Title

Oximeters Are The Preferred Diagnostic Method For Pre-Testing Patients Suspected of Having Moderate To Severe Obstructive Sleep Apnea

Clinical Question

How does a pulse oximeter analysis during sleep compare with the gold standard, overnight polysomnography (PSG) study in the diagnoses of Obstructive sleep apnea (OSA)?

Clinical Bottom Line

Pluse oximetry is a very useful test in pre-screening for Obstructive Sleep Apnea. Comparison of pulse oximeter analysis against the gold standard proved to be highly effective in producing accurate diagnosis. (See Comments on the CAT below)

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
10875559	Ross/2000	1784 patients	Meta-Analysis
Key results	The author of the article pointed out the importance of knowing that PSGs are recognized as the gold standard, despite the fact that this is an unproven assumption. Analysis of the patients studied demonstrated that in some cases where the likelihood of sleep apnea is highly probably, oximetry would prove to be sufficient. In these cases, PSG are thought to be unnecessary in the diagnosis of sleep apnea.
11706311	Boehlecke/2001	275 patients	Review
Key results	A pool of 275 patients suspected to have OSA were tested via polysomnography and oximetry, resulting in 79% of the tested population being diagnosed with OSAHS. Based on predetermined parameters the oximeter demonstrated a 71% sensitivity and 90% specificity in terms of its ability to classify the presence and type of OSA in the patient.

Evidence Search

("Sleep Apnea Syndromes/diagnosis"[Mesh] AND "Polysomnography"[Mesh]) AND "Severity of Illness Index"[Mesh] AND (Review[ptyp] OR Meta-Analysis[ptyp]) AND ("oximetry"[MeSH Terms] OR "oximetry"[All Fields]) OR ("Sleep Apnea Syndromes/diagnosis"[Mesh] AND "Polysomnography"[Mesh]) AND "Severity of Illness Index"[Mesh] AND Meta-Analysis[ptyp]

Comments on
The Evidence

When it is necessary to test a large population, in the presence of constrictions such as time and convenience, the oximeter proved to be a very useful tool in providing preliminary analysis for OSA screening. With this said, it is important to recognize the possibility of false positive and negative and the clinical factors that need to be considered in order to avoid such occurrences. In the event of a suspected possible false positive or false negative, it is strongly recommended that the patient undergo further study using an in-laboratory polysomnogram.

Applicability

Initial screening of suspected OSA can be accomplished using an in-home setting overnight oximetry.

Specialty

(Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Dental Hygiene)

Keywords

obstructive sleep apnea; polysomnogrpahy; oximeter

ID#

2372

Date of submission

02/28/2013

E-mail

Lomeli@livemail.uthscsa.edu

Author

Stephanie Lomeli

Co-author(s)

Austin Webb

Co-author(s) e-mail

WebbAG@livemail.uthscsa.edu

Faculty mentor

Faculty mentor e-mail

Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

by Ryushiro Sugita, DDS (San Antonio, Texas) on 11/17/2015
A PubMed search on the validation of oximeters diagnosing obstructive sleep apnea was performed Oct 2015. A more recent publication was found: Hang 2015, PubMed: 25880649. The cross sectional study utilizing 699 subjects showed that the oxyhemoglobin desaturation index (ODI) derived from oximetry measurements provided an accuracy of 90.42-90.55%, a sensitivity of 89.36-89.87%, a specificity of 91.08-93.05%. The predictive outcome of ODI to diagnose severe OSA patients is better than to diagnose moderate to severe OSA patients.

by David Faltys (San Antonio, TX) on 05/15/2013
A 2010 cross-sectional study conducted in article (PMID: 20815194 ) further strengthened the conclusion reached by this CAT. This study supported the notion that pulse oximetry is capable of diagnosing obstructive sleep apnea with high accuracy, as the results from oximetry were compared to a polysomnogram for each of the subjects. Furthermore, this study found single-channel nasal airflow devices to be equally accurate in the diagnoses of obstructive sleep apnea.