Skip to main content
SpringerLink
Log in

Validation of the WristOx 3100™ oximeter for the diagnosis of sleep apnea/hypopnea syndrome

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Objective

To evaluate the diagnostic accuracy of the Nonin WristOx 3100™ and its software (nVision 5.0) in patients with suspicion of sleep apnea/hypopnea syndrome (SAHS).

Methods

All participants (168) had the oximetry and polysomnography simultaneously. The two recordings were interpreted blindly. The software calculated: adjusted O2 desaturation index [ADI]-mean number of O2 desaturation per hour of total recording analyzed time of ≥ 2%, 3%, 4%, 5%, and 6% (ADI2, 3, 4, 5, and 6) and AT90-accumulated time at SO2 < 90%. The ADI2, 3, 4, 5, and 6 and the AT90 cutoff points that better discriminated between subjects with or without SAHS arose from the receiver operating characteristic curve analysis. The sensitivity (S), specificity (E), and positive and negative likelihood ratio (LR+, LR−) for the different thresholds for ADI were calculated.

Results

One hundred and fifty-four patients were included (119 men, mean age 51, median apnea/hypopnea index [AHI] 14, median body mass index [BMI] 28.3 kg/m2). The best cutoff points of ADI were: SAHS = AHI ≥ 5: ADI2 > 19.3 (S 89%, E 94%, LR+ 15.5 LR− 0.11); SAHS =AHI ≥ 10: ADI3 > 10.5 (S 88%, E 94%, LR+ 15 LR− 0.12); SAHS = AHI ≥ 15: ADI3 > 13.4 (S 88%, E 90%, LR+ 8.9, LR− 0.14). AT90 had the lowest diagnosis accuracy. An ADI2 ≤ 12.2 excluded SAHS (AHI ≥ 5 and 10; S 100%, LR− 0) and ADI3 > 4.3 (AHI ≥ 5 and 10) or 32 (AHI ≥ 15) confirmed SAHS (E 100%).

Conclusions

A negative oximetry defined as ADI2 ≤ 12.2 excluded SAHS defined as AHI ≥ 5 or 10 with a sensitivity and negative likelihood ratio of 100% and 0%, respectively. Furthermore, a positive oximetry defined as an ADI3 > 32 (SAHS = AHI ≥ 15) had a specificity of 100% to confirm the pathology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235. doi:10.1056/NEJM199304293281704

    Article  PubMed  CAS  Google Scholar 

  2. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384. doi:10.1056/NEJM200005113421901

    Article  PubMed  CAS  Google Scholar 

  3. Newman AB, Nieto J, Guirdry U, Lind BK, Redline S, Pickering TG, Quan SF, Sleep Heart Health Study Research Group (2001) Relation of sleep-disordered breathing to cardiovascular risk factors. Am J Epidemiol 154:50–59. doi:10.1093/aje/154.1.50

    Article  PubMed  CAS  Google Scholar 

  4. Lavie P, Herer P, Peled R, Berger I, Yoffe N, Zomer J et al (1995) Mortality in sleep apnoea patients; multivariate analysis of risk factors. Sleep 18:149–157

    PubMed  CAS  Google Scholar 

  5. Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J (2004) Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med 169:668–672. doi:10.1164/rccm.200308-1124PP

    Article  PubMed  Google Scholar 

  6. Ferber R, Millman R, Coppola M, Fleetham J, Murray CF, Iber C et al (1994) Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice. Sleep 17:378–392

    PubMed  CAS  Google Scholar 

  7. Netzer N, Eliasson AH, Netzer C, Kristo DA (2001) Overnight pulse oximetry for sleep-disordered breathing in adults: a review. Chest 120:625–633. doi:10.1378/chest.120.2.625

    Article  PubMed  CAS  Google Scholar 

  8. Lévy P, Pépin JL, Deschaux-Blanc C, Paramelle B, Brambilla C (1996) Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. Chest 109:395–399. doi:10.1378/chest.109.2.395

    Article  PubMed  Google Scholar 

  9. Olson LG, Ambrobetti A, Gyulay SG (1999) Prediction of sleep-disordered breathing by unattended overnight oximetry. J Sleep Res 8:51–55. doi:10.1046/j.1365-2869.1999.00134.x

    Article  PubMed  CAS  Google Scholar 

  10. Hussain SF, Fleetham JA (2003) Overnight home oximetry: can it identify patients with obstructive sleep apnea–hypopnea who have minimal daytime sleepiness? Respir Med 97:537–540. doi:10.1053/rmed.2003.1480

