Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1999 Nov;54(11):968–971. doi: 10.1136/thx.54.11.968

Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies?

E Chiner 1, J Signes-Costa 1, J M Arriero 1, J Marco 1, I Fuentes 1, A Sergado 1
PMCID: PMC1745404  PMID: 10525553

Abstract

BACKGROUND—Polysomnography (PSG) is currently the "gold standard" for the diagnosis of the sleep apnoea hypopnoea syndrome (SAHS). Nocturnal oximetry (NO) has been used with contradictory results. A prospective study was performed to determine the accuracy of NO as a diagnostic tool and to evaluate the reduction in the number of PSGs if the diagnosis of SAHS had been established by this method.
METHODS—Two hundred and seventy five patients with a clinical suspicion of SAHS were admitted to undergo, in the same night, full PSG and NO. Desaturation was defined as a fall in the haemoglobin saturation level (SaO2) to lower than 4% from the baseline level and an oxygen desaturation index per hour (ODI) was obtained in each patient with three cut off points: ⩾5 (ODI-5), ⩾10 (ODI-10), and ⩾15 (ODI-15).
RESULTS—SAHS was diagnosed in 216 patients (194 men). After withdrawing patients with abnormal lung function (forced expiratory volume in one second (FEV1) lower than 80% predicted), sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV) of NO were: ODI-5 (80%, 89%, 97%, 48%); ODI-10 (71%, 93%, 97%, 42%); ODI-15 (63%, 96%, 99%, 38%). The accuracy for each ODI was 0.81, 0.75, and 0.70, respectively. If NO had been considered as a diagnostic tool and PSG had been performed only in patients with a negative NO (false negative and true negative) and those with a positive NO and abnormal pulmonary function tests, 135/275 (ODI-5), 156/275 (ODI-10), and 170/275 (ODI-15) PSGs would have been performed, a reduction of 140, 119, and 105,respectively.
CONCLUSION—Nocturnal oximetry in patients with suspected SAHS and normal spirometric values permits the institution of therapeutic measures in most patients.



Full Text

The Full Text of this article is available as a PDF (69.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barbé F., Amilibia J., Capote F., Durán J., Mangado N. G., Jiménez A., Marín J. M., Masa F., Montserrat J. M., Terán J. Diagnóstico del síndrome de apneas obstructivas durante el sueño. Informe de Consenso del Area de Insuficiencia Respiratoria y Trastornos del Sueño. Arch Bronconeumol. 1995 Nov;31(9):460–462. doi: 10.1016/s0300-2896(15)30866-8. [DOI] [PubMed] [Google Scholar]
  2. Chiner E., Blanquer J., Arriero J. M., Marco J. Síndrome de la apnea obstructiva del sueño en la Comunidad Valenciana: situación actual, estudio de necesidades y perspectivas de futuro. Arch Bronconeumol. 1998 Apr;34(4):177–183. doi: 10.1016/s0300-2896(15)30449-x. [DOI] [PubMed] [Google Scholar]
  3. Douglas N. J., Thomas S., Jan M. A. Clinical value of polysomnography. Lancet. 1992 Feb 8;339(8789):347–350. doi: 10.1016/0140-6736(92)91660-z. [DOI] [PubMed] [Google Scholar]
  4. Epstein L. J., Dorlac G. R. Cost-effectiveness analysis of nocturnal oximetry as a method of screening for sleep apnea-hypopnea syndrome. Chest. 1998 Jan;113(1):97–103. doi: 10.1378/chest.113.1.97. [DOI] [PubMed] [Google Scholar]
  5. Farré R., Montserrat J. M., Ballester E., Hernández L., Rotger M., Navajas D. Importance of the pulse oximeter averaging time when measuring oxygen desaturation in sleep apnea. Sleep. 1998 Jun 15;21(4):386–390. doi: 10.1093/sleep/21.4.386. [DOI] [PubMed] [Google Scholar]
  6. Findley L. J., Unverzagt M. E., Suratt P. M. Automobile accidents involving patients with obstructive sleep apnea. Am Rev Respir Dis. 1988 Aug;138(2):337–340. doi: 10.1164/ajrccm/138.2.337. [DOI] [PubMed] [Google Scholar]
  7. Gould G. A., Whyte K. F., Rhind G. B., Airlie M. A., Catterall J. R., Shapiro C. M., Douglas N. J. The sleep hypopnea syndrome. Am Rev Respir Dis. 1988 Apr;137(4):895–898. doi: 10.1164/ajrccm/137.4.895. [DOI] [PubMed] [Google Scholar]
  8. Gries R. E., Brooks L. J. Normal oxyhemoglobin saturation during sleep. How low does it go? Chest. 1996 Dec;110(6):1489–1492. doi: 10.1378/chest.110.6.1489. [DOI] [PubMed] [Google Scholar]
  9. Gyulay S., Olson L. G., Hensley M. J., King M. T., Allen K. M., Saunders N. A. A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea. Am Rev Respir Dis. 1993 Jan;147(1):50–53. doi: 10.1164/ajrccm/147.1.50. [DOI] [PubMed] [Google Scholar]
  10. He J., Kryger M. H., Zorick F. J., Conway W., Roth T. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest. 1988 Jul;94(1):9–14. [PubMed] [Google Scholar]
  11. Johns M. W. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest. 1993 Jan;103(1):30–36. doi: 10.1378/chest.103.1.30. [DOI] [PubMed] [Google Scholar]
  12. Lévy P., Pépin J. L., Deschaux-Blanc C., Paramelle B., Brambilla C. Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. Chest. 1996 Feb;109(2):395–399. doi: 10.1378/chest.109.2.395. [DOI] [PubMed] [Google Scholar]
  13. Pépin J. L., Lévy P., Lepaulle B., Brambilla C., Guilleminault C. Does oximetry contribute to the detection of apneic events? Mathematical processing of the SaO2 signal. Chest. 1991 May;99(5):1151–1157. doi: 10.1378/chest.99.5.1151. [DOI] [PubMed] [Google Scholar]
  14. Ryan P. J., Hilton M. F., Boldy D. A., Evans A., Bradbury S., Sapiano S., Prowse K., Cayton R. M. Validation of British Thoracic Society guidelines for the diagnosis of the sleep apnoea/hypopnoea syndrome: can polysomnography be avoided? Thorax. 1995 Sep;50(9):972–975. doi: 10.1136/thx.50.9.972. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Siafakas N. M., Vermeire P., Pride N. B., Paoletti P., Gibson J., Howard P., Yernault J. C., Decramer M., Higenbottam T., Postma D. S. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J. 1995 Aug;8(8):1398–1420. doi: 10.1183/09031936.95.08081398. [DOI] [PubMed] [Google Scholar]
  16. Sériès F., Marc I., Cormier Y., La Forge J. Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome. Ann Intern Med. 1993 Sep 15;119(6):449–453. doi: 10.7326/0003-4819-119-6-199309150-00001. [DOI] [PubMed] [Google Scholar]
  17. Williams A. J., Yu G., Santiago S., Stein M. Screening for sleep apnea using pulse oximetry and a clinical score. Chest. 1991 Sep;100(3):631–635. doi: 10.1378/chest.100.3.631. [DOI] [PubMed] [Google Scholar]
  18. Young T., Palta M., Dempsey J., Skatrud J., Weber S., Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993 Apr 29;328(17):1230–1235. doi: 10.1056/NEJM199304293281704. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES