The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Overnight Oximetry in the Home is Crazy'

Carl Mottram, RRT, RPFT Wednesday, November 6, 1996

Sleep Apnea Syndrome (SAS) has been identified as a serious and potentially life threatening condition. Symptoms of functional impairment include day-time hypersomnolence, memory and judgmental problems, irritability and personally changes. These symptoms have been linked with higher rates of automobile and work-related accidents. Recent evidence shows that SAS is associated with systemic hypertension, cardiac arrhythmia, myocardial infarction and stroke^{1}. Young et al. estimated that 2 percent of women and 4 percent of men in the middle-aged work force meet the criteria for SAS^{2}.

Until recently polysomnography, which requires and overnight stay in a sleep lab, has been the only method for diagnosing SAS and still remains the "gold standard". Overnight oximetry in the home setting has become a cost effective and attractive alternative for the screening and prioritizing of patients with suspected SAS. Gyulay et al reported that an algorithm which includes clinical assessment, cumulative time < =90%, and counting desaturation events >= 4% can make home oximetry both sensitive and specific in the diagnosis of SAS^{3}. Home oximetry can also be effective in identifying nocturnal desaturation in patients with lung disease, neuromuscular disease and in the assessment of treatment modalities.

Our program consists of portable oximeters, computer data analysis, clinical assessment questionnaires and a quality assurance program. The quality assurance program incorporates the following: * Standardized instructional format * Recording in-house SpO_{2} reading * If the resting SpO_{2} is < = 90%, obtain ABG's * Log book for tracking oximeter trouble-shooting and maintenance

Using these methods our program has been successful in assisting with the diagnosis and management of patients with SAS and nocturnal desaturation.

References 1. National Heart, Lung, and Blood Institute. Sleep apnea: is your patient at risk? Am Fam Physician 1996;53:247-53.

2. Young T, M Palta, J Dempsey, J Skatrud, S Weber, S Badr. The occurrence of sleep-disordered breathing among middle-aged adults. New Eng J Med 1993;328:1230-35.

3. Gyulay S, LG Olson, MJ Hensley, MT King, KM Allen, NA Saunders. A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea. Am Rev Respir Dis 1993;147:50-53.

4. Yamashiro Y, MH Kryger. Nocturnal oximetry: is it a screening tool for sleep disorders? Sleep 1995;18:167-71.

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