    Article  PubMed  CAS  Google Scholar 

  11. Magalang UJ, Dmochowski J, Veeramachaneni S, Draw A, Mador MJ, El-Solh A et al (2003) Prediction of the apnea-hypopnea index from overnight pulse oximetry. Chest 124:1694–1701. doi:10.1378/chest.124.5.1694

    Article  PubMed  Google Scholar 

  12. Williams AJ, Yu G, Santiago S, Stein M (1991) Screening for sleep apnea using pulse oximetry and a clinical score. Chest 100:631–635. doi:10.1378/chest.100.3.631

    Article  PubMed  CAS  Google Scholar 

  13. Series F, Marc I, Cormier Y, Laforge J (1993) Utility of nocturnal home oximetry to case finding in patients with suspected sleep apnea hypopnea syndrome. Ann Intern Med 119:449–53

    PubMed  CAS  Google Scholar 

  14. Douglas NJ, Thomas S, Jan Ma (1992) Clinical value of polysomnogrphy. Lancet 339:347–350

    Article  PubMed  CAS  Google Scholar 

  15. Epstein LJ, Dorlac GR (1998) Cost-effectiveness analysis of nocturnal oximetry as a method of screening for sleep apnea-hypopnea syndrome. Chest 113:97–103. doi:10.1378/chest.113.1.97

    Article  PubMed  CAS  Google Scholar 

  16. Yamashiro Y, Kryger MH (1995) Nocturnal oximetry: is it a screening tool for sleep disorders? Sleep 18:167–171

    PubMed  CAS  Google Scholar 

  17. Herer B, Roche N, Carton M, Roig C, Poujol V, Huchon G (1999) Value of clinical, functional, and oximetric data for the prediction of obstructive sleep apnea in obese patients. Chest 116:1537–1544. doi:10.1378/chest.116.6.1537

    Article  PubMed  CAS  Google Scholar 

  18. Pepin JL, Levy P, Lepaulle B, Brambilla C, Guilleminault C (1991) Does oximetry contribute to the detection of apneic events? Mathematical processing of the SaO2 signal. Chest 99:1151–1157. doi:10.1378/chest.99.5.1151

    Article  PubMed  CAS  Google Scholar 

  19. Svanborg E, Larsson H, Carlsson-Nordlander B, Pirskanen R (1990) A limited diagnostic investigation for obstructive sleep apnea syndrome. Oximetry and static charge sensitive bed. Chest 98:1341–1345. doi:10.1378/chest.98.6.1341

    Article  PubMed  CAS  Google Scholar 

  20. Ryan PJ, Hilton MF, Boldy DA, Evans A, Bradbury S, Sapiano S et al (1995) Validation of British Thoracic Society guidelines for the diagnosis of the sleep apnea–hypopnea syndrome: can polysomnography be avoided? Thorax 50:972–975

    Article  PubMed  CAS  Google Scholar 

  21. Golpe R, Jiminez A, Carpizo R, Cifrian JM (1999) Utility of home oximetry as a screening test for patients with moderate to severe symptoms of obstructive sleep apnea. Sleep 22:932–937

    PubMed  CAS  Google Scholar 

  22. Raymond B, Cayton RM, Chappell MJ (2003) Combined index of heart rate variability and oximetry in screening for the sleep apnoea/hypopnoea syndrome. J Sleep Res 12:53–61. doi:10.1046/j.1365-2869.2003.00330.x

    Article  PubMed  Google Scholar 

  23. Nakano H, Ikeda T, Hayashi M, Ohshima E, Itoh M, Nishikata N et al (2004) Effect of body mass index on overnight oximetry for the diagnosis of sleep apnea. Respir Med 98:421–427. doi:10.1016/j.rmed.2003.11.009

    Article  PubMed  Google Scholar 

  24. Rauscher H, Popp W, Zwick H (1993) Model for investigating snorers with suspected sleep apnea syndrome. Thorax 48:275–279

    Article  PubMed  CAS  Google Scholar 

  25. Chiner E, Signes-Costa J, Arriero JM, Marco J, Fuentes I, Sergado A (1999) Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax 54:968–971

    Article  PubMed  CAS  Google Scholar 

  26. Gurubhagavatula I, Maislin G, Nkwuo JE, Pack AI (2004) Occupational screening for obstructive sleep apnea in commercial drivers. Am J Respir Crit Care Med 170:371–376. doi:10.1164/rccm.200307-968OC

