Minami et al.

Multidisciplinary Respiratory Medicine 2014, 9:24

http://www.mrmjournal.com/content/9/1/24

ORIGINAL RESEARCH ARTICLE Open Access

Ambulatory pulse oximetry monitoring in

Japanese COPD outpatients not receiving
oxygen therapy
Seigo Minami1*, Suguru Yamamoto1, Yoshitaka Ogata1, Takeshi Nakatani2, Yoshiko Takeuchi3,
Masanari Hamaguchi4, Taro Koba1 and Kiyoshi Komuta1

Abstract
Background: It remains unknown whether desaturation profiles during daily living are associated with prognosis in
patients with chronic obstructive pulmonary disease (COPD). Point measurements of resting oxygen saturation by
pulse oximetry (SpO2) and partial pressure of arterial oxygen (PaO2) are not sufficient for assessment of desaturation
during activities of daily living. A small number of studies continuously monitored oxygen saturation throughout
the day during activities of daily living in stable COPD patients. This study aims to analyse the frequency of
desaturation in COPD outpatients, and investigate whether the desaturation profile predicts the risk of exacerbation.
Methods: We studied stable COPD outpatients not receiving supplemental oxygen therapy. Baseline assessments
included clinical assessment, respiratory function testing, arterial blood gas analysis, body mass index, and the
COPD Assessment Test (CAT). Patients underwent 24-hour ambulatory monitoring of SpO2 during activities of daily
living. Exacerbations of COPD and death from any cause were recorded.
Results: Fifty-one patients were enrolled in the study, including 12 current smokers who were excluded from the
analyses in case high serum carboxyhaemoglobin concentrations resulted in inaccurately high SpO2 readings. The
mean percent predicted forced expiratory volume in one second (%FEV1) was 50.9%. The mean proportion of SpO2
values below 90% was 3.0% during the day and 7.4% during the night. There were no daytime desaturators,
defined as ≥ 30% of daytime SpO2 values below 90%. Twenty-one exacerbations occurred in 13 patients during the
mean follow-up period of 26.4 months. Univariate and multivariate Cox proportional hazards analyses did not detect
any significant factors associated with exacerbation.
Conclusions: Our 24-hour ambulatory oximetry monitoring provided precise data regarding the desaturation
profiles of COPD outpatients. Both daytime and nighttime desaturations were infrequent. The proportion of
ambulatory SpO2 values below 90% was not a significant predictor of exacerbation.
Keywords: Activities of daily living, Chronic obstructive pulmonary disease (COPD), Desaturator, Exacerbation,
Outpatients, Pulse oximetry

* Correspondence: [email protected]
1
Department of Respiratory Medicine, Osaka Police Hospital,
10-31 Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan
Full list of author information is available at the end of the article

