Overnight Pulse Oximetry for Sleep-Disordered Breathing in Adults: A Review

doi:10.1378/chest.120.2.625

Chest

Volume 120, Issue 2, August 2001, Pages 625-633

https://doi.org/10.1378/chest.120.2.625 Get rights and content

Pulse oximetry is a well-established tool routinely used in many settings of modern medicine to determine a patient's arterial oxygen saturation and heart rate. The decreasing size of pulse oximeters over recent years has broadened their spectrum of use. For diagnosis and treatment of sleep-disordered breathing, overnight pulse oximetry helps determine the severity of disease and is used as an economical means to detect sleep apnea. In this article, we outline the clinical utility and economical benefit of overnight pulse oximetry in sleep and breathing disorders in adults and highlight the controversies regarding its limitations as presented in published studies.

Section snippets

Interpretation and Technical Aspects of Overnight Pulse Oximetry

Common sense dictates that pulse oximetry can be a useful tool only if the user knows how to interpret the oximetry data. In a survey performed in 1997 with 203 respondents, only 36% of intensive care nurses, 4% of medical technicians, and 50% of anesthesia technicians believed that they had received adequate training in interpreting pulse oximetry data. Only 68.5% correctly stated what pulse oximeters actually measure.¹¹ These survey results were found despite the fact that practice guidelines

Sensitivity and Specificity of Overnight Pulse Oximetry in Screening for Sleep-Disordered Breathing

Over the last decade, a debate in the literature has questioned whether or not pulse oximetry could effectively screen patients for sleep-disordered breathing and possibly replace NPSG in many patients. Deegan and McNicholas²⁸ reported 250 consecutive Irish patients who underwent NPSG. In one third of these patients, patient history and pulse oximetry data would have been sufficient to make a diagnosis. In the other two thirds, a final diagnosis could be established only by NPSG.²⁸

Other studies

Overnight Pulse Oximetry in Combination With Other Parameters

Pulse oximetry is the most important parameter for identifying sleep-disordered breathing in many portable multichannel sleep apnea screening devices. The next most commonly measured parameters are snoring sound via microphone,⁴⁷⁴⁸ oronasal airflow measured via thermistor or nasal pressure cannula,⁴⁹⁵⁰⁵¹ and ECG recording.⁵² One author⁵² argues that the full ECG provides information about the comorbidity of cardiovascular disease in sleep apnea better than pulse oximetry alone. In 1998,

Other Applications

Overnight pulse oximetry is frequently being used to assess the response to the surgical interventions for OSA as well as the effectiveness of therapy with continuous positive airway pressure. However, this clinical practice is not established in the literature, and validation of its use for this indication is lacking. Continuous pulse oximetry is also in frequent use in a variety of other settings, including preoperative evaluations, the operating room, postanesthesia recovery suites, ICUs,

Limitations

While pulse oximetry is a useful clinical tool in sleep medicine, it suffers from major limitations due to the nature of the parameters that are monitored.⁷⁸⁷⁹⁸⁰ Limitations result from problems with blood flow, hemoglobin, or a lack of change in oxygen saturation.

Pulse oximetry relies on pulsatile blood flow for its measurements and is vulnerable to the effects of poor peripheral arterial blood flow. Therefore, body movements, vasoconstriction, and hypotension can cause artifacts through an

Cost-effectiveness

Bennet and Kinnear¹⁰ call pulse oximetry “sleep on the cheap” in their 1999 editorial because it generates a lot of data at a very low cost. Perhaps the only competitor for cost-effectiveness is a structured and validated questionnaire. In other fields of medicine, the cost-effectiveness of pulse oximetry is more or less accepted.⁸⁵ In sleep medicine, the clinical value of overnight pulse oximetry alone for the diagnosis of sleep apnea syndrome has become controversial since NPSG has been

