The Value of Oxygen Desaturation Index for Diagnosing Obstructive Sleep Apnea: A Systematic Review

Abstract

Objectives Intermittent hypoxemia is a risk factor for developing complications in obstructive sleep apnea (OSA) patients. The objective of this systematic review was to identify articles evaluating the accuracy of the oxygen desaturation index (ODI) as compared with the apnea–hypopnea index (AHI) and then provide possible values to use as a cutoff for diagnosing adult OSA. Study Design Systematic Review of Literature. Methods PubMed, the Cochrane Library, and SCOPUS databases were searched through November 2019. Results Eight studies (1,924 patients) met criteria (age range: 28–70.9 years, body mass index range: 21.9–37 kg/m2, and AHI range: 0.5–62 events/hour). Five studies compared ODI and AHI simultaneously, and three had a week to months between assessments. Sensitivities ranged from 32% to 98.5%, whereas specificities ranged from 47.7% to 98%. Significant heterogeneity was present; however, for studies reporting data for a 4% ODI ≥ 15 events/hour, the specificity for diagnosing OSA ranged from 75% to 98%, and only one study reported the positive predictive value, which was 97%. Direct ODI and AHI comparisons were not made because of different hypopnea scoring, different oxygen desaturation categories, and different criteria for grading OSA severity. Conclusion Significant heterogeneity exists in studies comparing ODI and AHI. Based on currently published studies, consideration should be given for diagnosing adult OSA with a 4% ODI of ≥ 15 events/hour and for recommending further evaluation for diagnosing OSA with a 4% ODI ≥ 10 events/hour. Screening with oximetry may be indicated for the detection of OSA in select patients. Further study is needed before a definitive recommendation can be made. Laryngoscope, 131:440–447, 2021

Digital oximetry biomarkers for assessing respiratory function: standards of measurement, physiological interpretation, and clinical use

“…Research on the use of existing and development of new oximetry biomarkers has mainly focused on the diagnosis of OSA, as echoed by five recent reviews in this field [7][8][9][10][11] . Although this paper will naturally somewhat overlap with these reviews, we present a new comprehensive review focusing on the physiological interpretation and clinical use of oximetry biomarkers, in the spirit of the work of Malik et al 3 in the field of HRV analysis.…”

Validation of an Overnight Wireless High-Resolution Oximeter plus Cloud-Based Algorithm for the Diagnosis of Obstructive Sleep Apnea

“…The oxygen desaturation index (ODI), developed in line with the diagnostic simplifications for OSA, which is determined by the isolation of the oximetry channel from the full PSG, has been reported to possess a high sensitivity and specificity for the detection of OSA in children and adults (12,13). However, a recent systematic review showed a large discrepancy in the sensitivities and specificities of the ODI obtained from pulse oximeters compared to the reference apnea-hypopnea index (AHI) (14). These observations explain why pulse oximetry is largely viewed as a screening tool (15).…”

<p>Obstructive Sleep Apnea Exacerbates Glucose Dysmetabolism and Pancreatic β-Cell Dysfunction in Overweight and Obese Nondiabetic Young Adults</p>

“…29,30 Useful oximetric measures related to OSA include ODI, LSpO 2 , mean SpO 2 , and TS90. 23 The European Sleep Apnea Database (ESADA) study stated ODI and nocturnal mean SpO 2 were better predictors of HbA1c levels than AHI among 2375 nondiabetic subjects who had undergone PSG. 24 Available study also indicated that nocturnal hypoxemia from OSA was associated with poorer glycemic control in the extremely obese subjects.…”

“…22 The oxygen desaturation index (ODI) is a measure of the number of times per hour that oxygen saturation decreases per hour, which was defined as the total number of at least 4% oxygen desaturations per total sleep time in hours. 23,24 The mean oxygenation saturation (mean SpO 2 ) was defined as the mean pulse oxygen saturation during the sleep period at night. The percentage of sleep duration with SpO 2 < 90% (TS90) and lowest nocturnal oxygen saturation (LSpO 2 ) were also determined as previously reported.…”