    Article  PubMed  Google Scholar 

  27. Lacassagne L, Didier A, Murris-Espin M, Charlet JP, Chollet P, Léophonte-Domairon ML et al (1997) Role of nocturnal oximetry in screening for sleep apnea syndrome in pulmonary medicine: study of 329 patients. Rev Mal Respir 14:201–207

    PubMed  CAS  Google Scholar 

  28. Zamarron C, Gude F, Barcala J, Rodriguez JR, Romero PV (2003) Utility of oxygen saturation and heart rate spectral analysis obtained from pulse oximetric recordings in the diagnosis of sleep apnea syndrome. Chest 123:1567–1576. doi:10.1378/chest.123.5.1567

    Article  PubMed  Google Scholar 

  29. del Campo F, Hornero R, Zamarron C, Abasolo DE, Alvarez D (2006) Oxygen saturation regularity analysis in the diagnosis of obstructive sleep apnea. Artif Intell Med 37:111–118. doi:10.1016/j.artmed.2005.10.005

    Article  PubMed  Google Scholar 

  30. Hornero R, Alvarez D, Abasolo D, del Campo F, Zamarron C (2007) Utility of approximate entropy from overnight pulse oximetry data in the diagnosis of the obstructive sleep apnea syndrome. IEEE Trans Biomed Eng 54:107–113. doi:10.1109/TBME.2006.883821

    Article  PubMed  Google Scholar 

  31. White DP (2005) Central sleep apnea. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine. 4th edn. Elservier, Philadelphia, pp 969–982

    Google Scholar 

  32. Rechtschafen A, Kales A (1968) A manual of standarized technology, techniques and scoring system for sleep stages of human subjects. Brain Information Service, Braininformation Institute, University of California, Los Angeles, CA

    Google Scholar 

  33. American Sleep Disorders Association (2002) The Atlas Task Force. EEG arousals: scoring rules and examples. Sleep 15:174–184

    Google Scholar 

  34. Sala H, Nigro C, Rabec C, Guardia AS, Smurra M (2001) Consenso Argentino de Trastornos Respiratorios Vinculados al Sueño. Medicina (B Aires) 61:351–363

    CAS  Google Scholar 

  35. Oeverland B, Skatvedt O, Kvaerner KJ, Akre H (2002) Pulseoximetry: sufficient to diagnose severe sleep apnea. Sleep Med 3:133–138. doi:10.1016/S1389-9457(01)00122–8

    Article  PubMed  Google Scholar 

  36. Zamarron C, Romero PV, Rodriguez JR, Gude F (1999) Oximetry spectral analysis in the diagnosis of obstructive sleep apnoea. Clin Sci (Lond) 97:467–473. doi:10.1042/CS19980367

    CAS  Google Scholar 

  37. Gyulay S, Olson LG, Hensley MJ, King MT, Allen KM, Saunders NA (1993) A comparison of clinical assesment and home oximetry in the diagnosis of obstructive sleep apnea. Am Rev Respir Dis 147:50–53

    PubMed  CAS  Google Scholar 

  38. Moser NJ, Phillips BA, Berry DTR, Harbison L (1994) What is hypopnea, anyway? Chest 105:426–428. doi:10.1378/chest.105.2.426

    Article  PubMed  CAS  Google Scholar 

  39. An American Sleep Disorders Association Review (1997) Practice parameters for the indications for polysomnography and related procedures. Sleep 20:406–422

    Google Scholar 

  40. Wiltshire N, Kendrick AH, Catterall JR (2001) Home oximetry studies for diagnosis of sleep apnea/hypopnea syndrome: limitation of memory storage capabilities. Chest 120:384–389. doi:10.1378/chest.120.2.384

    Article  PubMed  CAS  Google Scholar 

  41. Vazquez JC, Tsai WH, Flemons WW, Masuda A, Brant R, Hajduk E et al (2000) Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnea. Thorax 55:302–307. doi:10.1136/thorax.55.4.302

    Article  PubMed  CAS  Google Scholar 

  42. Takeda T, Nishimura Y, Satouchi M, Kamiryo H, Takenaka K, Kasai D et al (2006) Usefulness of the oximetry test for the diagnosis of sleep apnea syndrome in Japan. Am J Med Sci 331:304–308. doi:10.1097/00000441-200606000-00002

    Article  PubMed  Google Scholar 

  43. Stoohs R, Guilleminault C (1992) MESAM 4: an ambulatory device for the detection of patients at risk for obstructive sleep apnea syndrome (OSAS). Chest 101:1221–1227. doi:10.1378/chest.101.5.1221

