Characteristics of pulse oxygen saturation curves change in different obstructive respiratory events in patients with obstructive sleep apnea_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

PENG Cheng , XU Shaorong ,  WANG Yan , CHEN Baoyuan , WANG Jianqing , YANG Manru , SHI Yu

Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P. R. China;

Corresponding author：

WANG Yan, Email: wangy0504@126.com

Keywords：

Obstructive sleep apnea; hypoxic parameters; obstructive apnea; hypopnea

DOI：

10.7507/1671-6205.202302010

Video：

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Objective To analyze the the characteristics of pulse oximetry (SpO₂) curve changes in patients with obstructive sleep apnea (OSA), hypoxic parameters and to explore the difference and connection between obstructive apnea (OA) events and hypopnea (Hyp) events, evaluate the impact of different types of obstructive respiratory events on hypoxia, and provide a theoretical basis for exploration of hypoxic differences in each type of respiratory events and construction of prediction models for respiratory event types in the future. Methods Sixty patients with OSA diagnosed by polysomnography (PSG) were selected for retrospective analysis, and all respiratory events with oxygen drop in the recorded data overnight were divided into OA group (5972) according to the type of events and Hyp group (4110), recorded and scored events were exported from the PSG software as comma-separated variable (.csv) files, which were then imported and analyzed using the in-house built Matlab software. Propensity score matching was performed on the duration of respiratory events and whether they were accompanied by arousal in the two groups, and minimum oxygen saturation of events (e-minSpO₂), the depth of desaturation (ΔSpO₂), the duration of desaturation and resaturation (DSpO₂), the duration of desaturation (d.DSpO₂), duration of resaturation (r.DSpO₂), duration of SpO₂<90% (T90), duration of SpO₂<90% during desaturation (d.T90), duration of SpO₂<90% during resaturation (r.T90), area under the curve of SpO₂<90% (ST90), area under the curve of SpO₂<90% during desaturation (d.ST90), area under the curve of SpO₂<90% during resaturation (r.ST90), oxygen desaturation rate (ODR) and oxygen resaturation rate (ORR), a total of 13 hypoxic parameters differences. Results Various hypoxic parameters showed that more severe SpO₂ desaturation in severe OSA patients, compared with mild and moderate OSA patients (P<0.05); There were statistically significant differences in the respiratory events duration and whether accompanied by arousal between the Hyp group and OA group (P<0.05), and the respiratory events duration and whether accompanied by arousal were significantly correlated with most hypoxic parameters; After accounting for respiratory events duration and whether accompanied by arousal by propensity score matching, compared with the Hyp group, e-minSpO₂ was significantly lower in the OA group, ΔSpO₂, d.DSpO₂, r.DSpO₂, ODR, ORR, T90, d.T90, r.T90, ST90, d.ST90, r.ST90 were significantly increased (P<0.05). Conclusions Due to pathophysiological differences, all hypoxic parameters suggest that OA events will result in a more severe desaturation than Hyp events. Clinical assessment of OSA severity should not equate OA with Hyp events, which may cause more damage to the organism, establishing a basis for applying nocturnal SpO₂ to automatically identify the type of respiratory event.

Citation： PENG Cheng, XU Shaorong, WANG Yan, CHEN Baoyuan, WANG Jianqing, YANG Manru, SHI Yu. Characteristics of pulse oxygen saturation curves change in different obstructive respiratory events in patients with obstructive sleep apnea. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(8): 539-545. doi: 10.7507/1671-6205.202302010 Copy

