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Observational Study
. 2019 Jun 6;7(6):e12866.
doi: 10.2196/12866.

Wearable Finger Pulse Oximetry for Continuous Oxygen Saturation Measurements During Daily Home Routines of Patients With Chronic Obstructive Pulmonary Disease (COPD) Over One Week: Observational Study

Joren Buekers  1   2 , Jan Theunis  1 , Patrick De Boever  1   3 , Anouk W Vaes  4 , Maud Koopman  4 , Eefje Vm Janssen  4 , Emiel Fm Wouters  4   5 , Martijn A Spruit  4   5   6   7 , Jean-Marie Aerts  2
Affiliations
Observational Study

Wearable Finger Pulse Oximetry for Continuous Oxygen Saturation Measurements During Daily Home Routines of Patients With Chronic Obstructive Pulmonary Disease (COPD) Over One Week: Observational Study

Joren Buekers et al. JMIR Mhealth Uhealth. .

Abstract

Background: Chronic obstructive pulmonary disease (COPD) patients can suffer from low blood oxygen concentrations. Peripheral blood 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: A total of 20 COPD patients wore a WristOx2 pulse oximeter for 1 week to collect continuous SpO2 measurements. A SenseWear Armband simultaneously collected actigraphy measurements to provide contextual information. SpO2 time series were preprocessed and data quality was assessed afterward. Mean SpO2, SpO2 SD, and cumulative time spent with SpO2 below 90% (CT90) were calculated for every (1) day, (2) day in rest, and (3) night to assess SpO2 fluctuations.

Results: A high percentage of valid SpO2 data (daytime: 93.27%; nocturnal: 99.31%) could be obtained during a 7-day monitoring period, except during moderate-to-vigorous physical activity (MVPA) (67.86%). Mean nocturnal SpO2 (89.9%, SD 3.4) was lower than mean daytime SpO2 in rest (92.1%, SD 2.9; P<.001). On average, SpO2 in rest ranged over 10.8% (SD 4.4) within one day. Highly varying CT90 values between different nights led to 50% (10/20) of the included patients changing categories between desaturator and nondesaturator over the course of 1 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 generally had high amounts of valid data, except for motion artifacts during MVPA. The identified fluctuations can have implications for telemonitoring applications that are based on daily SpO2 spot checks. CT90 values can vary greatly from night to night in patients with a nocturnal mean SpO2 around 90%, indicating that these patients cannot be consistently categorized as desaturators or nondesaturators. We recommend using wearable sensors for continuous SpO2 measurements over longer time periods to determine the clinical relevance of the identified SpO2 fluctuations.

Keywords: COPD; finger pulse oximeter; nocturnal desaturation; oxygen saturation; telemonitoring; wearable sensor.

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Conflict of interest statement

Conflicts of Interest: MAS discloses receipt of renumeration for consultancy and/or lectures from Boehringer Ingelheim, GlaxoSmithKline, and AstraZeneca outside the scope of this work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript, apart from those disclosed.

Figures

Figure 1
Figure 1
General overview of the applied methods. COPD: chronic obstructive pulmonary disease; SpO2: peripheral blood oxygen saturation; CT90: cumulative time spent with SpO2 below 90%.
Figure 2
Figure 2
Visualization of the different preprocessing steps. Panel A shows all original data, containing error values, that are divided into daytime and nocturnal data. Panel B zooms in on the effect of data exclusion on a specific part of daytime peripheral blood oxygen saturation (SpO2) data. Panel C zooms in on the effect of down-sampling and interpolating on the same part of daytime SpO2 data.
Figure 3
Figure 3
The amount of invalid data of continuous peripheral blood oxygen saturation (SpO2) measurements for different activities. LIPA: low-intensity physical activity; MVPA: moderate-to-vigorous physical activity.
Figure 4
Figure 4
Mean nocturnal peripheral blood oxygen saturation (SpO2) compared to mean daytime SpO2 in rest. The dots indicate weekly averages of mean SpO2 for every patient, lines indicate the standard deviation of the mean SpO2 values over different days and nights, and the orange line is the line of equality.
Figure 5
Figure 5
Cumulative time spent with peripheral blood oxygen saturation (SpO2) below 90% (CT90) values for every night of every patient showed that 50% (10/20) of the included patients changed category between desaturator and nondesaturator. The number next to each dot indicates the corresponding night of the measuring week and the orange line indicates the threshold of CT90 (30%) that divides nights with and without desaturation. A missing night number indicates that no data was available for that night.
See this image and copyright information in PMC

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