title: Oxygen desaturation index from nocturnal oximetry: a sensitive and specific tool to detect sleep-disordered breathing in surgical patients.
abstract: BACKGROUND
  It is impractical to perform polysomnography (PSG) in all surgical patients suspected of having sleep disordered breathing (SDB). We investigated the role of nocturnal oximetry in diagnosing SDB in surgical patients.
  
  
  METHODS
  All patients 18 years and older who visited the preoperative clinics for scheduled inpatient surgery were approached for study participation. Patients expected to have abnormal electroencephalographic findings were excluded. All patients underwent an overnight PSG at home with a portable device and a pulse oximeter. The PSG recordings were scored by a certified sleep technologist. The oximetry recordings were processed electronically.
  
  
  RESULTS
  Four hundred seventy-five patients completed the study: 217 males and 258 females, aged 60 ± 11 years, and body mass index 31 ± 7 kg/m(2). The apnea-hypopnea index (AHI), the average number of episodes of apnea and hypopnea per hour of sleep, was 9.1 (2.8 to 21.4) [median (interquartile range)] and 64% patients had AHI >5. There was a significant correlation between oxygen desaturation index (ODI, hourly average number of desaturation episodes) and cumulative time percentage with SpO(2) <90% (CT90) from nocturnal oximetry, with the parameters measuring sleep breathing disorders from PSG. Compared to CT90, ODI had a stronger correlation and was a better predictor for AHI. The area under receiver operator characteristics curve for ODI to predict AHI >5, AHI >15, and AHI >30 was 0.908 (CI: 0.880 to 0.936), 0.931 (CI: 0.090 to 0.952), and 0.958 (CI: 0.937 to 0.979), respectively. The cutoff value based on the maximal accuracy for ODI to predict AHI >5, AHI >15, and AHI >30 was ODI >5, ODI >15, and ODI >30. The accuracy was 86% (CI: 83%-88%), 86% (CI: 83%-89%), and 94% (CI: 92%-96%), respectively. The ODI >10 demonstrated a sensitivity of 93% and a specificity of 75% to detect moderate and severe SDB.
  
  
  CONCLUSIONS
  ODI from a high-resolution nocturnal oximeter is a sensitive and specific tool to detect undiagnosed SDB in surgical patients.
authors.affiliation: Department of Anesthesia, University Health Network, University of Toronto, 399, Bathurst Street, Toronto, ON, Canada M5T 2S8. frances.chung@uhn.on.ca
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
authors.forename: Pu
authors.initials: P
authors.lastname: Liao
authors.forename: Hisham
authors.initials: H
authors.lastname: Elsaid
authors.forename: Sazzadul
authors.initials: S
authors.lastname: Islam
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
authors.forename: Yuming
authors.initials: Y
authors.lastname: Sun
mesh_terms: D000368:Aged; D001143:Arousal / Q000502:physiology; D015992:Body Mass Index; D003627:Data Interpretation, Statistical; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods; D010092:Oximetry / Q000379:methods*; D010101:Oxygen Consumption; D017286:Polysomnography; D012372:ROC Curve; D018401:Sample Size; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000378:metabolism*; D012894:Sleep Stages / Q000502:physiology