Conclusion

Overnight pulse oximetry is a very useful tool for the diagnosis of sleep-disordered breathing. Authoritatively establishing a final diagnosis is very difficult without oximetry data. As a screening tool for the diagnosis of OSA, pulse oximetry is cost-effective and shows substantial accuracy. Sensitivity and specificity remain controversial, however, and deserve further clarification through controlled studies. Technical limitations, limited user knowledge, and the lack of consensus on

References (91)

T Ahrens et al.
Pulse oximetry
Crit Care Nurs Clin North Am
(1999)
AJ Williams et al.
Screening for sleep apnea using pulse oximetry and a clinical score
Chest
(1991)
RE Gries et al.
Normal oxyhemoglobin saturation during sleep
Chest
(1996)
T Mooe et al.
Sleep-disordered breathing in women: occurrence and association with coronary artery disease
Am J Med
(1996)
LJ Epstein et al.
Cost-effectiveness analysis of nocturnal oximetry as a method of screening for sleep apnea-hypopnea syndrome
Chest
(1998)
DI Loube et al.
Comparison of respiratory polysomnographic parameters in matched cohorts of upper airway resistance and obstructive sleep apnea syndrome patients
Chest
(1999)
P Levy et al.
Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome
Chest
(1996)
E Calderon-Osuna et al.
A comparative study with chronic obstructive pulmonary disease with and without obstructive sleep apnea syndrome
Arch Bronchoneumol
(1999)
CF George
Diagnostic techniques in obstructive sleep apnea
Prog Cardiovasc Dis
(1999)
JM Rodriguez Gonzalez-Moro et al.
Usefulness of the visual analysis of night oximetry as a screening method in patients with suspected clinical sleep apnea syndrome
Arch Bronconeumol
(1996)

JA Bennett et al.

Sleep on the cheap: the role of overnight oximetry in the diagnosis of sleep apnea-hypopnea syndrome

Thorax

(1999)

PS Kruger et al.

BMJ

(1999)

S Redline et al.

Hypopnea, a floating metric: implications for prevalence, morbidity estimates, and case finding

Sleep

(1997)

E Ullmer et al.

Cheyne-stokes respiration of obstructive sleep apnea: pattern desaturation [letter]

Respiration

(2000)

Cited by (265)

