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How to interpret a negative high-resolution pulse oximetry in hospitalized patients screened for obstructive sleep apnea: an exploratory analysis

  • Sleep Breathing Physiology and Disorders • Short Communication
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Abstract

Introduction

Obstructive sleep apnea (OSA) is a highly prevalent disorder that often is unrecognized. Recently, a novel protocol for screening hospitalized patients for OSA resulted in early initiation of positive airway pressure (PAP) therapy and early post-discharge follow-up. The protocol utilizes a combination of high-resolution pulse oximetry (HRPO) and home sleep apnea tests (HSATs); the former has been well-validated in previous studies against HSAT and polysomnography. While a definitive treatment plan can be generated for patients with a positive HRPO for OSA, it is less clear how best to manage patients with a negative HRPO.

Materials and methods

A retrospective analysis of a registry of patients screened for OSA was conducted. Consecutive patients with HRPO-derived ODI (oxygen desaturation index) < 5/h who underwent same-night HRPO and HSAT were identified. The demographic and clinical characteristics of patients with ODI < 5/h and AHI (apnea hypopnea index) < 5/h were compared with patients with ODI < 5/h and AHI ≥ 5/h.

Results

The analysis revealed 190 patients with ODI < 5/h. Only 23 (12%) of these patients had AHI ≥ 5/h. When compared with patients who had ODI < 5/h and AHI < 5/h, there was no difference in most testing and patient characteristics. However, antiplatelet use and total time in minutes with saturation < 88% greater than 100 min were associated with a higher likelihood of discordant ODI and AHI.

Conclusion

HRPO-derived ODI has a low rate of false negativity. Clinicians should be aware of the possibility of a false negative ODI for patients with antiplatelet use and time with saturation < 88% greater than 100 min and antiplatelet therapy.

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Fig. 1

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, Morgantown, WV, 26506, USA

    Sunil Sharma, Christine Del Prado-Rico, Robert Stansbury, Chris Pham, Kassandra Olgers & Scott Knollinger

  2. Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Stuart F. Quan

Authors
  1. Sunil Sharma
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  2. Christine Del Prado-Rico
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  3. Robert Stansbury
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  4. Chris Pham
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  5. Kassandra Olgers
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  6. Scott Knollinger
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  7. Stuart F. Quan
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Corresponding author

Correspondence to Sunil Sharma.

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Sharma, S., Del Prado-Rico, C., Stansbury, R. et al. How to interpret a negative high-resolution pulse oximetry in hospitalized patients screened for obstructive sleep apnea: an exploratory analysis. Sleep Breath 27, 1935–1938 (2023). https://doi.org/10.1007/s11325-023-02778-4

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  • DOI: https://doi.org/10.1007/s11325-023-02778-4

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