A Comparison of Clinical Assessment and Home Oximetry in the Diagnosis of Obstructive Sleep Apnea

Abstract In order to determine whether measurement of arterial oxygen saturation (SaO2) could identify patients with obstructive sleep apnea (OSA), 98 consecutive patients referred for assessment of snoring and/or daytime somnolence were assessed clinically and then underwent both unsupervised oximetry in their homes and formal polysomnography. Clinical assessment identified patients with an apnea + hypopnea index (AHI) ⩾ 15 events per hour with a sensitivity of 79% and a specificity of 50%. Home oximetry analyzed by counting the number of arterial oxygen desaturations recorded was inferior to clinical assessment. For desaturations of 2% or more from baseline, desaturation index (DI) ⩾ 15 per hour identified patients with AHI ⩾ 15 with sensitivity 65% and specificity 74%; for 3% desaturations, sensitivity was 51% and specificity 90%; and for 4% desaturations, sensitivity was 40% and specificity 98%. From the oximetry data, the percentage of time spent at SaO2 below 90% (CT90) was also calculated. CT90 ⩾ 1% identified patients with AHI ⩾ 15 with sensitivity 93% and specificity 51%; for patients with AHI ⩾ 15 ultimately given nasal continuous positive airway pressure (CPAP), the sensitivity of a CT90 ⩾ 1% was 100%. We concluded that home oximetry with CT90 1% practically excludes clinically significant OSA. Conversely, home oximetry with DI ⩾ 15 for 4% desaturations makes OSA likely: the positive predictive value for OSA is 83% if the pretest probability of OSA is 30% and over 90% if the pretest probability is at least 50%.