Effects of nocturnal complete denture usage on cardiorespiratory parameters: A pilot study
2022, Journal of Prosthetic Dentistry
Sleeping without conventional complete dentures (CCDs) has been stated by some to induce negative effects on the cardiorespiratory functions of edentulous patients with obstructive sleep apnea (OSA), although others have reported the exact opposite. Therefore, a consensus on nocturnal CCD usage is lacking.
The purpose of this clinical study was to assess the effects of nocturnal denture usage on cardiorespiratory stability by using pulse oximetry (PO).
Thirty CCD wearers were enrolled in the study. The first nocturnal pulse oximetry (FNPO) recordings were made on 3 different nights while the participants were sleeping without dentures (WOD). Oxygen desaturation index (ODI) and other PO parameters of the participants, including total respiratory event (TRE), basal SpO₂ (BSpO₂), time≤88 (T88), average low SpO₂ (ALSpO₂), total pulse event (TPE), average pulse rate (APR), and heart rate variability index (HRVI), were processed and the obtained data were recorded as WOD condition values. According to the ODI scores, the OSA status of the participants was grouped as normal (ODI<5), mild (5<ODI<15), moderate (15<ODI<30), or severe (ODI>30). Complete dentures were fabricated by an experienced prosthodontist and a dental laboratory technician by following conventional procedures. At the end of the first month of the follow-up period, the second nocturnal PO recordings (SNPO) were made on 3 different nights while the participants slept wearing dentures (WID), and the data obtained were recorded as WID condition values. The comparison of mean PO values obtained from WOD and WID were analyzed with the Wilcoxon signed- rank test (α=.05).
Significant differences were found between WOD and WID values in terms of TRE (P=.01), ODI (P=.001), ALSpO2 (P=.006), TPE (P=.001), and HRVI (P=.001) parameters. The significance of the improvements in the WID condition increased with the severity of OSA.
Improvements were observed in substantial cardiorespiratory parameters such as the ODI and HRVI of the participants wearing dentures nocturnally.
Association of longitudinal changes in quality of life with comorbidities and exacerbations in patients with severe asthma
2022, Allergology International
Quality of life (QoL) assessment is important in the management of severe asthma, and comorbidities and/or exacerbations may affect longitudinal QoL. However, there are few reports on the longitudinal assessment of QoL in patients with asthma over multiple years and its related factors. This study aimed to clarify the relationship of longitudinal changes in QoL with comorbidities and/or exacerbations during a prolonged observation period in patients with severe asthma.
A total of 105 subjects who participated in the Hokkaido-based Investigative Cohort Analysis for Refractory Asthma (Hi-CARAT) with a six-year follow-up were analyzed. QoL was assessed annually, using the Standardized Asthma Quality of Life Questionnaire, and the subjects were divided into three groups: (1) persistently good QoL, (2) persistently poor QoL, and (3) fluctuating QoL. Assessed comorbidities comprised depression, gastroesophageal reflux disease, and excessive daytime sleepiness (EDS), a key symptom of obstructive sleep apnea.
Of 105 subjects with severe asthma, 53 (50%) were classified in the persistently good QoL group, 10 (10%) in the persistently poor QoL group, and 42 (40%) in the fluctuating QoL group. The persistently poor QoL group was associated with shorter time to hospitalization due to exacerbation and the presence of multiple comorbidities. In addition, the presence of EDS was an independent contributor to the fluctuating QoL group compared to the persistently good QoL group.
The presence of multiple comorbidities and hospitalization due to exacerbation contribute to longitudinal changes in QoL in patients with severe asthma.
Getting More from the Sleep Recording
2021, Sleep Medicine Clinics
Increased heart rate with sleep disordered breathing in hypertrophic cardiomyopathy
2021, International Journal of Cardiology
Citation Excerpt :
While the overnight oximetry provides a more affordable and practical sleep assessment compared to polysomnography, it cannot reliably distinguish between obstructive and central sleep apnea. It has been shown to serve as a reliable measure of SDB [35], and previous reports show significant correlation between oxygen desaturation index obtained during oximetry and apnea hypopnea index recorded during PSG [36]. Significant limitations arise also from the fact that HCM itself consists of various forms (apical, basal, etc.), and also of many specific genotype mutations.
Current guidelines recommend medications with rate control properties for symptomatic patients with hypertrophic cardiomyopathy (HCM) based on the rationale that lowering heart rate (HR) improves their symptoms. Whether sleep disordered breathing (SDB) is associated with increased HR in HCM patients is not known.
We diagnosed uncontrolled SDB (oxygen desaturation index ≥5) in consecutive echocardiographically confirmed HCM patients seen at Mayo Clinic, Rochester, and analyzed their HR as recorded by a 24-h Holter monitor. We compared mean, minimum, maximum HR between those with vs without SDB. In a pilot subanalysis of HCM patients with SDB who also underwent subsequent diagnostic polysomnography (PSG), we analyzed RR interval changes coinciding with obstructive sleep apnea and hypopnea episodes.
Of the 230 HCM patients included in this study (age 54 ± 16 years; 138 male; LVOT pressure gradient at rest 45 ± 39 mmHg), 115 (50%) patients had SDB. HCM patients with SDB were recorded to have higher mean HR (71 vs. 67 bpm; p = .002, adjusted p = .001), and this difference was most pronounced during night hours of 10 PM to 5 AM (61 vs. 67 bpm; p < .001). In the pilot analysis of the available PSG data, the release of obstructive sleep apneas and hypopneas coincided with fluctuation of HR.
SDB is independently associated with higher mean HR in patients with HCM, and this difference is most significant during sleep. Treatment of SDB, which is readily available, should be tested as a complementary modality to the currently recommended pharmacotherapy aimed at lowering HR in patients with symptomatic HCM.
Photoplethysmography in oxygenation and blood volume measurements
2021, Photoplethysmography: Technology, Signal Analysis and Applications
Since its discovery, photoplethysmography (PPG) has been almost exclusively associated with pulse oximetry, a noninvasive and continuous technique measuring oxygen saturation levels in blood. This chapter will describe how PPG signals are utilized in pulse oximetry to measure blood oxygen saturation (SpO₂). The chapter will also provide a snapshot on the capabilities and potentials of PPG in the clinical monitoring of oxygenation and perfusion. The first part of the chapter covers the principles, latest advancements, and applications of pulse oximetry, whereas the second part covers the application of PPG in measuring blood volume changes and perfusion among other parameters.
Risk factors for collisions attributed to microsleep-related behaviors while driving in professional truck drivers
2024, Scientific Reports

