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

Abstract

A large epidemiological study using oximetry to analyze obstructive sleep apnea (OSA) and metabolic comorbidities was performed in Japan; however, reliability and validity of oximetry in the Japanese population remains poorly understood. In this study, oximetry data from the epidemiological study were compared with data from clinically performed polysomnography (PSG) and out-of-center sleep testing (OCST) in epidemiological study participants who later attended our outpatient units. The oxygen desaturation index (ODI) from oximetry showed a moderate positive relationship (correlation coefficient r = 0.561, p < 0.001) with apnea/hypopnea data from PSG/OCST. The area under the receiver operating characteristic curve showed moderate accuracy of this method in the detection of moderate-to-severe or severe OSA. However, the optimal ODI thresholds to detect moderate-to-severe OSA and severe OSA were the same (ODI > 20.1). Oximetry may be a useful tool for screening moderate-to-severe or severe sleep apnea. However, it may be difficult to set an appropriate threshold to distinguish between moderate and severe sleep apnea by oximetry alone.

Obstructive Sleep Apnoea Severity Is Negatively Associated with Depressive Symptoms: A Cross-Sectional Survey of Outpatients with Suspected Obstructive Sleep Apnoea in Japan

“…We used the same in-laboratory PSG device; however, the OCST devices were different between the two settings. A comparison between AHI from PSG and REI from OCST was previously performed in the city hospital, which suggested a reasonable validity of REI compared with AHI [24]. The same sleep physician reviewed all of the analysed results; however, the PSG/OCST analyses were performed by different staff in both settings.…”

“…However, clinical tools, questionnaires, and prediction algorithms are strongly not recommended to diagnose OSA in the absence of polysomnography (PSG) or out-of-centre sleep testing (OCST) [23]. Pulse oximetry, a simple method to obtain physiological signals, may be another useful tool for screening OSA; however, it may be difficult to set an appropriate threshold to distinguish between moderate and severe OSA by oximetry alone [24].…”

Diagnostic accuracy of oximetry for obstructive sleep apnea: a study on older adults in a home setting

“…The variables associated with the severity of OSA ( 19), such as BMI, age, sex, and positional component, are commonly mentioned in the studies, yet they are not parameterized (16)(17)(18). Fabius et al (24) mentioned age and BMI as covariables that influence the relationship between AHI and ODI, owing to greater desaturation in the elderly.…”

“…Thus, it is necessary to investigate simpler and less expensive methods to expand access to OSA diagnosis. Previous studies (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) have assessed the ability of pulse oximetry to diagnose OSA; they observed that compared to the apnea-hypopnea index (AHI), the oxyhemoglobin desaturation index (ODI)-measured using the oximeterexhibited high sensitivity and specificity for diagnosing OSA. However, in most studies, validation was performed based on comparison of the test results in a controlled environmente.g., PSG type I in the laboratory-with different sampling designs, thus questions are raised regarding the diagnostic viability of ODI values measured in a laboratory environment for extrapolation in an unsupervised home environment.…”

Large Questionnaire Survey on Sleep Duration and Insomnia Using the TV Hybridcast System by Japan Broadcasting Corporation (NHK)

“…AIS score and sleep duration in this population were 6.82 ± 3.69 and 5.96 ± 1.13 h, respectively ( Table 1 ). AIS scores among city government employees and patients in a sleep apnoea outpatient unit in Japan were 4.98 ± 3.57 [ 4 ] and 3.64 ± 3.15 [ 24 ], respectively. Sleep duration in Japanese general population was reported to be 7.25–7.37 h [ 8 , 12 ].…”