The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Utility of Nocturnal Home Oximetry for Case Finding in Patients with Suspected Sleep Apnea Hypopnea Syndrome

Frederic Series, MD; Isabelle Marc, MD; Yvon Cormier, MD; and Jacques La Forge, MD
[+] Article, Author, and Disclosure Information

From the Unite de Recherche, Centre de Pneumologie, Hopital Laval, Universite Laval, Quebec, Canada. Requests for Reprints: Frederic Series, MD, Unite de recherche, Centre de Pneumologie, Hopital Laval, 2725 Chemin Sainte Foy, Sainte Foy (Quebec), G1V 4G5 Canada. Acknowledgments: The authors thank F. Pellegrini, N. Dupuis, J. Beauregard, and A. Veilleux for technical assistance. Grant Support: In part by The Respiratory Health Network of Centres of Excellence of Canada.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(6):449-453. doi:10.7326/0003-4819-119-6-199309150-00001
Text Size: A A A

Objective: To evaluate prospectively the validity of home oximetry for case finding in patients clinically suspected of having the sleep apnea hypopnea syndrome (SAHS).

Design: Blinded comparison of home oximetry and polysomnographic nocturnal recordings.

Setting: Sleep clinic of a tertiary referral center.

Patients: A total of 240 outpatients referred because of reported sleep disturbances or daytime hypersomnia compatible with the diagnosis of SAHS.

Measurements: All participants had nocturnal home oximetry followed by a conventional polysomnographic study. The two recordings were interpreted blindly. Home oximetry test results were classified as abnormal (suspicion of sleep-related breathing abnormalities) in the presence of repetitive, short-duration arterial oxyhemoglobin saturation (SaO2) fluctuations without any absolute or relative decrease in the SaO2 threshold. The diagnosis of SAHS was confirmed when the apnea-plus-hypopnea index was greater than 10.

Results: Based on the results of the polysomnographic sleep study, 110 patients had SAHS (apnea-plus-hypopnea index, 38.1 2.5/h; mean SE). Home oximetry test results were interpreted as abnormal in 176 patients (this included 108 patients with SAHS and 68 without SAHS) and were read as normal in 62 patients without SAHS and in 2 with SAHS. Home oximetry testing had a sensitivity of 108/110 or 98.2% (95% CI, 93.6% to 99.8%); a specificity of 62/130 or 47.7% (CI, 38.8% to 56.6%); a positive predictive value of 108/176 or 61.4%; and a negative predictive value of 62/64 or 96.9%.

Conclusions: A negative home oximetry test result is helpful in ruling out the diagnosis of SAHS in patients clinically suspected of having this syndrome, because a negative test result reduced the probability from 54.1% to 3.1% in our patients. However, a positive oximetry test increased the probability from 46% to 61.4% in our group of patients.


Grahic Jump Location
Figure 1.
Typical examples of abnormal, nocturnal arterial oxyhemoglobin saturation tracings. Top.Bottom.O2O2

Repetitive episodes of periodic deep desaturation are accompanied by cyclic variations in the pulse rate (PR). Small-amplitude periodic fluctuations in the arterial oxyhemoglobin saturation (Sa ) signal that were considered as abnormal even if the decreases in the Sa level were less than 4% or did not reach 90% or both.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Contingency Tables Comparing the Results of the Home Oximetry and Polysomnographic Recordings Using Two Different Diagnosis Thresholds of the Apnea-Plus-Hypopnea Index (AHI).
Grahic Jump Location
Grahic Jump Location
Figure 2.
Typical example of a normal home oximetry recording.O2

The arterial oxyhemoglobin saturation (Sa ) tracing was stable, and no periodic fluctuations occurred. PR = pulse rate.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Patient response to sleep apnea screening in a dental practice. J Public Health Dent Published online Jun 23, 2016;
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.