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Clinical Investigations: SLEEP AND BREATHING |

Home Oximetry Studies for Diagnosis of Sleep Apnea/Hypopnea Syndrome*: Limitation of Memory Storage Capabilities

Nicola Wiltshire; Adrian H. Kendrick, PhD; James R. Catterall, MD
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*From the Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol, England.

Correspondence to: Adrian H. Kendrick, PhD, Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol BS2 8HW, England; e-mail: adrian.kendrick@ubht.swest.nhs.uk



Chest. 2001;120(2):384-389. doi:10.1378/chest.120.2.384
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Background: Memory oximeters enable diagnostic studies for sleep apnea hypopnea syndrome (SAHS) to be performed in the home. However, memory capabilities may be limited.

Study Objectives: To compare a pulse oximeter used at home with an 8-h memory, storing data every 12 s, and in the laboratory, with on-line recording every 2 s.

Design: Prospective cohort study.

Setting: Patients’ homes and a sleep laboratory.

Patients: One hundred patients with suspected SAHS.

Measurements: Home oximetry and a laboratory full polysomnography. The number of ≥ 4% dips in pulse oximetric saturation (Spo2) was calculated for each study. Daytime sleepiness was assessed by the Epworth Sleepiness Scale (ESS) score.

Results: The mean dips per hour were 5.3/h (range, 0 to 53/h) for home studies and 13.4/h (range, 0 to 106/h) for laboratory studies; the relationship between home and laboratory studies was as follows: home = (0.4 × laboratory) − 0.01 ± 11.2; r2 = 0.64. Mean difference was 8.4/h (− 2.5 to + 77.9/h), which correlated with the mean of the measurements. At a cutoff point of 10/h, 52 studies were both negative and 13 studies were both positive. Nineteen home studies were false-negatives. Sensitivity was 0.41, and specificity was 1.0. In these 19 studies, 7 patients had an ESS score > 10 and 4 patients had an ESS score > 14. To confirm that differences were due to different sampling rates, 16 additional patients had on-line data and stored data collected simultaneously in the laboratory. Mean dips per hour were 3.2/h (range, 0.1 to 18.3/h) for the stored data and 8.34/h (0.2 to 22.8/h) for on-line data; the relationship being stored was as follows: 0.5 on-line − 1.17 ± 2.6; r2 = 0.69. Mean difference was 5.2/h (0.04 to 15.4 h), which correlated with the mean of the measurements.

Conclusion: Home studies using a memory storage pulse oximeter may underestimate the number of hypoxic dips, probably due to sampling rates. Clinically significant hypoxic SAHS may therefore be missed.

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