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The aims of this study were to assess the cut-off values for oxygen desaturation index ≥ 3% (ODI3) to confirm obstructive sleep apnea (OSA) in subjects undergoing polysomnography (PSG) and home-based respiratory polygraphy (RP), and to propose an algorithm based on pulse oximetry (PO) for initial management of patients with suspected OSA.This was an observational, cross-sectional, retrospective study. ODI3 was used to classify subjects as healthy (no OSA = AHI 5 or 15 events/h) or unhealthy (OSA = AHI ≥ 5 or ≥ 15 events/h). On the PSG or experimental group (Exp-G), we determined ODI3 cut-off values with 100% specificity (Sp) for both OSA definitions. ODI3 values without false positives in the Exp-G were applied to a validation group (Val-G) to assess their performance. A strategy based on PO was proposed in patients with suspected OSA.In Exp-G (PSG) 1141 patients and in Val-G (RP) 1141 patients were included. In Exp-G, ODI3 12 (OSA = AHI ≥ 5) had a sensitivity of 69.5% (CI95% 66.1-72.7) and Sp of 100% (CI95% 99-100), while an ODI3 ≥ 26 had a 53.8% sensitivity (CI95% 49.3-58.2) and Sp of 100% (CI95% 99.4-100) for AHI ≥ 15. A high pretest probability for OSA by Berlin questionaire (≥ 2 categories) had a lower diagnostic performance than by STOP-BANG questionnaire ≥ 5 points (AHI ≥ 5: 0.856 vs. 0.899, p 0.001; AHI ≥ 15: 0.783 vs. 0.807, p 0.026).We propose the initial use of PO at home in cases of moderate-to-high pretest probability of OSA. This algorithm considers PO as well as RP and PSG for more challenging cases or in case of doubt.

Objective To compare pulse oximetry with manual analysis against all signals of respiratory polygraphy. Material and Methods This retrospective study estimated sensitivity (S), specificity (Sp) and positive/negative likelihood ratio (LR+/-) of the oxygen desaturation index (ODI-test) and apnea-hypopnea index (AHI-reference). Results 3854 patients (61.5% men) were included. Age, BMI, Epworth sleepiness scale and AHI were: 55 years (44-65), 30.9kg/m2 (27-36), 7 points (4-11), and 14 events/hour (6-25), respectively. 18% showed an AHI 15 and < 30, and 31% > 30. The S, Sp, and LR+/- of ODI for AHI = 5 events/hour was 93%, 92%, 12 and 0.08 with an accuracy of 93%. For AHI = 15 events/hour, the values were: S 94%, Sp 94%, LR+ 15 and LR- 0.06 and 94% accuracy (r(2) Spearman: 0.92). Conclusion In a population at a high risk for OSA, home-based pulse oximetry had a diagnostic accuracy > 90% when is compared against all respiratory signals obtained from simplified home sleep testing.

To assess the relationship between hypoxemia during polysomnography (PSG) and patient-reported night sweats (NS).This retrospective observational study included adult patients who completed a standardized sleep questionnaire and the Epworth Sleepiness Scale (ESS) before PSG.We included 1397 patients (41% women). The median age was 52 years, 80% had obstructive sleep apnea (OSA) defined as an apnea-hypopnea index (AHI) ≥ 5, and 35% were obese. A total of 245 patients (17.5%) reported NS. Their prevalence was higher among patients with OSA compared to controls (18.9% vs. 12.2%, p 0.01). In the bivariate analysis, the variables associated with NS were BMI, AHI, hypoxemia (T90 ≥ 2.5% of total recording time plus minimum SOIn patients with OSA, night sweats were significantly and independently associated with a higher hypoxic burden.

The objective of the study was to develop a multiparametric oximetry indicator (IMp-SpO2) to diagnose obstructive sleep apnea in adults. This was an observational, retrospective study of diagnostic accuracy. We included adults who had had a diagnostic polysomnography with few artifacts and a total sleep time of at least 180 min in the sleep laboratory. Obstructive sleep apnea (OSA) was defined as an apnea-hypopnea index (AHI) ≥ 5. The database was randomly divided into an experimental (Exp-G) and validation (Val-G) group. The program calculated several parameters of oxygen saturation variability (Par-VarSpO2): (a) oxygen desaturation index (ODI ≥ 3, 4%) and (b) 90, 95, and 97.5 percentiles of both the number of oxygen desaturations ≥ 3 and 4% (P90–97.5 OD3/4 W5-60) and SpO2 standard deviations in moving windows from 5 to 60 min (P90–P97.5 SDSpO2 W5-10). Area under the ROC curve (AUC-ROC), sensitivity, specificity, positive/negative likelihood ratios, and accuracy were calculated. Of 1141 adults included in the study, experimental (571) and validation group (570) were similar (women 47% vs 45%, BMI 27.5 kg/m2 vs 27.2 kg/m2, and AHI 11.7 vs 12, p NS). The IMp-SpO2 developed in the experimental group consisted of a combination of 10 parameters of oxygen saturation variability. The presence of at least one IMp-SpO2 variable had a high diagnostic performance for OSA (sensitivity/specificity/accuracy: Exp-G: 92.8/94/93.2%; Val-G: 93/95.2/93.7%). The IMp-SpO2 AUC-ROC was higher (Exp-G 0.934, Val-G 0.941) than most of the Par-VarSpO2 (0.898–0.929, p 90% accuracy for OSA diagnosis in adults.

