Abstract
PurposePulse oximetry is the current standard for detecting drops in arterial blood oxygen saturation (SpO2) associated with obstructive sleep apnea and hypopnea events in polysomnographic (PSG) testing. However, cellular energy monitoring (CE monitoring), a measure related to cellular hypoxia in the skin, is likely to be more responsive to inadequate breathing during sleep because during hypoxic challenge, such as occurs during apneic events, regulatory mechanisms restrict blood flow to the skin to preferentially maintain SpO2 for more vital organs. We carried out initial proof of concept testing to determine if CE monitoring has promise for being more responsive to hypoxic challenge occurring during sleep-disordered breathing (SDB) than pulse oximetry.MethodsWe assessed both CE monitoring and pulse oximetry in a series of conditions which affect oxygen supply: (1) breathing nitrogen or 100% oxygen, (2) physical exertion, and (3) studying a night of sleep in an individual known to be a loud snorer. We also present the results of a preliminary study comparing CE monitoring to pulse oximetry in eight individuals undergoing standard clinical overnight polysomnography for suspected SDB.ResultsCE monitoring is responsive to changes in cellular oxygen supply to the skin and detects hypoxia during SDB events that is not detected by pulse oximetry.ConclusionCE monitoring is a promising tool for identifying pathology at the mild end of the SDB spectrum.
Highlights
The presence of pathology occurring with sleep-disordered breathing (SDB) is currently identified during polysomnography (PSG) by the presence of a drop in arterial blood oxygen saturation (SpO2), as measured with pulse oximetry, or by electroencephalographic (EEG) evidence of sleep disturbance [1,2,3,4]
Pilot study data analysis Analysis consisted of tabulating events scored on the basis of monitor Cellular energy monitor (CE) monitoring and comparing those with events detected by standard methods including apneas, hypopneas, and related arousals (RERAs)
Our pilot study provides more convincing evidence for proof of concept (POC) that CE monitoring might be more sensitive than pulse oximetry for detecting hypoxic events
Summary
The presence of pathology occurring with sleep-disordered breathing (SDB) is currently identified during polysomnography (PSG) by the presence of a drop in arterial blood oxygen saturation (SpO2), as measured with pulse oximetry, or by electroencephalographic (EEG) evidence of sleep disturbance [1,2,3,4] These findings are used as the basis for the widely employed definitions for apneas, hypopneas, and respiratory-related arousals (RERAs), which form the basis of the diagnosis of SDB and determine whether to institute therapy [1,2,3,4]. There is no proximal measure of pathology occurring during the sleep study (i.e., drop in SpO2 or disturbance of sleep), there is evidence suggesting that primary snoring is associated with cardiometabolic disease [5,6,7,8]
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