Reliability of noninvasive oximetry in black subjects during exercise and hypoxia
Abstract
Abstract The effect of skin pigmentation on the reliability of noninvasive oximetry, especially during exercise and hypoxia, has not been thoroughly investigated. This is the first study, to our knowledge, that specifically addresses this question. Thirty-three young black men performed multistage, steady-state cycle ergometry, breathing gas mixtures simulating different altitudes: 33 breathed gas simulating sea level (Pi O2 = 146 mm Hg), 11 breathed gas simulating 2,300 m (Pi O2 = 110 mm Hg), and 22 breathed gas simulating 4,000 m (Pi O2 = 85 mm Hg). Co-oximeter SaO2 determinations were performed in arterial blood samples obtained concurrently with ear oximetry that was measured using Hewlett-Packard 47201A (HP) and Biox IIA oximeters. The mean error or bias for the [HP - SaO2] and for [Biox IIA - SaO2] ± 95% CI were: at simulated sea level (SaO2 > 96%): −0.4 ± 0.3% and 2.1 ± 0.3%; at simulated 2,300 m (range of SaO2 means, 89 to 94%): −0.8 ± 0.5% and 3.5 ± 0.9%; for simulated 4,000 m (range of SaO2 means, 75 to 84%): −4.8 ± 1.6% and 9.8 ± 1.8%, respectively. A better coefficient correlation was observed for all the pairs between SaO2 versus HP (r = 0.94, p < 0.001, n = 279) than for the SaO2 versus Biox IIA (r = 0.80, p < 0.001, n = 242). In conclusion, the HP oximeter appears to estimate SaO2 more accurately than the Biox IIA oximeter. The previously described overestimation for the Biox IIA ear oximeter and the underestimation for the HP ear oximeter at low SaO2 values in whites is exaggerated in blacks. Although noninvasive oximetry may be used to follow desaturation trends in blacks, it would be unreliable to estimate absolute SaO2. The clinical utility of noninvasive oximetry in blacks is unacceptable at values of SaO2 < 85% for the HP and < 90% for the Biox IIA oximeters. The effect of skin pigmentation on the reliability of the many newer pulse oximeters requires further investigation.
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Darker skin pigmentation may influence PPG-based SpO2 and PR readings.
“Notably, darker skin pigmentation may influence PPG-based SpO2 and PR readings [7-10].”
From Impact of skin pigmentation on pulse oximetry blood oxygenation and wearable pulse rate accuracy: systematic review and meta-analysis (2024) · cites this paper as [9]
A study of two ear oximeters under normoxic and hypoxic conditions in 33 healthy male subjects (mostly with dark skin pigmentation) showed unacceptable readings for SpO2 values of less than 85% for one device and less than 90% for the other.
“A study of the reliability of two ear oximeters under normoxic and hypoxic conditions in 33 healthy male subjects (mostly with dark skin pigmentation) showed unacceptable readings for SpO2 values of less than 85% for one device and less than 90% for the other [87].”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [87]
Zeballos and Weisman found overestimations in the two compared oximeters in darkly pigmented subjects.
“Although they did not refer to a specific scale of skin pigmentation degree, they also found overestimations in the two compared oximeters in darkly pigmented subjects.”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [87]
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- Authors
- Zeballos, R. J., & Weisman, I. M.
- Affiliations
- William Beaumont Army Medical Center (US)
- Venue
- American Review of Respiratory Disease
- Publisher
- Oxford University Press (OUP)
- Published
- 1991-12-01
- Volume
- 144
- Issue
- 6
- Pages
- 1240-1244
- ISSN
- 0003-0805 (ISSN-L)
- OpenAlex
- W2010341130
- Cited by
- 108
- References
- 18
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 11 · 2023: 4 · 2022: 26 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 1 · 2013: 3 · 2012: 1
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Review of Respiratory Disease (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › High Altitude and Hypoxia
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- ear oximetry, skin pigmentation, Black subject, oxygen saturation, hypoxia, physical activity, simulated altitude, co-oximetry, arterial blood gases, measurement bias, correlation coefficient, young men
- MeSH terms
- Adult, Hypoxia, Ear, External, Exercise Test, Humans, Male, Oximetry, Skin Pigmentation, Reproducibility of Results, Exercise, Black People
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