0476 Can Oxygen Desaturation Be a Surrogate for Sleep Apnea in Sickle Cell Disease?

• Published in: Sleep (New York, N.Y.) N.Y.), 2018-04, Vol.41 (suppl_1), p.A180-A180
• Main Authors: Ayache, M, Strohl, K P, Little, J
• Format: Article
• Language: English
• Subjects: Accuracy; Hypoxemia; Sickle cell disease; Sleep apnea
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsy061.475

Abstract Introduction Nocturnal hypoxemia in people with sickle cell disease (SCD) is associated with worse clinical outcomes. The oxygen hemoglobin dissociation curve is shifted to the right in SCD. Therefore, the utility of oxygen desaturation index (ODI) in predicting apnea hypopnea index (AHI) is unclear. Overnight pulse oximetry (OPO) may shed light on whether significant sleep apnea can be recognized by oximetry data. The objective of this study is to investigate the relationship between ODI and AHI in SCD patients Methods Oximetry data and AHI were retrospectively collected from polysomnogram (PSG) reports of 45 adults with SCD over 2 years who underwent sleep testing for signs or symptoms of sleep-disordered breathing. [These data have resulted in a previous publication about nocturnal hypoxemia and reticulocytosis (Rotz el al. 2016)]. The Pearson correlation for AHI and 3%ODI (number of ≥3% desaturations per hour of sleep) was computed. Sensitivity and specificity of each 3%ODI point as a cutoff was calculated for the detection of AHI ≥15 and AHI ≥5. Results We found excellent correlation between AHI and 3%ODI (overall r=0.98; r= 0.99 in subjects with a mean saturation ≤93%). In 17 patients with a mean saturation >93%, a 3%ODI ≥19 was most accurate (92.3% accuracy, 100% sensitivity and 92.3% specificity) for the detection of AHI ≥15. For 28 patients with a mean saturation ≤93%, a 3%ODI cutoff ≥24 was associated with 80.00% accuracy (91.7% sensitivity and 88.24% specificity). For the detection of AHI ≥5, 3%ODI ≥6 was associated with 82.1% accuracy (sensitivity 92.3% and specificity 73.3%) in those with mean saturation >93%, while 3%ODI ≥11 was associated with 88.2% accuracy (100.0% sensitivity and 75.0% specificity) in those with mean saturation ≤93%. Conclusion The ODI from a PSG is closely associated with measures of sleep apnea in adult SCD patients. The tendency for ODI to overestimate AHI is more pronounced in those with lower mean saturation. Needed now are studies using OPO to predict sleep apnea in SCD patients. Support (If Any) none.