How Using Different Oximeters May Affect Clinical Decision-Making: A Method Comparison Study in Patients Receiving
Gatete Karege1, Bernard Egger2, David Lawi3
1Division of Pulmonology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.
Chest
|September 10, 2025
Summary
Different pulse oximetry devices show clinically meaningful variations in nocturnal oxygen saturation (SpO2) monitoring for patients on CPAP or NIV. These discrepancies can unpredictably impact clinical decisions.
Area of Science:
- Respiratory Medicine
- Medical Device Technology
- Sleep Science
Background:
- Nocturnal SpO2 monitoring is crucial for detecting sleep-disordered breathing in patients using CPAP or NIV.
- A common assumption is that different pulse oximetry devices yield similar results, which this study investigates.
- Understanding device variability is key for accurate patient management.
Purpose of the Study:
- To determine if simultaneous nocturnal monitoring with different pulse oximetry devices results in clinically significant differences.
- To assess the impact of device variability on SpO2 and oxygen desaturation index measurements.
- To evaluate the reliability of various devices used in clinical practice.
Main Methods:
- A prospective observational study involving stable patients on CPAP or NIV.
- Simultaneous overnight monitoring using three distinct devices: a transcutaneous oxycapnograph and two pulse oximeters (finger and ring probes).
- Statistical analysis included Bland-Altman plots, Cohen's kappa, and interclass correlation coefficients (ICCs).
Main Results:
- Limits of agreement exceeded the ±2% threshold for mean/median SpO2 and oxygen desaturation index (ODI) in all device comparisons.
- ICCs for mean/median SpO2 ranged from 0.77–0.84, while for ODI, they were 0.33–0.75.
- Cohen's kappa values indicated moderate agreement (0.46–0.73) between devices.
Conclusions:
- The use of different pulse oximetry devices in clinical practice can lead to unpredictable variations in monitoring results.
- These discrepancies may significantly influence clinical decision-making for patients receiving CPAP or NIV.
- Expert centers should be aware of potential device-related variability in SpO2 monitoring.
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