Unit of Otorhinolaryngology, Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
University of California Los Angeles (UCLA) Medical Center, Santa Monica, Santa Monica, California, USA.
Laryngoscope. 2021 Feb;131(2):440-447. doi: 10.1002/lary.28663. Epub 2020 Apr 25.
Intermittent hypoxemia is a risk factor for developing complications in obstructive sleep apnea (OSA) patients. The objective of this systematic review was to identify articles evaluating the accuracy of the oxygen desaturation index (ODI) as compared with the apnea-hypopnea index (AHI) and then provide possible values to use as a cutoff for diagnosing adult OSA.
Systematic Review of Literature.
PubMed, the Cochrane Library, and SCOPUS databases were searched through November 2019.
Eight studies (1,924 patients) met criteria (age range: 28-70.9 years, body mass index range: 21.9-37 kg/m , and AHI range: 0.5-62 events/hour). Five studies compared ODI and AHI simultaneously, and three had a week to months between assessments. Sensitivities ranged from 32% to 98.5%, whereas specificities ranged from 47.7% to 98%. Significant heterogeneity was present; however, for studies reporting data for a 4% ODI ≥ 15 events/hour, the specificity for diagnosing OSA ranged from 75% to 98%, and only one study reported the positive predictive value, which was 97%. Direct ODI and AHI comparisons were not made because of different hypopnea scoring, different oxygen desaturation categories, and different criteria for grading OSA severity.
Significant heterogeneity exists in studies comparing ODI and AHI. Based on currently published studies, consideration should be given for diagnosing adult OSA with a 4% ODI of ≥ 15 events/hour and for recommending further evaluation for diagnosing OSA with a 4% ODI ≥ 10 events/hour. Screening with oximetry may be indicated for the detection of OSA in select patients. Further study is needed before a definitive recommendation can be made. Laryngoscope, 131:440-447, 2021.
间歇性低氧血症是阻塞性睡眠呼吸暂停（OSA）患者发生并发症的危险因素。本系统评价的目的是确定评估氧减饱和指数（ODI）与呼吸暂停低通气指数（AHI）准确性的文章，然后提供可能的临界值用于诊断成人 OSA。
文献系统评价。
检索了 2019 年 11 月之前的 PubMed、Cochrane 图书馆和 Scopus 数据库。
符合标准的八项研究（1924 例患者；年龄范围：28-70.9 岁；体重指数范围：21.9-37kg/m2；AHI 范围：0.5-62 次/小时）。五项研究同时比较了 ODI 和 AHI，三项研究评估间隔为一周至几个月。敏感度范围为 32%至 98.5%，而特异度范围为 47.7%至 98%。存在显著的异质性；然而，对于报告 4%ODI≥15 次/小时的研究，诊断 OSA 的特异度范围为 75%至 98%，只有一项研究报告了阳性预测值，为 97%。由于不同的低通气评分、不同的氧减饱和分类和不同的 OSA 严重程度分级标准，无法直接比较直接 ODI 和 AHI。
比较 ODI 和 AHI 的研究存在显著的异质性。根据目前发表的研究，应考虑使用 4%ODI≥15 次/小时来诊断成人 OSA，并建议使用 4%ODI≥10 次/小时来进一步评估 OSA。对于特定患者，血氧饱和度监测可能有助于 OSA 的筛查。在做出明确的推荐之前，还需要进一步的研究。
喉镜，131：440-447，2021。
