Prediction of the Apnea-Hypopnea Index From Overnight Pulse Oximetry

• Published in: Chest Vol. 124; no. 5; pp. 1694 - 1701
• Main Authors: Magalang, Ulysses J., Dmochowski, Jacek, Veeramachaneni, Sateesh, Draw, Azmi, Mador, M. Jeffery, El-Solh, Ali, Grant, Brydon J.B.
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.11.2003; American College of Chest Physicians
• Subjects: Accuracy; Apnea - diagnosis; Biological and medical sciences; bootstrap aggregation; clinical prediction rules; Confidence intervals; Humans; Investigative techniques of respiratory function; Investigative techniques, diagnostic techniques (general aspects); Likelihood Functions; Medical sciences; Middle Aged; Models, Statistical; multivariate adaptive regression splines; Multivariate Analysis; overnight polysomnography; Oximetry; Patients; Polysomnography; Prospective Studies; Pulse oximetry; ROC Curve; Sensitivity and Specificity; Sleep apnea; sleep apnea syndrome; Sleep Apnea, Obstructive - blood; Sleep Apnea, Obstructive - diagnosis; St Louis Missouri; United States > US; pulse oximetry; clinical prediction rules; AHI; multivariate adaptive regression splines; CPAP; CI; overnight polysomnography; sleep apnea syndrome; ROC; VAMC; ASC; MARS; bootstrap aggregation; OSA; Human; Blood gas; Oxymetry; Prognosis; Night; Respiratory disease; Sleep disorder; Exploration; Apnea; Lung function; Sleep; Gas exchange
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.124.5.1694

To compare the relative usefulness of the different indexes derived from pulse oximetry in the diagnosis of obstructive sleep apnea (OSA), and to determine if a combination of these indexes improves the prediction of the apnea-hypopnea index (AHI) measured by polysomnography. Prediction model developed from 224 patients, validated prospectively in 101 patients from the same center (group 1) and in 191 patients from a different sleep center (group 2). Two independent sleep clinics run by university sleep specialists. Patients who underwent polysomnography for suspicion of OSA. The following indexes were calculated from pulse oximetry recordings performed simultaneously during polysomnography: (1) Δ index, the average of the absolute differences of oxygen saturation between successive 12-s intervals; (2) desaturation events per hour to 2%, 3%, and 4% levels; and (3) cumulative time spent below 90%, 88%, 86%, 84%, 82%, and 80% saturation. The best predictor was the Δ index, although desaturation events provided similar levels of diagnostic accuracy. An aggregation of multivariate models using combination of indexes reduced the prediction error (r2 = 0.70) significantly (p < 0.05) compared to using the Δ index alone (r2 = 0.60). The proportion of subjects from the validation groups within 95% confidence interval (CI) of the derivation group was 90% (95% CI, 83 to 95%) and 91% (95% CI, 86 to 95%) for groups 1 and 2, respectively. The overall likelihood ratios for the aggregated model in all patient groups were 4.2 (95% CI, 3.3 to 15.3), 3.4 (95% CI, 2.7 to 4.3), 3.0 (95% CI, 2.2 to 4.1), and 6.7 (95% CI, 4.9 to 9.2) for normal (AHI < 5/h), mild (AHI 5 to < 15/h), moderate (AHI 15 to < 30/h), and severe (AHI ≥ 30/h) disease, respectively. The Δ index and oxygen desaturation indexes provided similar levels of diagnostic accuracy. The combination of indexes improved the precision of the predicted AHI and may offer a potentially simpler alternative to polysomnography.