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A comparison between auto-scored apnea-hypopnea index and oxygen desaturation index in the characterization of positional obstructive sleep apnea

Authors Levendowski DJ, Hamilton GS, St. Louis EK, Penzel T, Dawson D, Westbrook PR

Received 11 February 2019

Accepted for publication 18 May 2019

Published 12 July 2019 Volume 2019:11 Pages 69—78


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Sutapa Mukherjee

Daniel J Levendowski,1 Garun S Hamilton,2 Erik K St. Louis,3 Thomas Penzel,4 David Dawson,5 Philip R Westbrook1

1Advanced Brain Monitoring, Inc., Carlsbad, CA, USA; 2Monash Health & School of Clinical Sciences, Monash University, Clayton, VIC, Australia; 3Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; 4Sleep Medicine Center, Charité Universitätsmedizin Berlin, GmbH, Berlin, Germany; 5Department of Anesthesiology, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK

Objective: Evaluate the concordance between overall and positional oxygen desaturation indices (ODI) and apnea-hypopnea indices (AHI) according to two different definitions for positional obstructive sleep apnea (POSA).
Methods: A total of 184 in-home polysomnograms were edited to simulate Level III home sleep apnea tests (HSAT) with the auto-scored AHI and ODI based on recording time. POSA was determined using 132 records with an AHI≥5 and at least 20 mins of recording time in both supine and non-supine positions. POSA was defined independently for the AHI and ODI based on ratios of overall/non-supine event/h ≥1.4 (O/NS) and supine/non-supine event/h≥2.0 (S/NS).
Results: Correlation between the AHI and ODI was 0.97 overall, 0.94 for supine, and 0.96 for non-supine recording times (all p<0.001). For most records, differences between the AHI and ODI were small, with only 14% of the records having a AHI-ODI difference exceeding >5/hr, and 6% exceeding >10 events/hr. The positive and negative percent agreements were uniformly good to excellent across varying clinical POSA cutoffs; percent agreements (positive, negative) were: AHI≥5=0.99, 0.78; AHI≥10=0.96, 0.89; and AHI≥15=0.96, 0.89. Cohen’s Kappa scores also showed substantial agreement for overall as well as supine and non-supine positions across varying clinical cutoffs of the AHI. Frequency of POSA was reproducibly uniform between 59% and 61% for both POSA criteria. When the O/NS and S/NS definitions conflicted in POSA characterization, O/NS was superior for identifying patients who might exhibit a greater response to supine restriction positional therapy.
Conclusions: Auto-scored positional oximetry is a clinically viable alternative to an auto-scored Level III HSAT AHI in the characterization of POSA based on a 3% desaturation.

Keywords: obstructive sleep apnea, positional, supine, apnea-hypopnea index, oxygen desaturation index

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