© 2014 Minami et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
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Background Methods
Chronic obstructive pulmonary disease (COPD) is a lead- Patient selection
ing cause of morbidity and disability worldwide, and is Patients were recruited from the outpatient clinic in the
predicted to become the third highest cause of death by Department of Respiratory Medicine at Osaka Police
2020 [1]. Desaturation profiles during a 6-minute walk test Hospital. The inclusion criteria were: (1) clinically stable
(6MWT) may predict prognosis primarily in patients with COPD according to the Global Initiative on Obstructive
severe COPD with a percent predicted forced expiratory Lung Disease guidelines, with a FEV1 to forced vital
volume in one second (FEV1) of < 50% [2]. Time to desat- capacity ratio of < 70% and minimal or no reversibility
uration during a 6MWT also predicts desaturation time in to β2-agonists (<200 mL and/or < 15%); (2) able to walk
24-hour ambulatory oximetry monitoring primarily in independently or with a cane; and (3) sufficient cogni-
moderately hypoxaemic COPD patients with a resting tive function to follow the instructions for using the
partial pressure of arterial oxygen (PaO2) between 60 and pulse oximeter. Patients were excluded if they were cur-
70 mmHg [3]. However, it remains unknown whether de- rently hospitalised, if they had experienced an exacerbation
saturation profiles measured by ambulatory oximetry can requiring hospitalisation or administration of antibiotics or
predict prognosis in COPD patients. Transient desatura- steroids during the preceding 3 months, if they had other
tions have been observed in patients with moderate to significant respiratory diseases or medical problems that
severe chronic pulmonary disorders, even without signifi- precluded ambulatory activities at home, and if they were
cant resting hypoxemia [4]. Point measurements of resting receiving supplemental oxygen therapy.
oxygen saturation by pulse oximetry (SpO2) and PaO2, the
conventional parameters used to determine requirements Experimental design
of long-term oxygen therapy, are not sufficient for assess- Within 1 month of ambulatory oximetry monitoring, all
ment of desaturation during activities of daily living [5]. patients underwent spirometry, arterial blood gas analysis,
Field walking tests such as the 6MWT, which is the stand- assessment of the modified Medical Research Council
ard test used for assessment of functional exercise toler- (mMRC) dyspnoea scale score, and the Japanese version
ance, do not always provide a good reflection of variations of the COPD assessment test (CAT) (GlaxoSmithKline;
in oxygen saturation, because most activities of daily living http://www.catestonline.org/) [7,8]. Spirometry was per-
are performed at submaximal levels of effort. 6MWT re- formed using an autospirometer (Autospirometer System
sults did not predict the degree of desaturation during 7; Minato Medical Science, Osaka, Japan) according to the
defecation in patients with chronic respiratory failure [6]. American Thoracic Society guidelines. Samples for arterial
Conventional assessment methods are therefore not satis- blood gas analysis were obtained from the radial artery
factory for obtaining a comprehensive understanding of with the patient resting in the sitting position and breath-
oxygen saturation throughout the day. ing room air, and PaO2 and partial pressure of arterial
Pulse oximetry is a rapid, non-invasive method of moni- carbon dioxide (PaCO2) were immediately measured using
toring the oxygen saturation of haemoglobin. Recent a blood gas analyser (RAPIDPoint 405 Arterial Blood Gas
technological advances have enabled development of low- Analyzer; Siemens Healthcare Diagnostics Inc., Tarrytown,
cost, small, user-friendly, portable pulse oximeters that NY, USA).
can record data for over 24 hours. Many studies have A portable pulse oximeter (PULSOX-Me300; Konica-
evaluated the usefulness of pulse oximetry in COPD Minolta, Tokyo, Japan) was used to obtain continuous
patients, but most studies only monitored patients con- oximetry data over a 24-hour period. SpO2 and the pulse-
tinuously during the night or for a short period during rate waveform were recorded every second. A nurse indi-
the day. Although several studies monitored patients vidually instructed each patient on the proper use of the
continuously during the day, most of these included portable oximeter before the start of monitoring. The
patients with severe COPD on long-term oxygen ther- finger probe of the portable oximeter was positioned on
apy, or exclusively analysed patients on long-term oxy- the patient’s non-dominant hand to minimise interference
gen therapy. during normal daily activities. The portable oximeter was
This study aimed to evaluate the desaturation profiles attached to the patient’s wrist during the monitoring
of Japanese COPD outpatients not receiving supplemental period. Periods during which the heart rate fell abruptly
oxygen therapy during activities of daily living at home by ≥ 25 beats/minute were excluded from the analyses. All
using continuous 24-hour pulse oximetry monitoring, and data were downloaded to a computer for analysis (DS-Me
analyse the frequency of desaturation and relationships version 2.10). A calibration check according to the manu-
between the desaturation profile and the clinical charac- facturer’s instructions was performed before and after use.
teristics and risk of exacerbation. The ability of the Patients were instructed to keep an activity log to record
desaturation profile to predict exacerbation of COPD the times of major daily activities (sleeping, eating, walking
was investigated. outdoors, bathing, and other physical activities). Based on
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the patient’s activity log, periods of sleep were defined as Table 1 Baseline characteristics of ex-/non-smokers
night, and all other periods were defined as day. Patients (n = 39)
were encouraged to perform all normal daily ambulatory Age (years) Mean ± SD 71.6 ± 8.8
activities, and to maintain their baseline levels of activity. Sex Male/female 36/3
The daytime and nighttime mean SpO2 value, proportion Smoking pack/years Mean ± SD 68.2 ± 33.4
of SpO2 values below 90%, and heart rate were analysed.
BMI (kg/m2) Mean ± SD 23.1 ± 3.8
The 3% oxygen desaturation index (3%ODI) during the
Underweight (BMI < 18.5 kg/m2) n (%) 4 (10.3)
night was measured to detect patients with possible
obstructive sleep apnoea (OSA) [9]. Overweight (BMI 25–30 kg/m2) n (%) 5 (12.8)
Patients were followed up for as long as possible after Obese (BMI ≥ 30 kg/m2) n (%) 2 (5.1)
their ambulatory oximetry monitoring, and exacerba- Unadjusted Charlson Comorbidity Median (range) 1 (0–4)
tions and survival were analysed. Exacerbations were re- Index
corded from the day of oximetry monitoring. Follow-up Age-adjusted Charlson Comorbidity Median (range) 5 (2–9)
ended on 30 November 2013. Exacerbation was defined Index
as an increase in respiratory symptoms lasting at least Treatment
3 days and requiring treatment with antibiotics or Long-acting muscarinic antagonist n (%) 26 (67%)
systemic steroids. Long-acting β2 agonist n (%) 27 (69%)
The primary outcome was the proportion of desatura-
Inhaled corticosteroid n (%) 27 (69%)
tors, defined by Levi-Valensi et al. as patients with ≥ 30%
PaO2 (mmHg) Mean ± SD 78.2 ± 8.9
of SpO2 values below 90% [10]. This definition was vali-
dated by Casanova et al. [11] and has also been used in PaCO2 (mmHg) Mean ± SD 39.1 ± 4.9
other recent studies of 24-hour or daytime oximetry GOLD stage I/II/III/IV 2/18/13/6
monitoring [3,5,12]. The secondary outcomes were the FEV1 (L) Mean ± SD 1.3 ± 0.6
mean SpO2, heart rate and occurrence of exacerbation. FEV1 (%predicted) Mean ± SD 50.9 ± 18.5
Based on the results of previous studies [3,11], the pro-
FVC (L) Mean ± SD 2.3 ± 1.0
portion of desaturators was estimated to be approxi-
mMRC dyspnoea grade Mean ± SD 2.2 ± 1.1
mately 24% in COPD patients with a resting PaO2 of
60–70 mmHg. The proportion of desaturators in this Median (range) 2 (0–4)
study was estimated to be 8%, because we expected the CAT score Mean ± SD 11.7 ± 7.0
study to include a higher proportion of patients with Median (range) 10 (0–29)
mild COPD than previous studies. For a one-sided alpha BMI, Body mass index; CAT, Chronic obstructive pulmonary disease assessment
of 5% and a power of 80%, we estimated that 47 evalu- test; FEV1, Forced expiratory volume in one second; FVC, Forced vital capacity;
GOLD, Global Initiative on Obstructive Lung Disease; mMRC, Modified Medical
able subjects would be needed. Given the possibility of Research Council; SD, Standard deviation.
incomplete data in some patients, we considered that 50
subjects would be needed for this study. The study was
approved by the Osaka Police Hospital ethics committee.
All patients provided written informed consent for
inclusion in the study. Table 2 Pulse oximetry monitoring results in
ex-/non-smokers (n = 39)
Data analysis Daytime Nighttime
The values for normally distributed continuous variables, Monitoring duration (hours)
discrete variables, and categorical variables are expressed Mean ± SD 14.5 ± 3.7 8.5 ± 3.0
as the mean ± standard deviation (SD), median (range),
Proportion of SpO2 values < 90% (%)
and frequency, respectively. Comparisons between groups
were performed using the unpaired t-test for normally dis- Mean ± SD 3.0 ± 5.5 7.4 ± 16.1
tributed continuous variables. Simple and multiple regres- Median (range) 1.1 (0.0–28.1) 1.3 (0.0–87.3)
sion analyses were performed to evaluate relationships Mean SpO2 (%)
between variables and the proportion of daytime SpO2 Mean ± SD 94.7 ± 1.2 93.7 ± 1.8
values below 90%. The following factors were included in Median (range) 94.9 (90.7–97.4) 93.9 (88.8–96.8)
the simple regression analyses: percent predicted FEV1 (%
Heart rate (beats/min)
FEV1), mMRC dyspnoea grade, CAT score, resting PaO2,
resting PaCO2, body mass index (BMI), and age. All vari- Mean ± SD 76.9 ± 10.6 69.0 ± 9.0
ables with a p value of < 0.2 on univariate analysis were Median (range) 75.0 (49.4–101.0) 68.2 (49.4–87.1)
included in the multiple regression analysis. The multiple SD, Standard deviation; SpO2, Oxygen saturation by pulse oximetry.
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Table 3 Characteristics of exacerbations in Results

