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. 2017 Jan 15;13(1):73-79.
doi: 10.5664/jcsm.6392.

Unanticipated Nocturnal Oxygen Requirement During Positive Pressure Therapy for Sleep Apnea and Medical Comorbidities

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Unanticipated Nocturnal Oxygen Requirement During Positive Pressure Therapy for Sleep Apnea and Medical Comorbidities

Safal Shetty et al. J Clin Sleep Med. .
Free PMC article

Abstract

Study objectives: Home-based management of sleep-disordered breathing (SDB) generally excludes patients with significant medical comorbidities, but such an approach lacks scientific evidence. The current study examined whether significant medical comorbidities are associated with persistent hypoxia that requires unanticipated nocturnal O2 supplementation to positive airway pressure (PAP) therapy. Conceivably, in such patients, home-based management of SDB may not detect or therefore adequately treat persistent hypoxia.

Methods: In this retrospective study of 200 patients undergoing laboratory-based polysomnography, we ascertained significant medical comorbidities (chronic obstructive pulmonary disease, congestive heart failure, and morbid obesity) and their association with the need for unanticipated O2 supplementation to PAP therapy. Postural oxygen (SpO2) desaturations between upright and reclining positions were determined during calm wakefulness.

Results: Postural change in SpO2 during calm wakefulness was greater in patients who eventually needed nocturnal O2 supplementation to PAP therapy than those needing PAP therapy alone (p < 0.0001). The presence of chronic obstructive pulmonary disease (odds ratio [OR] 6.0; 95% confidence interval [CI]; 2.1, 17.5; p = 0.001), morbid obesity (OR 3.6; 95% CI 1.9, 7.0; p < 0.0001), and age older than 50 y (OR 2.8; 95% CI 1.3, 5.9; p = 0.007) but not heart failure were associated with unanticipated need for nocturnal O2 supplementation. A clinical prediction rule of less than two determinants (age older than 50 y, morbid obesity, chronic obstructive pulmonary disease, and postural SpO2 desaturation greater than 5%) had excellent negative predictive value (0.92; 95% CI 0.85, 0.96) and likelihood ratio of negative test (0.08; 95% CI 0.04, 0.16).

Conclusions: Medical comorbidities can predict persistent hypoxia that requires unanticipated O2 supplementation to PAP therapy. Such findings justify the use of medical comorbidities to exclude home management of SDB.

Commentary: A commentary on this article appears in this issue on page 7.

Keywords: clinical prediction rule; home sleep apnea testing; obstructive sleep apnea; oxygen; portable testing; positive airway pressure therapy.

Figures

Figure 1
Figure 1. Degree of postural oxygen desaturation in finger pulse oximetry (SpO2) was greater in patients who eventually needed positive airway pressure (PAP) with O2 supplementation than PAP therapy alone.
PAP alone = patients who needed PAP therapy alone, PAP + O2 = patients who needed PAP therapy with unanticipated O2 supplementation for their sleep-disordered breathing (Mann-Whitney U test).
Figure 2
Figure 2. Receiver operating characteristic (ROC) curve for degree of postural desaturation in O2 saturation by pulse oximetry as a predictor of need for O2 supplementation in addition to PAP therapy in patients with sleep-disordered breathing.
AUC = area under the curve, CI = confidence interval.

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