Pre-Dialytic SpO2 Measured with a Wearable Device as a Predictor of Mortality in Patients with OSA and Chronic Kidney Disease

Hsiao-Wei Lu,Jia-Feng Chang,Mai-Szu Wu,Jian-Chiun Liou,Cheuk-Sing Choy,Pin-Hung Kuo,Jing-Quan Zheng,Chih-Yu Hsieh

doi:10.3390/app112210674

Abstract

Hypoxemia and obstructive sleep apnea (OSA) have been recognized as a threat to life. Nonetheless, information regarding the association between pre-dialytic pulse oximeter saturation (SpO2) level, OSA and mortality risks remains mysterious in patients with maintenance hemodialysis (MHD). Bioclinical characteristics and laboratory features were recorded at baseline. Pre-dialytic SpO2 was detected using a novel microchip LED oximetry, and the Epworth Sleepiness Scale (ESS) score greater than 10 indicated OSA. Non-adjusted and adjusted hazard ratios (aHRs) of all-cause and cardiovascular (CV) mortality were analyzed for pre-dialytic SpO2, OSA and potential risk factors. During 2152.8 patient-months of follow-up, SpO2 was associated with incremental risks of all-cause and CV death (HR: 0.90 (95% CI: 0.82–0.98) and 0.88 (95% CI: 0.80–0.98), respectively). The association between OSA and CV mortality was significant (HR: 3.19 (95% CI: 1.19–9.38). In the multivariate regression analysis, pre-dialytic SpO2 still had an increase in all-cause and CV death risk (HR: 0.88 (95% CI: 0.79–0.98), 0.82 (95% CI: 0.71–0.96), respectively). Considering the high prevalence of silent hypoxia in the post COVID-19 era, a lower pre-dialytic SpO2 level and severe OSA warn clinicians to assess potential CV risks. In light of clinical accessibility, the microchip LED oximetry could be developed as a wearable device within smartphone technologies and used as a routine screen tool for patient safety in the medical system.

Highlights

Hypoxemia is doomed to the common terminal pathway of multiple pathologies: clinicians are fearful of silent hypoxemia in the post COVID-19 era [1,2]
A total of ten patients were censored because they met one of the criteria listed below during the follow-up: (1) patients were transferred to another dialysis unit; (2) patients during the follow-up: (1) patients were transferred to another dialysis unit; (2) patients abandoned HD treatment; (3) patients switched to peritoneal dialysis; (4) patients lost to abandoned HD treatment; (3) patients switched to peritoneal dialysis; (4) patients lost to follow up; and (5) patients received the renal transplant
In the post COVID-19 era, which has seen a high prevalence of silent hypoxia, a lower pre-dialytic SpO2 level and severe obstructive sleep apnea (OSA) warn clinicians to assess for potential CV risks and determine a prompt and appropriate management

Summary

Introduction

Hypoxemia is doomed to the common terminal pathway of multiple pathologies: clinicians are fearful of silent hypoxemia in the post COVID-19 era [1,2]. Coronary artery diseases (CAD) and obstructive sleep apnea (OSA) are closely related to hypoxia and are common in patients with maintenance hemodialysis (MHD); it is no wonder that cardiovascular (CV) mortality remains the leading cause of death [3,4,5,6]. OSA is a disease that manifests with restriction of the airflow through the upper airways during sleep, leading to the development of hypertensive CV diseases, CAD, and cardiac arrhythmia [7]. OSA is the most prevalent form of sleep-related breathing disorders, which is characterized by repetitive episodes of hypoxia, contributing to extremely high mortality rates, secondary to associated CV and metabolic risks [3]

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