The Association between Oxygen Saturation by Pulse Oximetry and Respiratory Disturbance Index (RDI) and Apnea-Hypopnea Index (AHI) among Adult Snorer Patients
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Abstract
Introduction:
Obstructive sleep apnea (OSA) is common disorder as diagnosed by polysomnography (PSG)
and screening of adult snorer patients for priority PSG appointment is still a problem.
Objectives:
▪ To investigate association between minimum-SpO2 and RDI.
▪ To investigate association between minimum-SpO2 and AHI.
▪ To find minimum-SpO2 screening cut off for priority PSG appointment.
Methods:
Retrospective “PSG data” study of 1,159 adult snorer patients of the Department of
Otolaryngology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University.
Results:
Findings are inverse relationships (the lower the minimum-SpO2, the higher the RDI and the
lower the minimum-SpO2, the higher the AHI), an association between minimum-SpO2 and RDI
with area under curve (AUC) of 0.75, an association between minimum-SpO2 and AHI (AUC of
0.79), a highly significant statistical difference p < 0.001 (OR 1.09, 95 % CI, 1.07 - 1.11) between
minimum-SpO2 values of subjects with RDI ≥ 15/h and those of subjects with RDI <15/h, a
highly significant statistical difference p < 0.001 (OR 1.12, 95 % CI, 1.09 - 1.14) between
minimum-SpO2 values of subjects with AHI ≥ 15/h and those of subjects with AHI
< 15/h, and possible screening minimum-SpO2 values of 81%.
Conclusions:
1. There were association between minimum-SpO2 and RDI, and association between
minimum-SpO2 and AHI (by AUC values).
2. Minimum-SpO2 levels of 81% may be recommended for cutoffs in the screening of adult
snorer patients for priority PSG waiting-list.
3. Minimum-SpO2 may be used for screening during problematic periods with too long PSG
waiting-lists.
Keywords: obstructive sleep apnea, oxygen desaturation, minimum SpO2, polysomnography, pulse oximetry,
screening, snorer, snore, AHI, OSA, PSG, RDI, SpO2
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ต้นฉบับที่ส่งมาพิจารณายังวารสารหู คอ จมูก และใบหน้า จะต้องไม่อยู่ในการพิจารณาของวารสารอื่น ในขณะเดียวกันต้นฉบับที่จะส่งมาจะผ่านการอ่านโดยผู้ทรงคุณวุฒิ หากมีการวิจารณ์หรือแก้ไขจะส่งกลับไปให้ผู้เขียนตรวจสอบแก้ไขอีกครั้ง ต้นฉบับที่ผ่านการพิจารณาให้ลงตีพิมพ์ถือเป็นสมบัติของวารสารหู คอ จมูกและใบหน้า ไม่อาจนำไปลงตีพิมพ์ที่อื่นโดยไม่ได้รับอนุญาต
ตารางแผนภูมิ รูปภาพ หรือข้อความเกิน 100 คำที่คัดลอกมาจากบทความของผู้อื่น จะต้องมีใบยินยอมจากผู้เขียนหรือผู้ทรงลิขสิทธิ์นั้นๆ และใหร้ะบุกำกับไว้ในเนื้อเรื่องด้วย
References
Fitzpatrick MF, Martin K, Fossey E, Shapiro CM, Elton RA, Douglas NJ. Snoring, asthma and sleep disturbance in Britain: a community-based survey. Eur Respir J. 1993;6(4):531-5.
Puvanendran K, Goh KL. From snoring to sleep apnea in a Singapore population. Sleep Res Online. 1999;2(1):11-14.
Ohta Y, Okada T, Kawakami Y, Suetsugu S, Kuriyama T. Prevalence of risk factors for sleep apnea in Japan: a preliminary report. Sleep. 1993; 16(8 Suppl):S6-7.
Wali SO, Abaalkhail BA. Prevalence and predictors of habitual snoring in a sample of Saudi middle-aged adults. Saudi Med J. 2015;36(8):920-7.
Neruntarat C, Chantapant S. Prevalence of sleep apnea in HRH Princess Maha Chakri Srinthorn Medical Center, Thailand. Sleep Breath. 2011;15(4):641-8.
Mirrakhimov AE, Sooronbaev T, Mirrakhimov EM. Prevalence of obstructive sleep apnea in Asian adults: a systematic review of the literature. BMC Pulm Med. 2013;13:10. Published online 2013 Feb 23. Doi: 10.1186/1471-2466-13-10.
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14.
Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, et al. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US Preventative Services Task Force. JAMA. 2017;317(4):407-14. Doi:10.1001/jama.2016.20325
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;328(17):1230-5.
