Chest
Volume 98, Issue 6, December 1990, Pages 1341-1345
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Clinical Investigations
A Limited Diagnostic Investigation for Obstructive Sleep Apnea Syndrome: Oximetry and Static Charge Sensitive Bed

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A simplified sleep apnea investigation consisting of combined oximetry and respiration movement monitoring was compared with conventional polysomnography. These two types of recordings were performed simultaneously during one night in 77 patients with suspected obstructive sleep apnea syndrome (OSAS). A static charge sensitive bed (SCSB) was used in the simplified recording because it provides a comfortable and reliable means of recording respiration movements. Periods of obstructive apneas gave a diamond-shaped periodic respiration movement pattern in the SCSB, usually accompanied by repetitive oxygen desaturations. The average number of desaturations ≥4 percent per sleeping hour was termed the oxygen desaturation index (ODI) and compared with the apnea index (AI). In the whole population they were well correlated (p<0.0001, R2=0.41), but in individual cases there were considerable discrepancies. Patients with periodic respiration movements <18 percent of total sleeping time and ODI <2 never had AI ≥5, whereas patients with periodic respiration >45 percent and ODI >6 always had AI ≥5. Fifty-one of the 77 patients fulfilled these criteria. A bradycardia response to apneas was absent in 29 percent of patients with AI ≥5. A combination of respiration movement and oximetry recording thus seems to give sufficient information to confirm or negate a diagnosis of OSAS in a majority of patients with clinical symptoms. In borderline patients, further investigations should be performed.

Section snippets

Subjects

Seventeen healthy, non-habitually snoring volunteers (nine men, eight women, aged 15 to 58 years; mean age, 36 years) underwent one night of SCSB-recording in their homes to study their respiration movement patterns. Recording of respiration movements and body movements were made on a two-channel tape recorder (Oxford Medilog). The relatives were asked to note when the subject fell asleep and woke up.

Seventy-seven patients (69 men, 8 women, aged 17 to 68 years; mean age, 49 years), whose

Results

In none of the recordings of the 17 normal control subjects did the diamond-shaped periodic respiration movement pattern appear.

The SCSB-oximetry and the simultaneously performed polysomnographic recordings were compared for each patient. It was found that the sleeping time could be fairly well estimated from the SCSB-trace alone, if the time during which there were indications of wakefulness (frequent body movements combined with irregular respiration movements) was deducted from the

Discussion

Based on the results of comparison with polysomnography, we suggest the following criteria to be used for diagnosis of OSAS with the SCSB-oximetry type of recording: (1) If periodic respiration movements are present during less than 20 percent of estimated sleep time and, in addition, ODI is less than 2, there is no evidence of significant upper airway obstruction. (2) If periodic respiration movement exceeds 45 percent of estimated sleep time and ODI exceeds 6, the recording is pathologic,

ACKNOWLEDGMENTS

The authors thank Professors Christian Guilleminault and Bengt Y Nilsson for valuable criticism, Dr. H-G Hårdemark for help with the statistical analysis, and Ms. Berit Lundin for preparation of the manuscript.

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    Supported by a grant from foe Karolinska Institute.

    Manuscript received November 29; revision accepted May 3.

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