1.	Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest, 2014, 146(5): 1387-1394.
2.	中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版). 中华结核和呼吸杂志, 2012, 35(1): 9-12.
3.	Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med, 2017, 13(3): 479-504.
4.	Kendzerska T, Gershon AS, Atzema C, et al. Sleep apnea increases the risk of new hospitalized atrial fibrillation: a historical cohort study. Chest, 2018, 154(6): 1330-1339.
5.	Berry RB, Quan SF, Abreu AR, et al. For the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Speecifications. Darien, IL: American Academy of Sleep Medicine, 2020. Version 2.6.
6.	Borker PV, Reid M, Sofer T, et al. Non-REM apnea and hypopnea duration varies across population groups and physiologic traits. Am J Respir Crit Care Med, 2021, 203(9): 1173-1182.
7.	Leppänen T, Kulkas A, Mervaala E, et al. Increase in body mass index decreases duration of apneas and hypopneas in obstructive sleep apnea. Respir Car, 2019, 64(1): 77-84.
8.	Durmaz DY, Güneş A. Is there a relationship between hematological parameters and duration of respiratory events in severe OSA. Aging Male, 2020, 23(2): 125-131.
9.	Butler MP, Emch JT, Rueschman M, et al. Apnea-hypopnea event duration predicts mortality in men and women in the Sleep Heart Health Study. Am J Respir Crit Care Med, 2019, 199(7): 903-912.
10.	Saraç S, Afsar GC. Effect of mean apnea-hypopnea duration in patients with obstructive sleep apnea on clinical and polysomnography parameter. Sleep Breath, 2020, 24(1): 77-81.
11.	Kulkas A, Duce B, Leppänen T, et al. Severity of desaturation events differs between hypopnea and obstructive apnea events and is modulated by their duration in obstructive sleep apnea. Sleep Breath, 2017, 21(4): 829-835.
12.	Kulkas A, Duce B, Leppänen T, et al. Gender differences in severity of desaturation events following hypopnea and obstructive apnea events in adults during sleep. Physiol Meas, 2017, 38(8): 1490-1502.
13.	Bahr K, Geisler V, Huppertz T, et al. Intensity of respiratory cortical arousals is a distinct pathophysiologic feature and is associated with disease severity in obstructive sleep apnea patients. Brain Sci, 2021, 11(3): 282.
14.	Leppänen T, Kulkas A, Oksenberg A, et al. Differences in arousal probability and duration after apnea and hypopnea events in adult obstructive sleep apnea patients. Physiol Meas, 2018, 39(11): 114004.
15.	Dempsey JA, Veasey SC, Morgan BJ, et al. Pathophysiology of sleep apnea. Physiol Rev, 2010, 90(1): 47-112.
16.	Trzepizur W, Blanchard M, Ganem T, et al. Sleep apnea-specific hypoxic burden, symptom subtypes, and risk of cardiovascular events and all-cause mortality. Am J Respir Crit Care Med, 2022, 205(1): 108-117.
17.	Chung F, Zhou L, Liao P. Parameters from preoperative overnight oximetry predict postoperative adverse events. Minerva Anestesiol, 2014, 80(10): 1084-1095.
18.	Delazer M, Zamarian L, Frauscher B, et al. Oxygen desaturation during night sleep affects decision-making in patients with obstructive sleep apnea. J Sleep Res, 2016, 25(4): 395-403.
19.	Kainulainen S, Töyräs J, Oksenberg A, et al. Severity of desaturations reflects OSA-related daytime sleepiness better than AHI. J Clin Sleep Med, 2019, 15(8): 1135-1142.
20.	Labarca G, Campos J, Thibaut K, et al. Do T90 and SaO₂ nadir identify a different phenotype in obstructive sleep apnea? Sleep Breath, 22019, 23(3): 1007-1010.
21.	Kazemeini E, Van de Perck E, Dieltjens M, et al. Critical to know Pcrit: a review on pharyngeal critical closing pressure in obstructive sleep apnea. Front Neurol, 2022, 13: 775709.
22.	Strohl KP, Altose MD. Oxygen saturation during breath-holding and during apneas in sleep. Chest, 1984, 85(2): 181-186.
23.	Blekic N, Bold I, Mettay T, et al. Impact of desaturation patterns versus apnea-hypopnea index in the development of cardiovascular comorbidities in obstructive sleep apnea patients. Nat Sci Sleep, 2022, 14: 1457-1468.
24.	Foldvary-Schaefer NR, Waters TE. Sleep-disordered breathing. Continuum (Minneap Minn), 2017, 23(4, Sleep Neurology): 1093-1116.
25.	Shiomi T, Guilleminault C, Stoohs R, et al. Leftward shift of the interventricular septum and pulsus paradoxus in obstructive sleep apnea syndrome. Chest, 1991, 100(4): 894-902.
26.	Tolle FA, Judy WV, Yu PL, et al. Reduced stroke volume related to pleural pressure in obstructive sleep apnea. J Appl Physiol Respir Environ Exerc Physiol, 1983, 55(6): 1718-1724.
27.	Wang NN, Meng ZL, Ding N, et al. Oxygen desaturation rate as a novel intermittent hypoxemia parameter in severe obstructive sleep apnea is strongly associated with hypertension. J Clin Sleep Med, 2020, 16(7): 1055-1062.
28.	Findley LJ, Ries AL, Tisi GM, et al. Hypoxemia during apnea in normal subjects: mechanisms and impact of lung volume. J Appl Physiol Respir Environ Exerc Physiol, 1983, 55(6): 1777-1783.
29.	Bhattacharjee R, Hakim F, Gozal D. Sleep, sleep-disordered breathing and lipid homeostasis: translational evidence from murine models and children. Clin Lipidol, 2012, 7(2): 203-214.

1. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest, 2014, 146(5): 1387-1394.
2. 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版). 中华结核和呼吸杂志, 2012, 35(1): 9-12.
3. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med, 2017, 13(3): 479-504.
4. Kendzerska T, Gershon AS, Atzema C, et al. Sleep apnea increases the risk of new hospitalized atrial fibrillation: a historical cohort study. Chest, 2018, 154(6): 1330-1339.
5. Berry RB, Quan SF, Abreu AR, et al. For the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Speecifications. Darien, IL: American Academy of Sleep Medicine, 2020. Version 2.6.
6. Borker PV, Reid M, Sofer T, et al. Non-REM apnea and hypopnea duration varies across population groups and physiologic traits. Am J Respir Crit Care Med, 2021, 203(9): 1173-1182.
7. Leppänen T, Kulkas A, Mervaala E, et al. Increase in body mass index decreases duration of apneas and hypopneas in obstructive sleep apnea. Respir Car, 2019, 64(1): 77-84.
8. Durmaz DY, Güneş A. Is there a relationship between hematological parameters and duration of respiratory events in severe OSA. Aging Male, 2020, 23(2): 125-131.
9. Butler MP, Emch JT, Rueschman M, et al. Apnea-hypopnea event duration predicts mortality in men and women in the Sleep Heart Health Study. Am J Respir Crit Care Med, 2019, 199(7): 903-912.
10. Saraç S, Afsar GC. Effect of mean apnea-hypopnea duration in patients with obstructive sleep apnea on clinical and polysomnography parameter. Sleep Breath, 2020, 24(1): 77-81.
11. Kulkas A, Duce B, Leppänen T, et al. Severity of desaturation events differs between hypopnea and obstructive apnea events and is modulated by their duration in obstructive sleep apnea. Sleep Breath, 2017, 21(4): 829-835.
12. Kulkas A, Duce B, Leppänen T, et al. Gender differences in severity of desaturation events following hypopnea and obstructive apnea events in adults during sleep. Physiol Meas, 2017, 38(8): 1490-1502.
13. Bahr K, Geisler V, Huppertz T, et al. Intensity of respiratory cortical arousals is a distinct pathophysiologic feature and is associated with disease severity in obstructive sleep apnea patients. Brain Sci, 2021, 11(3): 282.
14. Leppänen T, Kulkas A, Oksenberg A, et al. Differences in arousal probability and duration after apnea and hypopnea events in adult obstructive sleep apnea patients. Physiol Meas, 2018, 39(11): 114004.
15. Dempsey JA, Veasey SC, Morgan BJ, et al. Pathophysiology of sleep apnea. Physiol Rev, 2010, 90(1): 47-112.
16. Trzepizur W, Blanchard M, Ganem T, et al. Sleep apnea-specific hypoxic burden, symptom subtypes, and risk of cardiovascular events and all-cause mortality. Am J Respir Crit Care Med, 2022, 205(1): 108-117.
17. Chung F, Zhou L, Liao P. Parameters from preoperative overnight oximetry predict postoperative adverse events. Minerva Anestesiol, 2014, 80(10): 1084-1095.
18. Delazer M, Zamarian L, Frauscher B, et al. Oxygen desaturation during night sleep affects decision-making in patients with obstructive sleep apnea. J Sleep Res, 2016, 25(4): 395-403.
19. Kainulainen S, Töyräs J, Oksenberg A, et al. Severity of desaturations reflects OSA-related daytime sleepiness better than AHI. J Clin Sleep Med, 2019, 15(8): 1135-1142.
20. Labarca G, Campos J, Thibaut K, et al. Do T90 and SaO₂ nadir identify a different phenotype in obstructive sleep apnea? Sleep Breath, 22019, 23(3): 1007-1010.
21. Kazemeini E, Van de Perck E, Dieltjens M, et al. Critical to know Pcrit: a review on pharyngeal critical closing pressure in obstructive sleep apnea. Front Neurol, 2022, 13: 775709.
22. Strohl KP, Altose MD. Oxygen saturation during breath-holding and during apneas in sleep. Chest, 1984, 85(2): 181-186.
23. Blekic N, Bold I, Mettay T, et al. Impact of desaturation patterns versus apnea-hypopnea index in the development of cardiovascular comorbidities in obstructive sleep apnea patients. Nat Sci Sleep, 2022, 14: 1457-1468.
24. Foldvary-Schaefer NR, Waters TE. Sleep-disordered breathing. Continuum (Minneap Minn), 2017, 23(4, Sleep Neurology): 1093-1116.
25. Shiomi T, Guilleminault C, Stoohs R, et al. Leftward shift of the interventricular septum and pulsus paradoxus in obstructive sleep apnea syndrome. Chest, 1991, 100(4): 894-902.
26. Tolle FA, Judy WV, Yu PL, et al. Reduced stroke volume related to pleural pressure in obstructive sleep apnea. J Appl Physiol Respir Environ Exerc Physiol, 1983, 55(6): 1718-1724.
27. Wang NN, Meng ZL, Ding N, et al. Oxygen desaturation rate as a novel intermittent hypoxemia parameter in severe obstructive sleep apnea is strongly associated with hypertension. J Clin Sleep Med, 2020, 16(7): 1055-1062.
28. Findley LJ, Ries AL, Tisi GM, et al. Hypoxemia during apnea in normal subjects: mechanisms and impact of lung volume. J Appl Physiol Respir Environ Exerc Physiol, 1983, 55(6): 1777-1783.
29. Bhattacharjee R, Hakim F, Gozal D. Sleep, sleep-disordered breathing and lipid homeostasis: translational evidence from murine models and children. Clin Lipidol, 2012, 7(2): 203-214.

Chinese Journal of Respiratory and Critical Care Medicine

Characteristics of pulse oxygen saturation curves change in different obstructive respiratory events in patients with obstructive sleep apnea

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