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Predictive value of automated oxygen saturation analysis for the diagnosis and treatment of obstructive sleep apnoea in a home-based setting

Laboratoire du sommeil, Centre hospitalier de l’Université de Montréal (CHUM)–Hôtel-Dieu, Montréal, Québec, Canada

Correspondence to:
Correspondence to:
François Bellemare PhD
Laboratoire du sommeil, CHUM–Hôtel-Dieu, 3840 St-Urbain, Montréal, Québec, Canada H2W 1T8; bellemare{at}videotron.qc.ca

ABSTRACT
Background: A portable monitor for the automated analysis of episodic nocturnal oxygen saturation or SpO₂ (the Remmers Sleep Recorder, RSR) has been proposed for the diagnosis of obstructive sleep apnoea-hypopnoea (OSAH). A study was undertaken to compare the diagnostic performance of automated analysis with the manual scoring of polygraphic data by a more comprehensive respiratory monitor (the Suzanne recorder) used simultaneously in their intended home environment.

Methods: The respiratory disturbance indexes of the two monitors were compared in 94 consecutive adult patients suspected of having OSAH and who were deemed eligible for home-based investigation.

Results: The RSR overestimated the number of respiratory events associated with a 4% fall in SpO₂ by 13% (p<0.005) but underestimated the number of apnoeas and hypopnoeas defined on the basis of respiratory variables alone or their association with a 4% fall in SpO₂ or autonomic arousals by 38–48% (p<0.0001). In addition to these significant biases, the limits of agreement in all instances were wide, indicating a poor concurrence between the two monitors.

Conclusion: The automated analysis of SpO₂ with the RSR cannot be substituted for the manual scoring of polygraphic data with the more comprehensive respiratory monitor in the diagnosis of OSAH in an ambulatory home-based setting.

Abbreviations: AHI, apnoea-hypopnoea index; ESS, Epworth Sleepiness Scale; FEV₁, forced expiratory volume in 1 s; OSAH, obstructive sleep apnoea-hypopnoea; PSG, polysomnography; RDI, respiratory disturbance index; RSR, Remmers Sleep Recorder; SpO₂, oxygen saturation

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