Chest
Clinical InvestigationsSLEEP AND BREATHINGPrediction of the Apnea-Hypopnea Index From Overnight Pulse Oximetry*
Section snippets
Patient Population
Five hundred sixteen patients suspected of having OSA were enrolled into this prospective study. Patients were recruited from two independent sleep clinics in Buffalo, NY: the Associated Sleep Center (ASC) and the Buffalo Veterans Affairs Medical Center (VAMC) Sleep Center. The eligibility criteria were all patients who underwent overnight polysomnography for suspected sleep apnea. The exclusion criteria were age < 18 years; oxygen supplementation was used during the sleep study, or CPAP
Patient Characteristics
A total of 224 patients were entered into the derivation group. Another 101 patients were enrolled in validation group 1, and 191 patients were enrolled in validation group 2. Therefore, a total of 516 patients were included in the analysis. The patient characteristics of the derivation and two validation groups are shown in Table 1. All groups have similar body mass index and AHI. The patients in validation group 2 were significantly older compared to the derivation group and validation group
Discussion
The major findings of this study are as follows: (1) among the different oximetry indexes, the Δ index was the best predictor of the presence of OSA, although desaturation events provided similar levels of diagnostic accuracy; (2) the Δ index had good sensitivity but low specificity; (3) a bootstrap aggregation of models involving a combination of all the oximetry indexes (compared to using the Δ index alone) improved the precision of the prediction of the AHI; and (4) the prediction model
Multivariate Prediction Models
We used multivariate adaptive regression splines (MARS) to develop prediction models.15 The splines used in this study consisted of one or more of a series of linear segments joined at adjacent ends that could be fitted to nonlinear data. MARS is a multivariate nonparametric procedure that builds flexible regression-like models using exhaustive search techniques to test the necessity of different predictors. Interactions between independent variables are simultaneously tested. The model is
References (32)
- et al.
Clinical value of polysomnography
Lancet
(1992) - et al.
Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome
Chest
(1996) - et al.
Which derivative from overnight oximetry best predicts symptomatic response to nasal continuous positive airway pressure in patients with obstructive sleep apnea?
Respir Med
(2000) - et al.
A comparison of severity of illness scoring systems for critically ill obstetric patients
Chest
(1996) - et al.
Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement
Chest
(1999) - et al.
A cause of excessive daytime sleepiness: the upper airway resistance syndrome
Chest
(1993) - et al.
The occurrence of sleep-disordered breathing among middle-aged adults
N Engl J Med
(1993) - Systematic review of the literature regarding the diagnosis of sleep apnea: summary, evidence report/technology...
- et al.
A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea
Am Rev Respir Dis
(1993) - et al.
Nocturnal oximetry: is it a screening tool for sleep disorders?
Sleep
(1995)
Nocturnal oximetry for the diagnosis of the sleep apnea hypopnoea syndrome: a method to reduce the number of polysomnographies?
Thorax
Users’ guides to the medical literature, III: How to use an article about a diagnostic test B; What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group
JAMA
Prediction of sleep-disordered breathing by unattended overnight oximetry
J Sleep Res
Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnea
Thorax
A manual of standardized technology, techniques and scoring system for sleep stages of human subjects
EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Task Force of the American Sleep Disorders Association
Sleep
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2021, Medical Clinics of North AmericaCitation Excerpt :Consequently, portable PSGs often underestimate the severity of the OSA by averaging oxygenation patterns while awake during the time period in which the study is performed. Overnight oximetry can be used to screen, rather than diagnose, OSA given the high sensitivity of 98%, but specificity is as low as 40%.16 When portable PSGs are suspected to be inaccurate, formal in-laboratory sleep PSGs can be performed, which include electroencephalography, electrocardiography, submental electromyography (EMG), anterior tibialis EMG, and electrooculography, and measure nasal/oral airflow, oxygenation level, respiratory effort, and sleeping position, to calculate the sleep stage, AHI, and respiratory disturbance index (RDI).
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Supported by Research for Health in Erie County, Inc. and Veterans Affairs Enhancement Funds.