Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
PLoS One. 2021 May 6;16(5):e0250777. doi: 10.1371/journal.pone.0250777. eCollection 2021.
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.
在患有心血管危险因素并接受非心脏大手术的成年人中，未被识别的阻塞性睡眠呼吸暂停（OSA）与术后心血管并发症有关。因此，我们需要一种易于使用和获取的家用设备来预测睡眠呼吸暂停。本研究旨在确定夜间脉搏血氧仪在预测高危手术患者睡眠呼吸暂停中的预测性能。
这是一项多中心前瞻性队列研究的事后分析，共纳入 1218 例无睡眠呼吸暂停既往诊断的高危手术患者。所有患者同时接受家庭睡眠呼吸暂停测试（ApneaLink Plus，ResMed）和脉搏血氧仪（PULSOX-300i，Konica Minolta Sensing，Inc.）检查。确定 4%氧减饱和度指数（ODI）与呼吸暂停低通气指数（AHI）的预测性能。
1218 例患者中，平均年龄为 67.2 ± 9.2 岁，体重指数（BMI）为 27.0 ± 5.3 kg/m2。预测中重度和重度 OSA 的最佳截断值为 ODI≥15 次/小时。对于预测中重度 OSA（AHI≥15），ODI≥15 次/小时的敏感性和特异性分别为 88.4%（95%置信区间[CI]，85.7-90.6）和 95.4%（95%CI，94.2-96.4）。对于重度 OSA（AHI≥30），敏感性和特异性分别为 97.2%（95%CI，92.7-99.1）和 78.8%（95%CI，98.2-99.0）。中重度和重度 OSA 的曲线下面积（AUC）分别为 0.983（95%CI，0.977-0.988）和 0.979（95%CI，0.97-0.909）。
血氧仪的 ODI 在预测高危手术人群中的中重度或重度 OSA 方面具有较高的敏感性和特异性。它为疑似 OSA 的高危手术患者提供了一种简单、准确、易于获取的工具。