Background and Objective: The usefulness of pulse oximetry for the management of obstructive sleep apnea is controversial. The aim of this study was to assess the accuracy for indication of Continuous Positive Airway Pressure (CPAP) treatment in patients with suspected obstructive sleep apnea (OSA) based on clinical and oximetry data as compared to polysomnography (PSG). Methods: This multicenter observational study involved seven sleep laboratories. Patients with suspicion of OSA who completed a standardized sleep questionnaire and a diagnostic PSG were enrolled. Eight observers logged on to a website independently and blindly. Seven observers only accessed the clinical data, curve and pulse oximetry results (Os-SO2-test method), while the eighth observer had full access to all indicators of PSG (O-PSG-reference method). Once observers assessed the information available on the website, they had to choose between three CPAP treatment options (yes/no/do not know) based on their knowledge and criteria. Results: 411 subjects (228 men), median age 54 years, were available for evaluation. Os-SO2 had lower sensitivity (S), greater specificity (Sp) and positive likelihood ratio (PLR) to prescribe CPAP in patients more symptomatic (Epworth Sleepiness Scale-ESS > 10 or comorbidities) than those with fewer symptoms (ESS < 11 without comorbidities) (S 45-75% versus 45-91%, p 0.028); Sp 93.8-100% versus 68.5-96.6%, p 0.004; PLR > 10 versus 2.9-17, p

To evaluate the performance of clinical criteria (CC) for diagnosis and initiation of empirical treatment with continuous positive airway pressure (CPAP) in patients with suspected obstructive sleep apnea (OSA) compared with the treatment decision based on sleep studies (polysomnography or respiratory polygraphy), guidelines, and experience of participating physicians. This was a simulated intention-to-treat study in a retrospective (G1) and prospective (G2) cohort. Four observers (two per group) called CC1 and CC2 reviewed the sleep questionnaires and indicated CPAP if the patients presented snoring, frequent apneas (≥ 3–4/week), body mass index (BMI) > 25 kg/m2, sleepiness (Epworth > 11), or tiredness (at least 3–4 times per week) and some comorbidity (hypertension, coronary/cerebrovascular event, diabetes). Ten independent observers formed two groups of five (FD1 and FD2) and were blinded to each other’s opinion. These observers in FD1 and FD2 decided CPAP treatment based on guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) or guidelines of the American Academy of Sleep Medicine (AASM) and factored in their own opinion. Sensitivity (S), specificity (Sp), and positive/negative likelihood ratios (LR+/−) were calculated with the test method: CC1/2, and the reference method: majority decision of FD1/2. A total of 653 patients (264 women, 40%) were studied. Median age was 54 years, BMI 28 kg/m2, and apnea hypopnea index (AHI) 16.5 events/h. S ranged from 21 to 25% (p 0.60), Sp 96.1 to 97.6% (p 0.39), and LR+ of clinical criteria 6.4 to 8.9 (p 0.52). CPAP indication without a previous sleep study showed a low sensitivity (≅ 22%) but a specificity greater than 95% in patients with high pretest probability for OSA (snoring, report of frequent apneas, BMI > 25 kg/m2 and sleepiness or tiredness plus comorbidity).

Purpose: Obstructive Sleep Apnea-Hypopnea Syndrome (OSAS) is a public health problem. We designed a pilot study to validate empiric indication of CPAP therapy in a population with moderate- to-high pre-test probabilities who underwent self-administered home-based respiratory polygraphy (RP). Methods: A cross-sectional simulation study was performed. CPAP therapy could be indicated by two independent blind observers. Observer 1´s decision was based on the results of STOP-BANG (SBQ) and Epworth Sleepiness Scale (ESS) and Observer 2 used all objective data provided by RP + SBQ + ESS. Results: We evaluated 1763 patients; 1060 men and 703 women (39.2%) with a mean age of 53.6±13.8 and a body mass index (BMI) of 32.8±7.5 kg/m2. We found evidence of mild (34.1%), moderate (26.6%), and severe (18.3%) There were Apnea-Hypopnea Index (AHI) relationship between > 5 or < 5 SBQ and RP AHI (p 25 kg/m2 + snoring (S) + observed apnea (O) + 1 of the following: ESS > 11, hypertension (HT) or > 5 SBQ components showed sensitivity of 40% (CI95%: 37.3-43) and specificity of 95.1% (CI93.4-96.4). The performance of 5 SBQ components with regard to gender and empirical CPAP therapy was; (women vs. men): AUC-ROC 0.625 (CI95%: 0.599-0.651) vs. 0.70 (CI95%: 0.68-0.72), p

