Validation of the oxygen desaturation index in the diagnostic workup of obstructive sleep apnea
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Obstructive sleep apnea (OSA) is common, and diagnosis requires expensive and laborious testing to assess the apnea hypopnea index (AHI). We performed an analysis to explore the relationship between the oxygen desaturation index (ODI) as measured with pulse oximetry and the AHI in our large portable monitoring (PM) database to find an optimal cutoff value for the ODI in order to be able to exclude AHI ≥ 5 on PM.
Three thousand four hundred thirteen PM recordings were randomly divided into a training set (N = 2281) and a test set (N = 1132). The optimal cutoff for the ODI to exclude an AHI ≥ 5 on PM was determined in the training set and subsequently validated in the test set.
Area under the curve of the ODI to exclude an AHI ≥ 5 on PM was 0.997 in the training set and 0.996 in the test set. In the training set, the optimal cutoff to predict an AHI < 5 was an ODI < 5. Using this cutoff in the test set provided a sensitivity of 97.7%, a specificity of 97.0%, a positive predictive value of 99.2%, and a negative predictive value of 91.4%.
An ODI < 5 predicts an AHI < 5 with high sensitivity and specificity when measured simultaneously using the same oximeter during PM recording.
KeywordsObstructive sleep apnea Apnea hypopnea index Oxygen desaturation index Pulse oximetry
TF contributed to the design, analysis of the data, interpretation of the data, and writing of the manuscript and takes full responsibility for the content of the manuscript, including the data and analysis; JB contributed to the design, data extraction, analysis of the data, and critical revision of the manuscript; LB contributed to the design, analysis of the data, and writing of the manuscript. JvdP contributed to the design, statistical analysis, interpretation of the data, and critical revision of the manuscript; FdJ contributed to the design, interpretation of the data, and critical revision of the manuscript; ME contributed to the design, data collection, interpretation of the data, and critical revision of the manuscript.
Compliance with ethical standards
Conflict of interest
JB reports shares in DiagnOSAS B.V., a company that aims to facilitate screening for sleep apnea in a primary care setting. All other authors (TF, LB, JvdP, FdJ, and ME) certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Both the local ethics committee and the board of directors of the Medisch Spectrum Twente approved the study protocol.
This study is based on anonymous data. Therefore, obtaining informed consent was deemed unnecessary (as approved by the local ethics committee).
- 4.Franklin KA, Lindberg E (2015) Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea. J Thorac Dis 7:1311–1322Google Scholar
- 5.Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R (2007) Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 3:737–747Google Scholar
- 8.Nigro CA, Dibur E, Rhodius E (2011) Pulse oximetry for the detection of obstructive sleep apnea syndrome: can the memory capacity of oxygen saturation influence their diagnostic accuracy? Sleep Disord 2011:427028Google Scholar
- 12.Collop NA, Tracy SL, Kapur V, Mehra R, Kuhlmann D, Fleishman SA, Ojile JM (2011) Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med 7:531–548Google Scholar
- 13.Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med 8:597–619Google Scholar
- 14.Chai-Coetzer CL, Antic NA, Hamilton GS, McArdle N, Wong K, Yee BJ, Yeo A, Ratnavadivel R, Naughton MT, Roebuck T, Woodman R, McEvoy RD (2017) Physician decision making and clinical outcomes with laboratory polysomnography or limited-channel sleep studies for obstructive sleep apnea: a randomized trial. Ann Intern Med 166:332–340CrossRefGoogle Scholar
- 15.Corral J, Sánchez-Quiroga MÁ, Carmona-Bernal C, Sánchez-Armengol Á, de la Torre AS, Durán-Cantolla J, Egea CJ, Salord N, Monasterio C, Terán J, Alonso-Alvarez ML, Muñoz-Méndez J, Arias EM, Cabello M, Montserrat JM, de la Peña M, Serrano JC, Barbe F, Masa JF, for the Spanish Sleep Network (2017) Conventional polysomnography is not necessary for the management of most patients with suspected obstructive sleep apnea. Noninferiority, randomized controlled trial. Am J Respir Crit Care Med 196:1181–1190Google Scholar
- 17.Chai-Coetzer CL, Antic NA, Rowland LS, Reed RL, Esterman A, Catcheside PG, Eckermann S, Vowles N, Williams H, Dunn S, McEvoy RD (2013) Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life: a randomized trial. JAMA 309:997–1004CrossRefGoogle Scholar
- 18.Dawson A, Loving RT, Gordon RM, Abel SL, Loewy D, Kripke DF, Kline LE (2015) Type III home sleep testing versus pulse oximetry: is the respiratory disturbance index better than the oxygen desaturation index to predict the apnoea-hypopnoea index measured during laboratory polysomnography? BMJ Open 5:e007956CrossRefGoogle Scholar
- 21.Davila DG, Richards KC, Marshall BL, O’Sullivan PS, Osbahr LA, Huddleston RB, Jordan JC (2003) Oximeter’s acquisition parameter influences the profile of respiratory disturbances. Sleep 26:91–95Google Scholar
- 23.Gumb T, Twumasi A, Alimokhtari S, Perez A, Black K, Rapoport DM, Sunderram J, Ayappa I (2017) Comparison of two home sleep testing devices with different strategies for diagnosis of OSA. Sleep Breath:1–9Google Scholar