Bixler EO, Vgontzas AN, Lin HM, Have TT, Leiby BE, Vela-Bueno A, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med. 2000;160(15):2289-95.
Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479-504.
Bianchi MT, Lipoma T, Darling C, Alamedddine Y, Westover MB. Automated Sleep Apnea Quantification Based on Respiratory Movement. Int J Med Sci. 2014;11(8):796-802.
Goyal M, Johnson J. Obstructive sleep apnea diagnosis and management. Mo Med. 2017;114(2):120-4.
https://aasm.org/resources/clinicalguidelines/ diagnostic-testing-osa.pdf
Editors. Sleep Apnea Association and The Royal College of Otolaryngologists-Head and Neck Surgeons of Thailand: “Guideline for Development of Diagnosis and Treatment of Snoring and Obstructive Sleep Apnea in Thailand for Adults”, 2017.
Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep. 2006;29(3):375-80.
The Report of an American Academy of Sleep Medicine Task Force for American Academy of Sleep Medicine (AASM). Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667-89.
Redline S, Kapur VK, Sanders MH, Quan SF, Gottlieb DJ, Rapoport DM, et al. Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment. Am J Respir Crit Care. 2000;161:369-74.
Iber C, Ancoli-Israel S, Chesson AL, Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events. Rules, Terminology and Technical Specifications. Westchester, IL: American Academy of Sleep Medicine, 2007.
Redline S, Budhiraja R, Kapur V, Marcus CL, Mateika JH, Mehra R, et al. The scoring of respiratory events in sleep: reliability and validity. J Clin Sleep Med. 2007;3:169-200.
Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597-619.
Berry RB, Brooks R, Gamaldo CE, Harding SM, Llyod RM, Marcus C, et al. for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specifications. Version 2.1. www.aasmnet.org. Darien, Illinois: American Academy of Sleep Medicine. 2014.
Riley RW, Powell NB, Guilleminault C. Maxillofacial surgery and nasal CPAP. A comparison of treatment for obstructive sleep apnea syndrome. Chest. 1990;98(6):1421-5.
Maisel F, Antonelli PJ, Iber C, Mahowald M, Wilson KS, Fiedler B, Schluter J. Uvulopalatopharyngoplasty for obstructive sleep apnea: a community's experience. Laryngoscope. 1992;102(6):604-7.
Friedman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, Caldarelli D. Effect of improved nasal breathing on obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000;122(1):71-4.
Patel AV, Hwang D, Masdeu MJ, Chen GM, Rapoport DM, Ayappa I. Predictors of response to a nasal expiratory resistor device and its potential mechanisms of action for treatment of obstructive sleep apnea. J Clin Sleep Med. 2011;7:13-22.
Friedman M, Tanyeri H, Lim JW, Landsberg R, Vaidyanathan K, Caldarelli D. Impact of nasal obstruction on obstructive sleep apnea, Otolaryngol Head Neck Surg. 2011;144(6):1000-4.
Dixon JB, Schachter LM, O'Brien PE. Polysomnography before and after weight loss in obese patients with severe sleep apnea. Int J Obes (Lond). 2005;29(9):1048-54.
Cillo JE Jr, Finn R, Dasheiff RM. Combined open rhinoplasty with spreader grafts and laser-assisted uvuloplasty for sleep-disordered breathing: long-term subjective outcomes. J Oral Maxillofac Surg. 2006;64(8):1241-7.
Verse T, Baisch A, Maurer JT, Stuck BA, Hörmann K. Multilevel surgery for obstructive sleep apnea: short-term results. Otolaryngol Head Neck Surg. 2006;134(4):571-7.
Vicente E, Marín JM, Carrizo S, Naya MJ. Tongue-base suspension in conjunction with uvulopalatopharyngoplasty for treatment of severe obstructive sleep apnea: long-term follow-up results. Laryngoscope. 2006;116(7):1223-7.
Almeida FR, Parker JA, Hodges JS, Lowe AA, Ferguson KA. Effect of a titration polysomnogram on treatment success with a mandibular repositioning appliance. J Clin Sleep Med. 2009;5:198-204.
Eun YG, Kwon KH, Shin SY, Lee KH, Byun JY, Kim SW. Multilevel surgery in patients with rapid eye movement-related obstructive sleep apnea. Otolaryngol Head Neck Surg. 2009;140(4):536-41.
Kezirian EJ, Malhotra A, Goldberg AN, White DP, Changes in obstructive sleep apnea severity, biomarkers, and quality of life after multilevel surgery. Laryngoscope. 2010;120(7):1481-8.
