Prospective Evaluation of Nocturnal Oximetry for Detection of Sleep-Related Breathing Disturbances in Patients With Chronic Heart Failure
Abstract
Background Because patients with chronic heart failure (CHF) can benefit from specific treatment for coexisting obstructive and central sleep apnea (CSA), there is a need to develop accurate screening tools to identify or exclude these sleep-related breathing disturbances (SRBDs) in patients with CHF. Objectives To evaluate, prospectively, the diagnostic value of nocturnal home oximetry in identifying SRBD in CHF patients and in distinguishing central events from obstructive events. Design Blinded comparison of hospital and home oximetry, and polysomnographic nocturnal recordings Setting Cardiac heart failure and sleep clinics in three tertiary referral centers. Patients Fifty consecutive patients who were investigated for participation in the Canadian Continuous Positive Airway Pressure Trial for Congestive Heart Failure with Central Sleep Apnea and were recruited from three different centers. Measurements and results Patients underwent two oximetry recordings, one at home and one during a polysomnographic study. The criterion for an SRBD was the presence of > 15 apneas and hypopneas per hour of sleep during polysomnography or an oxygen desaturation index of > 10 events per hour during oximetry. The pattern of desaturation/resaturation during oximetry was also examined to distinguish obstructive events from central events. Using a 2% fall in pulse oximetric saturation as the criterion for oxygen desaturation, home oximetry had a 85% sensitivity and a 93% specificity (p Concl…
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In patients with stable heart failure (Class 2-4; left ventricular ejection fraction < 40%), home oximetry (positive if 2% ODI ≥ 10) had a sensitivity of 0.85 and specificity of 0.93 for identifying sleep-disordered breathing compared with PSG (positive if AHI ≥ 15).
“This study found oximetry to have a sensitivity of 0.85 and specificity of 0.93 in identifying sleep-disordered breathing.117”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [117]
Meta-analysis of these studies found that in a population of 1,000 patients at high risk of moderate to severe OSA (64% prevalence), 45 to 230 more false negatives and 18 to 79 more false positives would result from the use of HSAT.
“Meta-analysis of these studies (see supplemental material, Table S61) found that in a population of 1,000 patients at high risk of moderate to severe OSA (64% prevalence), 45 to 230 more false negative and 18 to 79 more false positives would result from the use of HSAT.117,119,120”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [117]
In the same study, home oximetry had poor specificity (0.17) but sensitivity 1.0 for identifying CSA based on desaturation/resaturation patterns, with 10 of 12 patients with OSA identified as having CSA.
“The specificity was poor for identifying CSA, based on desaturation/ resaturation patterns (specificity of 0.17; sensitivity of 1.0) with 10 of 12 patients with OSA identified as having CSA.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [117]
The evidence for HSAT in diagnosis of OSA among patients with comorbid heart failure was based on three studies and was downgraded to low because of imprecision and indirectness.
“The evidence for the use of HSAT in diagnosis of OSA among patients with comorbid heart failure was based on three studies, and this evidence was downgraded to low because of imprecision and indirectness.117,119,120”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [117]
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- Authors
- Sériès, F., Kimoff, R. J., Morrison, D., Leblanc, M. H., Smilovitch, M., Howlett, J., Logan, A. G., Floras, J. S., & Bradley, T. D.
- Affiliations
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- McGill University Health Centre (CA)
- Queen Elizabeth II Health Sciences Centre (CA)
- Mount Sinai Hospital (CA)
- Corresponding author
- Sériès, Frédeéric
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2005-05
- Volume
- 127
- Issue
- 5
- Pages
- 1507-1514
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W2131416048
- Cited by
- 83
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2022: 1 · 2019: 1 · 2018: 6 · 2017: 3 · 2016: 3 · 2015: 6 · 2014: 2 · 2013: 10 · 2012: 5
- FWCI
- 4.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- chronic heart failure, central sleep apnea, obstructive sleep apnea, nocturnal oximetry, oxygen desaturation index, polysomnography, diagnostic accuracy
- MeSH terms
- Adolescent, Adult, Aged, Female, Heart Failure, Humans, Male, Middle Aged, Oximetry, Prospective Studies, Sensitivity and Specificity, Reproducibility of Results, Polysomnography, Sleep Apnea, Obstructive, Sleep Apnea, Central
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