View all citing articles on Scopus

View full text

Chest

ReviewsOvernight Pulse Oximetry for Sleep-Disordered Breathing in Adults: A Review

Section snippets

Interpretation and Technical Aspects of Overnight Pulse Oximetry

Sensitivity and Specificity of Overnight Pulse Oximetry in Screening for Sleep-Disordered Breathing

Overnight Pulse Oximetry in Combination With Other Parameters

Other Applications

Limitations

Cost-effectiveness

Conclusion

Crit Care Nurs Clin North Am

Chest

Chest

Am J Med

Chest

Chest

Chest

Arch Bronchoneumol

Prog Cardiovasc Dis

Arch Bronconeumol

Br J Anesth

J Neurol Sci

Chest

Br J Anaesth

Chest

Chest

Otolaryngol Clin North Am

Respir Med

Lancet

Forty years of blood gases and critical care analytes measurement [in French]

Ann Biol Clin

Clinical assessment of sleep apnea syndrome

QJM

Clinical diagnosis and assessment of obstructive sleep apnea syndrome

Arch Chest Dis

Predictors and prevalence of obstructive sleep apnea and snoring in 1001 middle aged men

Thorax

Model for investigating snorers with suspected sleep apnea syndrome

Thorax

Pulse oximeters go mobile as prices continue dropping

Hosp Mater Manage

Sleep on the cheap: the role of overnight oximetry in the diagnosis of sleep apnea-hypopnea syndrome

Thorax

A study of a hospital staff's knowledge of pulse oximetry

Anesth Intensive Care

AARC (American Association for Respiratory Care) clinical practice guideline: pulse oximetry

Respir Care

Sleep and breathing in recreational climbers at an altitude of 4200 and 6400 meters

Sleep Breathing

Evaluation of the Ohmeda 3700 pulse oximeter

Thorax

Importance of the pulse oximeter averaging time when measuring oxygen desaturation in sleep apnea

Sleep

The effects of motion on the performance of pulse oximeters in volunteers

Anesthesiology

Detection of movement artifact in recorded pulse oximetry saturation

Eur J Pediatr

Computerized detection of respiratory events during sleep from rapid increases in oxyhemoglobin saturation

Lung

Prevalence of sleep-disordered breathing in ages 40–64 years: a population-based survey

Sleep

Automated detection and classification of sleep-disordered breathing from conventional polysomnography data

Sleep

Value of nocturnal oxygen saturation as a screening test for sleep apnea

Thorax

Screening of sleep apnea-hypopnea syndrome by home pulse oximetry

Nihon Kokyuki Gakkai Zasshi

Validation of British Thoracic Society guidelines for the diagnosis of the sleep apnea-hypopnea syndrome: can polysomnography be avoided?

Thorax

Predictive value of clinical features for the obstructive sleep apnea syndrome

Eur Respir J

Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnea

Thorax

Waveforms are needed to interpret figures shown by pulse oximeters [letter]

BMJ

Hypopnea, a floating metric: implications for prevalence, morbidity estimates, and case finding

Sleep

Cheyne-stokes respiration of obstructive sleep apnea: pattern desaturation [letter]

Respiration

Reviews
Overnight Pulse Oximetry for Sleep-Disordered Breathing in Adults: A Review