Abstract
BackgroundPolysomnography (PSG) is treated as the gold standard for diagnosing obstructive sleep apnea (OSA). However, it is labor-intensive, time-consuming, and expensive. This study evaluates validity of overnight pulse oximetry as a diagnostic tool for moderate to severe OSA patients.MethodsA total of 699 patients with possible OSA were recruited for overnight oximetry and PSG examination at the Sleep Center of a University Hospital from Jan. 2004 to Dec. 2005. By excluding 23 patients with poor oximetry recording, poor EEG signals, or respiratory artifacts resulting in a total recording time less than 3 hours; 12 patients with total sleeping time (TST) less than 1 hour, possibly because of insomnia; and 48 patients whose ages less than 20 or more than 85 years old, data of 616 patients were used for further study. By further considering 76 patients with TST < 4 h, a group of 540 patients with TST ≥ 4 h was used to study the effect of insufficient sleeping time. Alice 4 PSG recorder (Respironics Inc., USA) was used to monitor patients with suspected OSA and to record their PSG data. After statistical analysis and feature selection, models built based on support vector machine (SVM) were then used to diagnose moderate and moderate to severe OSA patients with a threshold of AHI = 30 and AHI = 15, respectively.ResultsThe SVM models designed based on the oxyhemoglobin desaturation index (ODI) derived from oximetry measurements provided an accuracy of 90.42-90.55%, a sensitivity of 89.36-89.87%, a specificity of 91.08-93.05%, and an area under ROC curve (AUC) of 0.953-0.957 for the diagnosis of severe OSA patients; as well as achieved an accuracy of 87.33-87.77%, a sensitivity of 87.71-88.53%, a specificity of 86.38-86.56%, and an AUC of 0.921-0.924 for the diagnosis of moderate to severe OSA patients. The predictive outcome of ODI to diagnose severe OSA patients is better than to diagnose moderate to severe OSA patients.ConclusionsOvernight pulse oximetry provides satisfactory diagnostic performance in detecting severe OSA patients. Home-styled oximetry may be a tool for severe OSA diagnosis.
Highlights
Polysomnography (PSG) is treated as the gold standard for diagnosing obstructive sleep apnea (OSA)
Home pulse oximetry has been proposed as a valuable screening tool, its effectiveness in screening patients with Obstructive sleep apnea (OSA) has been debated for several years [13]
The objectives of this study are to (1) validate nocturnal oximetry for the screening of high-risk OSA patients using oxyhemoglobin desaturation index (ODI) to detect severe and moderate-to-severe patients; (2) consider the effect of patients with total sleeping time (TST) less than 4 hours compared with those having longer TST during PSG examination; and (3) determine the best kernel and features used for constructing the support vector machine (SVM) classifiers to discriminate the OSA patients from the normal subjects
Summary
Polysomnography (PSG) is treated as the gold standard for diagnosing obstructive sleep apnea (OSA). Obstructive sleep apnea (OSA) is prevalent in 4% of men and 2% of women [4]; among them, up to 93% of women and 82% of men have not been diagnosed [5], resulting in an increased risk of 2–7 folds in causing motor vehicle crashes [6] and causing several chronic diseases, such as metabolic syndrome [7]; neurocognitive deficits [8], vigilance alteration and attentional decline [9]; and erectile dysfunction [10]. Brouillette and colleagues reported that oximetry could be used to diagnose OSA for children with a positive predictive value of 97% [19]
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