High-resolution wrist-worn overnight oximetry has high positive predictive value for obstructive sleep apnea in a sleep study referral population.
BACKGROUND
Reducing the need for diagnostic sleep studies for obstructive sleep apnea (OSA) would reduce direct and opportunity costs while expediting time to treatment for this common and morbid disorder. We sought to determine if an established sleep apnea screening questionnaire (STOP-BANG) and wrist-worn overnight oximetry data could provide high positive predictive value for the presence of OSA.


METHODS
We conducted a prospective observational study of consecutive unattended sleep study patients at a single facility. Patients were referred for sleep testing after chart review by a sleep physician. We assessed area under the receiver-operating characteristic curve (ROC AUC) and positive predictive value (PPV) of STOP-BANG score and oxygen desaturation index (ODI) for a respiratory disturbance index (RDI) ≥15/h.


RESULTS
Among 234 test patients, 65 % had an RDI ≥15/h. STOP-BANG had poor ability to discriminate these patients (ROC AUC 0.62). ODI added significant diagnostic information to the STOP-BANG score, increasing the ROC AUC to 0.86. Having the ODI, the STOP-BANG score no longer contributed significant diagnostic information, and the ODI alone discriminated as well as the combination (ROC AUC 0.86). Forty nine percent had an ODI ≥7/h, which had PPV of 92 % (95 % confidence interval (CI), 86 to 96 %). In the validation sample of 1,196 consecutive patients, ODI ≥ 7/h had a PPV of 97 % (95 % CI, 95 to 97 %).


CONCLUSIONS
Among patients with a high prevalence of OSA, high ODI is common and its presence has high PPV for OSA. These data suggest that overnight oximetry prior to sleep testing could significantly reduce the number of patients requiring sleep studies, thereby reducing costs and time to treatment.
Pulmonary, Critical Care, and Sleep Apnea (111N), Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA. kunis001@umn.edu.|University of Minnesota, Minneapolis, MN, USA. kunis001@umn.edu.
Ken M
http://orcid.org/0000-0001-8644-2827
KM
Kunisaki
Pulmonary, Critical Care, and Sleep Apnea (111N), Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA.|University of Minnesota, Minneapolis, MN, USA.
Oksana A
OA
Bohn
Pulmonary, Critical Care, and Sleep Apnea (111N), Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA.|University of Minnesota, Minneapolis, MN, USA.
Erin E
EE
Wetherbee
Pulmonary, Critical Care, and Sleep Apnea (111N), Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA.|University of Minnesota, Minneapolis, MN, USA.
Thomas S
TS
Rector
D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation*; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D010092:Oximetry / Q000295:instrumentation*; D010100:Oxygen / Q000097:blood; D017286:Polysomnography / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D011795:Surveys and Questionnaires
D010100:Oxygen
Oximetry; Predictive value of tests; Questionnaires; Sleep apnea syndromes