Nocturnal Oxygen Desaturation Index Correlates with Respiratory Depression in Post-Surgical Patients Receiving Opioids--A Post-Hoc Analysis from the Prediction of Opioid-Induced Respiratory Depression in Patients Monitored by Capnography

• Published in: Nature and science of sleep Vol. 14; pp. 805 - 817
• Main Authors: Liu, Katherine E, Ti, Lian Kah, Liew, Lydia Q.N, Sim, Ming Ann, Chua, Vanessa T.Y, Khanna, Ashish K, Law, Lawrence S.C, Piazza, Fabio Di, Seet, Edwin, Weingarten, Toby N
• Format: Journal Article
• Language: English
• Published: Dove Medical Press Limited 31.05.2022
• Subjects: Analysis; Capnography; Hospital patients; Medical research; Medicine, Experimental; Opioids; Oximetry; Oxyhemoglobin; Patient monitoring equipment; Sleep apnea syndromes; Germany
• ISSN: 1179-1608; 1179-1608
• DOI: 10.2147/NSS.S351840

Purpose: Postoperative monitoring of respiratory status on general care wards typically consists of intermittent checks of oxyhemoglobin saturation and respiratory rate, allowing substantial unmonitored time for severe opioid induced respiratory depression (RD) to develop unnoticed. Oxygen desaturation index (ODI) can be computed solely by continuous pulse oximetry monitoring. In this post-hoc analysis, we evaluate whether nocturnal ODI correlates with RD. Patients and Methods: The PRODIGY trial (NCT02811302) was a multinational study conducted where adult patients receiving parenteral opioids on the general care floor were continuously monitored by blinded pulse oximetry and capnography monitoring to detect episodes of RD. An RD episode was defined as: respiratory rate [less than or equal to]5 breaths/min (bpm) for [greater than or equal to]3 minutes, oxygen saturation (Sp[O.sub.2]) [less than or equal to]85% for [greater than or equal to]3 minutes, end-tidal carbon dioxide (EtC[O.sub.2]) [less than or equal to]15 or [greater than or equal to]60 mm Hg for [greater than or equal to]3 minutes, apnea episode lasting >30 seconds, or any respiratory opioid-related adverse event. Data were used to calculate nocturnal (00:00 - 06:00) ODI4% based on desaturation episodes (4% decrease from mean oxyhemoglobin saturation in the past 120 seconds, lasting [greater than or equal to]10 seconds). Continuous monitoring began after a patient received parenteral opioids, allowing identification of potential RD and ODI4% episodes during opioid therapy. The average number of ODI4% episodes ([greater than or equal to]1, [greater than or equal to]5, [greater than or equal to]10, [greater than or equal to]15 episodes/hour) were analyzed. Logistic regression and area under the receiver operating characteristic curve (AUC) were computed. Results: A final cohort of 1072 (out of 1335) patients had suffcient data, with 76% (N=817/1072) having [greater than or equal to]1 episode of ODI4%. Multivariable logistic regression showed that ODI4% was strongly associated with RD, with greater risk for higher ODI4% scores: [greater than or equal to]5 episodes/hour odds ratio 2.59 (95% CI 1.72-3.89, p<0.0001); [greater than or equal to]10 episodes/hour 3.39 (95% CI 1.80-6.39, p=0.0002); [greater than or equal to]15 episodes/hour 4.71 (95% CI 1.93-11.47, p=0.0006).There was no significant association between ODI4% and respiratory adverse events. Conclusion: Nocturnal ODI4% was highly correlated with RD among hospitalized patients receiving parenteral opioids. Patients with a high ODI4%, especially with [greater than or equal to]15 episodes/hour, are more likely to experience RD and should be evaluated for the need of closer monitoring after opioid administration. Keywords: opioids, oxygen desaturation index, respiratory depression, sleep apnea