    Article  PubMed  CAS  Google Scholar 

  44. Koziej M, Cieslicki JK, Gorzelak K, Sliwinski P, Zielinski J (1994) Hand-scoring of MESAM 4 recordings is more accurate than automatic analysis in screening for obstructive sleep apnoea. Eur Respir J 7:1771–1775. doi:10.1183/09031936.94.07101771

    Article  PubMed  CAS  Google Scholar 

  45. Nigro CA, Rhodius EE (2005) Variation in the duration of arousal in obstructive sleep apnea. Med Sci Monit 11:188–192

    Google Scholar 

  46. Series F, Cormier Y, La Forge J (1989) Role of lung volumens in sleep apnoea-related oxygen desaturation. Eur Respir J 2:26–30

    PubMed  CAS  Google Scholar 

  47. Farebrother MJ, McHardy GJ, Munro JF (1974) Relation between pulmonary gas exchange and closing volume before and after substantial weight loss in obese subjects. BMJ 3:391–393

    PubMed  CAS  Google Scholar 

  48. Hannhart B, Haberer JP, Saunier C, Laxenaire MC (1991) Accuracy and precision of fourteen pulse oximeters. Eur Respir J 4:115–119

    PubMed  CAS  Google Scholar 

  49. Jensen LA, Onyskiw JE, Prasad NG (1998) Meta-analysis of arterial oxygen saturation monitoring by pulse oximetry in adults. Heart Lung 27:387–408. doi:10.1016/S0147-9563(98)90086–3

    Article  PubMed  CAS  Google Scholar 

  50. Brouillette RT, Lavergne J, Leimanis A, Nixon GM, Ladan S, McGregor CD (2002) Differences in pulse oximetry technology can affect detection of sleep-disordered breathing in children. Anesth Analg 94(1):S47–S53

    PubMed  Google Scholar 

  51. Zafar S, Ayappa I, Norman RG, Krieger AC, Walsleben JA, Rapoport DM (2005) Choice of oximeter affects apnea-hypopnea index. Chest 127:80–88. doi:10.1378/chest.127.1.80

    Article  PubMed  Google Scholar 

  52. Mosko SS, Dickel MJ, Ashurst J (1988) Night to night variability in sleep apnea and sleep-related periodic leg movements in the elderly. Sleep 11:340–348

    PubMed  CAS  Google Scholar 

  53. Cooper BG, Veale D, Griffiths CJ, Gibson GJ (1991) Value of nocturnal oxygen saturation as a screening test for sleep apnea. Thorax 46:586–588

    Article  PubMed  CAS  Google Scholar 

  54. Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J (2004) Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med 140:189–202

    PubMed  Google Scholar 

  55. Ayappa I, Norman RG, Krieger AC, Rosen A O'malley RL, Rapoport DM (2000) Non-Invasive detection of respiratory effort-related arousals (REras) by a nasal cannula/pressure transducer system. Sleep 23:763–71

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The authors wish to thank Ms. Jaquelina Mastantuono for revising the English text.

Author information

Authors and Affiliations

  1. Staff Pulmonary Physician and Coordinator of Sleep Laboratory, Hospital Alemán, Buenos Aires, Argentina

    Carlos Alberto Nigro, Silvia Aimaretti, Sergio Gonzalez & Edgardo Rhodius

  2. Sleep Laboratory Polysomnographic Technician, Hospital Alemán, Buenos Aires, Argentina

    Silvia Aimaretti & Sergio Gonzalez

  3. FCCP, Chief of Pneumonology Unit, Hospital Alemán, Buenos Aires, Argentina

    Edgardo Rhodius

  4. Cachimayo 333, 4 Piso, CP 1424, Buenos Aires, Argentina

    Carlos Alberto Nigro

  5. Pueyrredón 1640, CP 1418, Buenos Aires, Argentina

    Silvia Aimaretti, Sergio Gonzalez & Edgardo Rhodius

Authors
  1. Carlos Alberto Nigro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Silvia Aimaretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sergio Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edgardo Rhodius
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos Alberto Nigro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nigro, C.A., Aimaretti, S., Gonzalez, S. et al. Validation of the WristOx 3100™ oximeter for the diagnosis of sleep apnea/hypopnea syndrome. Sleep Breath 13, 127–136 (2009). https://doi.org/10.1007/s11325-008-0217-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-008-0217-3

Keywords

Search

Navigation