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).
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