ex-/non-smokers (n = 39) A total of 51 Japanese patients were enrolled in the study
Follow-up duration Mean ± SD 26.4 ± 6.7 from February 2011 to September 2011. Thirty-eight pa-
(months) tients were ex-smokers, 12 were current smokers, and 1
Median (range) 27.8 (4.1–32.8)
All exacerbations Total exacerbations/patients 21/13 was a non-smoker who had been chronically exposed to
Exacerbation-related Total admissions/patients 13/9 excessive environmental tobacco smoke. We excluded the
admission 12 current smokers from our analyses, because smoking
Antibiotic use Total uses/patients 15/10 status was not considered at study entry and some current
Systemic steroid use Total uses/patients 4/4 smokers were unexpectedly included. Current smoking
SD, Standard deviation.
may increase SpO2 values due to a high serum carboxy-
haemoglobin (COHb) concentration [15-17]. The charac-
teristics of the ex-/non-smokers are shown in Table 1.
The daytime and nighttime oximetry monitoring results
regression analysis results are expressed as the unstan- are shown in Table 2. There were no daytime desaturators
dardized regression coefficient (β) with the corresponding and three nighttime desaturators. Although we did not con-
95% confidence interval, and the coefficient of determin- firm OSA by polysomnography, the results showed possible
ation (R2). Univariate and multivariate Cox proportional OSA (3%ODI of more than 15 desaturations/hour) in six
hazards models were used to evaluate relationships patients [9]. Comparison of these 6 patients with the
between the variables and exacerbation. The following remaining 33 patients found no significant differences in
factors were included in the multivariate analysis: age- the proportion of SpO2 values below 90% in the daytime
adjusted Charlson Comorbidity Index [13], BMI, %FEV1, (1.7 ± 2.1 vs 3.2 ± 6.0%, p = 0.28) or nighttime (15.4 ± 9.9
and proportion of SpO2 values below 90% during the day vs 5.9 ± 17.0%, p = 0.08) or in the mean daytime SpO2
and night. The Cox proportional hazards analysis results value (94.6 ± 0.8 vs 94.7 ± 1.3%, p = 0.86), but did find a
are expressed as risk ratio (RR) with the 95% confidence significant difference in the mean nighttime SpO2 value
interval. A two-tailed p value of < 0.05 was considered (92.3 ± 0.9 vs 93.9 ± 1.8%, p = 0.03). In the nine patients
statistically significant. Statistical analyses were performed with a resting PaO2 of 60–70 mmHg (resting PaO2 66.2 ±
using StatMate statistical software (StatMate version IV; 2.8 mmHg), including no daytime and two nighttime
ATMS Co., Ltd., Tokyo, Japan). The sample calculation desaturators, the proportion of SpO2 values below 90%
was performed using EZR (Saitama Medical Centre, was 8.4 ± 9.0% during the day and 20.2 ± 28.5% during the
Jichi Medical University, Saitama City, Japan), a graph- night, and the 3%ODI was more than 15 desaturations/
ical user interface for R (The R Foundation for Statis- hour in one ex-smoker (15.6 desaturations/hour).
tical Computing) [14]. EZR is a modified version of R Simple regression analysis showed that higher %FEV1
commander designed to add statistical functions and (β = −0.12, p = 0.01), higher PaO2 (β = −0.30, p = 0.002)
frequently used in biostatistics. and lower mMRC dyspnoea grade (β = 2.38, p = 0.002)

