by-case basis.…”

Validation of Oximetry for Diagnosing Obstructive Sleep Apnea in a Clinical Setting

“…Previous studies compared AHI and ODI from the same recordings, with correlation coefficients reported to range between 0.745 and 0.97 [ 14 , 15 , 16 , 17 , 18 , 19 ]. Some studies compared simultaneously performed oximetry and PSG, with correlation coefficients reported to be 0.617–0.95 [ 20 , 21 ], while others independently performed oximetry and PSG [ 23 , 24 ], with correlation coefficients of 0.6 and 0.62.…”

“…First, the oximetry ODI was not measured simultaneously with PSG/OCST. Comparisons of ODI and AHI/REI from the same recordings showed the best correlation [ 14 , 15 , 16 , 17 , 18 , 19 ] ( Figure 5 ), followed by simultaneous recording by different devices [ 20 , 21 , 25 ]. The correlation was worst when comparing ODI and AHI/REI from different devices on different nights [ 23 , 24 ] ( Figure 2 a and Figure 6 ).…”

“…These variations may come, in part, from different study designs. Some studies have compared oximetry data obtained as a part of PSG recordings to apnea events analyzed from the same PSG recordings [ 14 , 15 , 16 , 17 , 18 , 19 ]. Others have compared oximetry data with data from simultaneous PSG [ 20 , 21 , 22 ].…”

Screening of obstructive sleep apnea in patients who snore using a patch-type device with electrocardiogram and 3-axis accelerometer

“…7 Oximetry is another less expensive and easier alternative that is widely available. 8,9 However, attaching a device to the finger during sleep is uncomfortable and may limit natural position change during sleep; moreover, the device is removed on waking up, which limits its use in multiday, continuous recordings.…”