JMIR Publications

ABSTRACT

Background:

Chronic obstructive pulmonary disease (COPD) patients can suffer from low blood oxygen concentrations. Peripheral oxygen saturation (SpO2), as assessed by pulse oximetry, is commonly measured during the day using a spot check, or continuously during one or two nights to estimate nocturnal desaturation. Sampling at this frequency may overlook natural fluctuations in SpO2.

Objective:

This study used wearable finger pulse oximeters to continuously measure SpO2 during daily home routines of COPD patients and assess natural SpO2 fluctuations.

Methods:

20 COPD patients wore a WristOx2 pulse oximeter during one week to collect continuous SpO2 measurements. A SenseWear armband simultaneously collected actigraphy measurements to provide contextual information. SpO2 time series were pre-processed and data quality was assessed afterwards. Mean SpO2, SpO2 standard deviation (SpO2 std.) and cumulative time spent with SpO2 below 90% (CT90) were calculated for every i) day, ii) day in rest and iii) night to assess SpO2 fluctuations.

Results:

A high percentage of valid SpO2 data (daytime: 93.27%; nocturnal: 99.31%) could be obtained during a seven-day monitoring period, except during moderate-to-vigorous intensity physical activities (MVPA; 67.86%). Mean nocturnal SpO2 (89.9% ± 3.4) was lower than mean daytime SpO2 in rest (92.1% ± 2.9; P < .001). On average, SpO2 in rest ranged over 10.8% (± 4.4) within one day. Highly varying CT90 values between different nights led to 50% (10/20) of the included patients to change category between desaturator and non-desaturator over the course of one week.

Conclusions:

Continuous SpO2 measurements with wearable finger pulse oximeters identified significant SpO2 fluctuations between and within multiple days and nights of patients with COPD. Continuous SpO2 measurements during daily home routines of patients with COPD were feasible and generally had high amounts of valid data, except for motion artefacts during MVPA. The identified fluctuations can have implications for telemonitoring applications that are based on daily SpO2 spot checks. CT90 values can greatly vary from night to night in patients with a nocturnal mean SpO2 around 90%, indicating that these patients cannot be consistently categorised as desaturators or non-desaturators. We recommend using wearable sensors for continuous SpO2 measurements over longer time periods to determine the clinical relevance of the identified SpO2 fluctuations.