Smoothed Periodogram of Oxyhemoglobin Saturation by Pulse Oximetry in Sleep Apnea Syndrome : An Automated Analysis

Background:Variability of oxyhemoglobin saturation (Spo2) during sleep has been utilized as a diagnostic index for sleep apnea. Spectral analysis with its graphical presentation, the periodogram, is an approach for measuring such variability. This work examined the parameters on a smoothed periodogram created from series data for Spo2obtained by pulse oximetry during a sleep study.Design and results:Spo2was recorded during polysomnography study of 273 subjects. Clinical data of subjects were collected retrospectively. A novel automated algorithm was created to measure the low-frequency (< 0.1 Hz) peak and the slope of spectral density vs frequency in the frequency region of 0.1 to 0.5 Hz (slope0.1–0.5). Two successive modified Daniell smoothers with span lengths of 3 to 121 in odd numbers were applied to determine the effect of smoothing on these parameters. slope0.1–0.5was least affected by smoothing and had a sensitivity of 78% and a specificity of 80% in diagnosing sleep apnea defined by a value of apnea-hypopnea index ≥ 5. Combining slope0.1–0.5with parameters of the low-frequency peak enlarged the area under the receiver operating characteristic curve. A composite indicator comprised of slope0.1–0.5and ratio of the area under the curve of the low-frequency peak to that of whole periodogram (AUCratio) had a positive likelihood ratio of 15.25 in identifying patients with moderate-to-severe obstructive sleep apnea. The algorithm was validated in another 206 patients undergoing polysomnographic studies.Conclusions:These analytical results demonstrate that the smoothed periodogram of Spo2is a useful tool for screening subjects with sleep apnea.