Proposal of a diagnostic algorithm based on the use of pulse oximetry in obstructive sleep apnea

• Published in: Sleep & breathing Vol. 27; no. 5; pp. 1677 - 1686
• Main Authors: Borsini, Eduardo, Nigro, Carlos Alberto
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2023; Springer Nature B.V
• Subjects: Algorithms; Apnea; Cross-Sectional Studies; Dentistry; Humans; Internal Medicine; Medicine; Medicine & Public Health; Neurology; Otorhinolaryngology; Oximetry; Pediatrics; Pneumology/Respiratory System; Pulse oximetry; Retrospective Studies; Sleep apnea; Sleep Apnea, Obstructive - diagnosis; Sleep Breathing Physiology and Disorders • Original; Sleep Breathing Physiology and Disorders • Original Article; Sleep disorders; Sleep apnea syndromes; Algorithms; Diagnosis; Oximetry
• ISSN: 1520-9512; 1522-1709; 1522-1709
• DOI: 10.1007/s11325-022-02757-1

  Purpose The aims of this study were to assess the cut-off values for oxygen desaturation index ≥ 3% (ODI3) to confirm obstructive sleep apnea (OSA) in subjects undergoing polysomnography (PSG) and home-based respiratory polygraphy (RP), and to propose an algorithm based on pulse oximetry (PO) for initial management of patients with suspected OSA. Methods This was an observational, cross-sectional, retrospective study. ODI3 was used to classify subjects as healthy (no OSA = AHI < 5 or < 15 events/h) or unhealthy (OSA = AHI ≥ 5 or ≥ 15 events/h). On the PSG or experimental group (Exp-G), we determined ODI3 cut-off values with 100% specificity (Sp) for both OSA definitions. ODI3 values without false positives in the Exp-G were applied to a validation group (Val-G) to assess their performance. A strategy based on PO was proposed in patients with suspected OSA. Results In Exp-G (PSG) 1141 patients and in Val-G (RP) 1141 patients were included. In Exp-G, ODI3 > 12 (OSA = AHI ≥ 5) had a sensitivity of 69.5% (CI95% 66.1–72.7) and Sp of 100% (CI95% 99–100), while an ODI3 ≥ 26 had a 53.8% sensitivity (CI95% 49.3–58.2) and Sp of 100% (CI95% 99.4–100) for AHI ≥ 15. A high pretest probability for OSA by Berlin questionaire (≥ 2 categories) had a lower diagnostic performance than by STOP-BANG questionnaire ≥ 5 points (AHI ≥ 5: 0.856 vs. 0.899, p  < 0.001; AHI ≥ 15: 0.783 vs. 0.807, p 0.026). Conclusion We propose the initial use of PO at home in cases of moderate-to-high pretest probability of OSA. This algorithm considers PO as well as RP and PSG for more challenging cases or in case of doubt.