Introduction: The most effective treatment for moderate to severe obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP) but adherence may be a limiting factor. Most compliance studies often only include patients under CPAP treatment, neglecting the importance of access to treatment. The aim of this study was to evaluate CPAP access and compliance in OSA patients, after CPAP indication and titration. Methods: We included moderate to severe OSA patients, diagnosed by in-lab polysomnography (PSG), with CPAP indication and effective pressure titration. Between 12 to 18 months after treatment was indicated a telephone questionnaire was administered including questions about access to CPAP, reasons of no access, reported adherence and symptoms improvement. Results: A total of 213 patients responded to the survey (171 males, mean age 53.4±13.5 and BMI 34.02±8.8 kg/m2). Almost a third of the patients (28.2%) did not initiate CPAP treatment. Out of 213, 153 patients (71.8%) started treatment with CPAP and 120 (56.3%) reported still being under treatment a year after indication, additionally, 85.8% reported that they were using it =4hs/night. Those who accessed to CPAP were on average, older age, had full coverage of treatment by their medical insurance, required lower effective pressure and experienced more severe sleepiness compared to those individuals who did not accessed to CPAP. Discussion: A significant proportion of OSA patients with CPAP indication did not initiate and/or eventually abandoned CPAP. Approximately only 50% of the patients were still under treatment, with acceptable selfreported adherence rate and clinical response, one year after the initial treatment indication. Additional measures are necessary to increase access to CPAP and improve long-term compliance.

It has been reported that the clinical expression of obstructive sleep apnea (OSA) may differ in women and men. The objective of this study was to evaluate the influence of gender on reported OSA-related symptoms in a large clinical population of patients. The database from the sleep laboratory of a tertiary care center was examined. Adult patients who had undergone a diagnostic polysomnography and completed the Berlin questionnaire, a sleep questionnaire, and the Epworth sleepiness scale were selected. Multiple logistic regression analysis was performed to assess the relationship between OSA-associated symptoms and different potential explanatory variables. The study sample included 1084 patients, median age was 53 years, 46.5% (504) were women, 72.7% (788) had OSA (apnea/hypopnea index ≥ 5), and 31.2% were obese. After adjusting for age, body mass index, and apnea/hypopnea index, men were more likely to report snoring (OR 4.06, p

There is scarce information about whether the diagnosis of OSA supported only by medical record data can be a useful and reliable tool to initiate a CPAP treatment. The aim of this study is to develop and assess the accuracy of clinical parameters for the diagnosis and prescription of CPAP in patients with suspected OSA. Adult patients who underwent polysomnography and completed the Berlin questionnaire, a clinical record, and the Epworth sleepiness scale were included in the study. A situation was simulated in which two blinded and independent observers would be able to indicate CPAP treatment if the patients were snorers with frequent apnea reports (≥3–4 times a week) and overweight (BMI > 25 kg/m2) plus one of the following: diurnal symptoms (tiredness after sleeping or at waking time ≥3–4 times a week or Epworth sleepiness scale >11), arterial hypertension, cerebrovascular accident, coronary event, type II diabetes or cardiac arrhythmias (observer 1, clinical criteria) or on the basis of the respiratory disturbance index, significant tiredness (≥3–4 times a week) or sleepiness (Epworth >11) and associated comorbidities (observer 2, reference method). The area under the ROC curve (ABC-ROC), sensitivity, specificity, and likelihood ratios were calculated. Among 516 subjects (72 % men), the median age was 52 years, BMI 28.3 kg/m2, and RDI 19.7 events/h. The ABC-ROC, sensitivity, specificity, and positive likelihood ratio of the clinical parameters were of 0.64 to 0.65, 31 to 33 %, 97 to 98 %, and 11 to15 respectively. No differences in the diagnostic performance of the clinical criteria were observed between men and women. These clinical parameters made it possible to indicate CPAP in approximately one third of the population with OSA which would have required it on the basis of their PSG and clinical history. This approach showed high specificity; hence, few patients who did not meet the criteria for CPAP use would have received this treatment.