Assessment of hypoxemia in patients with sleep disorders using saturation impairment time

A method of recording cumulative nocturnal oxygen desaturation was utilized to develop a quantitative index of nocturnal hypoxemia (SIT index) to provide reference values and distributional properties for apneic and nonapneic sleep-disordered patients. The SIT indices were compared in patients with varying degrees of obstructive sleep apnea (OSA) as determined by traditional methods of counting apneas and hypopneas. We studied 298 patients who were divided into five groups based on the presence and frequency of apnea or sleep-related respiratory deterioration. SIT indices for patient groups and individual patients were compared with the respiratory disturbance index (apneas + hypopneas x 60/total sleep time = RDI) using scatter plots, Kruskal-Wallis analysis of variance, and Mann-Whitney U tests. The OSA and non-respiratory-impaired patient groups had mean SIT values that were significantly different (p < 0.05). Subjects with severe apnea differed (p < 0.05) from subjects with mild and moderate apnea at SIT index thresholds < baseline, < 90, < 80, and < 70% SaO2, but subjects with mild and moderate apnea did not differ statistically from each other at any threshold. In individual patients with similar RDI values, considerable variation in SIT index can be seen, and the reverse is also true. This suggests that using both RDI and SIT may provide complementary information in assessing the severity of OSA.