Diagnostic accuracy of oximetry for obstructive sleep apnea: a study on older adults in a home setting

João Carlos Fraga Da Rosa,Alessandra Peres,Luciano Gasperin,Denis Martinez,Vania Fontanella

doi:10.6061/clinics/2021/e3056

Abstract

OBJECTIVES:Owing to the fact that obstructive sleep apnea (OSA) is an underreported disease, the strategy used for the diagnosis of OSA has been extensively dissected to devise a simplified process that can be accessed by the public health services. Polysomnography (PSG) type I, the gold standard for the diagnosis of OSA, is expensive and difficult to access by low-income populations. In this study, we aimed to verify the accuracy of the oxyhemoglobin desaturation index (ODI) in comparison to the apnea-hypopnea index (AHI) using a portable monitor.METHODS:We evaluated 94 type III PSG home test results of 65 elderly patients (69.21±6.94 years old), along with information, such as the body mass index (BMI) and sex, using data obtained from a clinical trial database.RESULTS:A significant linear positive correlation (r=0.93, p<0.05) was observed between ODI and AHI, without any interference from sex, BMI, and positional component. The sensitivity of ODI compared to that of AHI increased with an increase in the severity of OSA, while the specificity of ODI in comparison to that of AHI was high for all degrees of severity. The accuracy of ODI was 80.7% for distinguishing between patients with mild and moderate apnea and 84.4% for distinguishing between patients with moderate and severe apnea.CONCLUSION:The ODI values obtained in uncontrolled conditions exhibited high sensitivity for identifying severe apnea compared to the AHI values, and correctly identified the severity of OSA in more than 80% of the cases. Thus, oximetry is promising strategy for diagnosing OSA.

Highlights

Obstructive sleep apnea (OSA) is a global public health problem associated with serious clinical outcomes, such as cardiovascular diseases [1]
This study employed a database of patients selected for the randomized controlled trial (RCT), which aimed to evaluate the response to OSA treatment using intraoral mandibular advancement appliances, conducted between 2018 and 2020, containing 116 consecutive tests of type III PSG, with concomitant oxyhemoglobin desaturation index (ODI) and apnea-hypopnea index (AHI) records using the same equipment (ApneaLinkt, ResMed Corporation, Poway, CA, USA)
A significant linear and positive correlation (r=0.93, po0.05; Pearson correlation coefficient) was observed between the ODI and AHI, with 86.17% of the variability of AHI explained by the ODI (Figure 1A)

Summary

Introduction

Obstructive sleep apnea (OSA) is a global public health problem associated with serious clinical outcomes, such as cardiovascular diseases [1]. It is estimated that at least 730 million individuals aged 30 to 69 years are affected by OSA, with a higher prevalence in China, the United States, Brazil, and India [2]. Studies indicate that senescence leads to an increase in the prevalence of OSA, a condition characterized by a decrease in muscle activity in the upper airway, pharyngeal dilator reflex, and lung capacity, and a higher prevalence of comorbidities [3,4]. Polysomnography (PSG) type I is the gold standard for the diagnosis of OSA [5]. This test is performed in a specialized sleep laboratory, where an experienced team monitors and interprets the results.

Objectives

Methods

Results

Conclusion