Figure 1 Kaplan–Meier curves for exacerbation of COPD in 39 ex-/non-smokers (blue line).

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were significantly associated with a lower proportion of Table 5 Multivariate Cox proportional hazards analysis of
daytime SpO2 values below 90% (Additional file 1: Data relationships between variables and exacerbation in
1). Multivariate analysis identified only PaO2 as a signifi- ex-/non-smokers (n = 39)
cant predictor of the proportion of daytime SpO2 values Variable Risk ratio 95% CI p
below 90% (β = −0.21, p = 0.04) (Additional file 1: Data 2). Age-adjusted Charlson Comorbidity 0.96 0.67 – 1.37 0.82
Five ex-smokers were lost to follow-up. Two ex- Index
smokers died of acute heart failure and unknown cause, Body mass index 0.88 0.72 – 1.06 0.18
respectively. Thirty-two ex-/non-smokers were alive and CAT score 1.08 0.99 – 1.18 0.10
still followed up at the time of data cut-off. One third of %FEV1 0.99 0.95 – 1.02 0.45
the patients experienced exacerbations during the follow-
Daytime proportion of SpO2 1.00 0.84 – 1.18 0.97
up period (Table 3). The median time from oximetry values < 90%
monitoring to the first exacerbation was not reached Nighttime proportion of SpO2 0.99 0.92 – 1.05 0.68
(Figure 1). Univariate (Table 4) and multivariate (Table 5) values < 90%
analyses did not detect any factors that were significantly CAT, Chronic obstructive pulmonary disease assessment test; CI, confidence
associated with exacerbation. interval; FEV1, forced expiratory volume in one second; SpO2, Oxygen
saturation by pulse oximetry.