Magalang UJ, Dmochowski J, Veeramachaneni S, Draw A, Mador MJ, El-Solh A, Grant BJB. Prediction of the apnea-hypopnea index from overnight pulse oximetry. Chest. 2003;124:1694-701.
Lin C-L, Yeh C, Yen C-W, Hsu W-H, Hang L-W. Comparison of the indices of oxyhemoglobin saturation by pulse oximetry in obstructive sleep apnea hypopnea syndrome. Chest. 2009;135:86-93.
Kezirian EJ, Weaver EM, Criswell MA, de Vries N, Woodson BT, Piccirillo JF. Reporting results of obstructive sleep apnea syndrome surgery trials. Otolaryngol Head Neck Surg. 2011;144(4):496-99.
Ravesloot MJL, de Vries N. Reliable calculation of the efficacy of non-surgical and surgical treatment of obstructive sleep apnea revisited. Sleep. 2011;34(1):105-10.
Eiseman NA, Westover MB, Ellenbogen JM, Bianchi MT. The impact of body posture and sleep stages on sleep apnea severity in adults. J Clin Sleep Med. 2012;8:655-66.
Karakoc O, Akcam T, Gerek M, Genc H, Ozgen F. The upper airway evaluation of habitual snorers and obstructive sleep apnea patients. ORL J Otorhinolaryngol Relat Spec. 2012;74(3):136-40.
Gunawardena I, Robinson S, MacKay S, Woods CM, Choo J, Esterman A, Carney AS. Submucosal lingualplasty for adult obstructive sleep apnea. Otolaryngol Head Neck Surg. 2013;148(1):157-65.
Choi JH, Lee SH, Cho JH, Kim SW, Cho KS, Koo SK, et al. Five-year subjective outcomes of obstructive sleep apnea surgery: a multi-institutional study. Clin Exp Otorhinolaryngol. 2015;8(4):370-5.
Muntarbhorn K, Kunachak S. Severe sleep apnea and very severe sleep apnea: apnea-hypopnea index of 55 per hour separated very severe subgroup from severe subgroup for research. Asian Rhinol J. 2016:3(1):64-9.
Hang LW, Wang HL, Chen JH, Hsu JC, Lin HH, Chung WS, et al. Validation of overnight oximetry to diagnose patients with moderate to severe obstructive sleep apnea. BMC Pulmonary Medicine. 2015;15:24. DOI: 10.1186/s12890-015-0017z. ODI SENS 89.4 - 89.9 %, SPEC 86.4 - 86.6 %
Dumitrache-Rujinski S, Calcaianu G, Zaharia D, Toma CL, Bogdan M. The role of overnight pulse-oximetry in recognition of obstructive sleep apnea syndrome in morbidly obese and non-obese patients. Maedica (Buchur). 2013;8:237–42.
Netzer N, Eliasson AH, Netzer C, Kristo DA. Overnight pulse oximetry for sleep-disordered breathing in adults: A review. Chest. 2001;120:625–33.
Scott AS, Baltzan MA, Wolkove N. Examination of pulse oximetry tracings to detect obstructive sleep apnea in patients with advanced chronic obstructive pulmonary disease. Can Respir J. 2014;21:171-175.
Singh S, Khan SZ, Singh D,Verma S,Talwar A. The uses of overnight pulse oximetry. Lung India. 2020;37(2):151-7. Published online 2020 Feb 27. Doi: 10.4103/ lungindia. lungindia_302_19.
Temirbekov D, Güneş S, Yazıcı ZM, İbrahim Sayın İ. The ignored parameter in the diagnosis of obstructive sleep apnea syndrome: the oxygen desaturation index. Turk Arch Otorhinolaryngol. 2018;56(1):1-6.
Kulpraneet M. Can overnight pulse oximetry recording be used as a screening measure for onstructive sleep apnea. Thai J TB Chest dis Crit Care Med. 2007;28(1):9-11.
Muntarbhorn K, Kunachak S. Extremely severe sleep apnea as one of the two categories of “very severe sleep apnea” adult snorers: usefulness of apnea-hypopnea indexes and lowest oxygen desaturations to create such categories for research. Asian Rhinol J. 2018;4(1):6-10.
Honero R, Alvarez D, Albásolo D, del Campo F, Zarmarrón C. Utility of approximate entropy from overnight pulse oximetry data in the diagnosis of obstructive sleep apnea syndrome. IEEE Trans Biomed Eng. 2007;54(1):107-13.
Liu J, Huang R, Xiao Y, Lin S. ApEn for assessing hypoxemia severity in obstructive sleep apnea hypopnea syndrome patients. Sleep Breath. 2020;24(4):1481-6.