Predictive performance of oximetry in detecting sleep apnea in surgical patients with cardiovascular risk factors

• Published in: PloS one 2021-05, Vol.16 (5), p.e0250777
• Main Authors: Waseem, Rida, Chan, Matthew T V, Wang, Chew Yin, Seet, Edwin, Chung, Frances
• Format: Article
• Language: English
• Subjects: Aged; Apnea; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - etiology; Care and treatment; Complications; Confidence intervals; Congestive heart failure; Coronary artery; Coronary artery disease; Creatinine; Demographic aspects; Diabetes; Diabetes mellitus; Diagnosis; Editing; Female; Funding; Health care networks; Health risks; Health services; Heart Disease Risk Factors; Heart diseases; Heart surgery; Hospitals; Humans; Hypertension; Ischemia; Likelihood ratio; Male; Medicine and Health Sciences; Middle Aged; Orthopedics; Oximetry; Oximetry - methods; Patients; Performance prediction; Physical Sciences; Polysomnography; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Predictive Value of Tests; Prospective Studies; Pulse oximetry; Renal function; Risk analysis; Risk Factors; Sleep; Sleep apnea; Sleep apnea syndromes; Sleep Apnea Syndromes - diagnosis; Sleep Apnea, Obstructive - diagnosis; Sleep disorders; Software; Stroke; Surgery; Transient ischemic attack
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0250777

In adults with cardiovascular risk factors undergoing major noncardiac surgery, unrecognized obstructive sleep apnea (OSA) was associated with postoperative cardiovascular complications. There is a need for an easy and accessible home device in predicting sleep apnea. The objective of the study is to determine the predictive performance of the overnight pulse oximetry in predicting OSA in at-risk surgical patients. This was a planned post-hoc analysis of multicenter prospective cohort study involving 1,218 at-risk surgical patients without prior diagnosis of sleep apnea. All patients underwent home sleep apnea testing (ApneaLink Plus, ResMed) simultaneously with pulse oximetry (PULSOX-300i, Konica Minolta Sensing, Inc). The predictive performance of the 4% oxygen desaturation index (ODI) versus apnea-hypopnea index (AHI) were determined. Of 1,218 patients, the mean age was 67.2 ± 9.2 years and body mass index (BMI) was 27.0 ± 5.3 kg/m2. The optimal cut-off for predicting moderate-to-severe and severe OSA was ODI ≥15 events/hour. For predicting moderate-to-severe OSA (AHI ≥15), the sensitivity and specificity of ODI ≥ 15 events per hour were 88.4% (95% confidence interval [CI], 85.7-90.6) and 95.4% (95% CI, 94.2-96.4). For severe OSA (AHI ≥30), the sensitivity and specificity were 97.2% (95% CI, 92.7-99.1) and 78.8% (95% CI, 78.2-79.0). The area under the curve (AUC) for moderate-to-severe and severe OSA was 0.983 (95% CI, 0.977-0.988) and 0.979 (95% CI, 0.97-0.909) respectively. ODI from oximetry is sensitive and specific in predicting moderate-to-severe or severe OSA in at-risk surgical population. It provides an easy, accurate, and accessible tool for at-risk surgical patients with suspected OSA.