Discussion To the best of our knowledge, only four previous stud-

This study of Japanese COPD outpatients not receiving ies have reported the results of continuous 24-hour oxy-
supplemental oxygen therapy included no daytime desa- gen saturation monitoring during activities of daily living
turators and few nighttime desaturators. The propor- using a portable pulse oximeter (Table 6) [3,5,11,18]. The
tions of daytime and nighttime SpO2 values below 90% population of the present study differed from the popula-
did not predict exacerbation. tions of these previous studies in terms of race, disease
severity (%FEV1 and resting PaO2), physique (BMI), and
Table 4 Univariate Cox proportional hazards analysis of SpO2 values. Patients with more severe COPD generally
relationships between variables and exacerbation in tend to be more underweight [19-21]. However, the pa-
ex-/non-smokers (n = 39)
tients in this study had milder COPD but were more
Variable Risk ratio 95% CI p
underweight than patients in previous non-Asian studies.
Age (years) 1.04 0.97 – 1.10 0.26 Additionally, our oximetry results were much better than
Unadjusted Charlson Comorbidity 0.93 0.57 – 1.51 0.76 in previous studies. Patients in this study had less frequent
Index
daytime and nighttime desaturations than those in the
Age-adjusted Charlson Comorbidity 1.06 0.76 – 1.46 0.74 previous studies. Although even the nine patients with a
Index
resting PaO2 of 60–70 mmHg had better oxygen satur-
Pack/years 1.00 0.98 – 1.01 0.69 ation profiles than patients in the previous non-Asian
Body mass index 0.87 0.73 – 1.03 0.10 studies, their desaturation profiles and pulmonary func-
mMRC dyspnoea grade 1.19 0.73 – 1.96 0.49 tion were comparable to those of the 55 non-desaturators
CAT score 1.08 1.00 – 1.16 0.054 in the study by Casanova et al., which also found that
PaO2 0.97 0.92 – 1.03 0.35
non-desaturators were less hypercapnic and less hypox-
emic during the daytime than desaturators in spite of
PaCO2 0.95 0.84 – 1.08 0.45
having similar pulmonary function and Saint George’s
FEV1 0.60 0.23 – 1.53 0.28 Respiratory Questionnaire scores [11]. Our nine patients
%FEV1 0.99 0.96 – 1.02 0.45 with a resting PaO2 of 60–70 mmHg had lower resting
Daytime PaCO2 values than patients in the previous studies. These
Proportion of SpO2 values < 90% (%) 1.01 0.92 – 1.11 0.78 comparisons suggest that desaturators are likely to have
Mean heart rate 1.02 0.97 – 1.07 0.42
hypercapnic respiratory failure.
In this study, oximetry results did not predict exacerba-
Nighttime
tion. This is consistent with the findings of Trauer et al.,
Proportion of SpO2 values < 90% 0.98 0.92 – 1.03 0.41 who reported that ambulatory oximetry results in patients
3%ODI 0.92 0.82 – 1.02 0.12 with a resting PaO2 of 56–70 mmHg did not predict
Mean heart rate 1.01 0.95 – 1.07 0.71 exacerbation or survival [12]. They proposed four reasons
CAT, Chronic obstructive pulmonary disease assessment test; CI, Confidence for the lack of association between oximetry results and
interval; FEV1, Forced expiratory volume in one second; mMRC, Modified survival: 1) oximetry results are not fundamentally impor-
Medical Research Council; ODI, Oxygen desaturation index; PaCO2, Partial
pressure of arterial carbon dioxide; PaO2, Partial pressure of arterial oxygen;
tant for predicting prognosis, 2) progression of COPD is
SpO2, Oxygen saturation by pulse oximetry. unpredictably heterogeneous, 3) the sample size was not
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Table 6 Studies of continuous 24-hour oximetry monitoring during activities of daily living
Authors N PaO2 Supplemental PaO2 %FEV1 BMI Proportion of Mean proportion
(Year) inclusion oxygen PaCO2 desaturators of SpO2 values
[Ref] criteria therapy (mmHg) < 90%
Soguel Schenkel 30 inpts Not defined 3 Patients* Median (range) Median (range) Median (range) Not described Not described
(1996) [18]
68 (54–89) 37 (16–64) 25.5 (17.1–42.5)
42 (35–51)
Casanova 88 outpts 60–70 mmHg None Mean ± SD Mean ± SD Mean ± SD Daytime 22% Non-desaturators
(2006) [11]
64.7 ± 2.8 38 ± 13 27 ± 4 Nighttime 50% 24-hour 12.2%
45 ± 5.7 Daytime 8.9%
Nighttime 18.8%
Desaturators
24-hour 55.1%
Daytime 42.3%
Nighttime 77.3%
Garcia-Talavera 67 outpts 60–70 mmHg None Median (range) Median (range) Not described 24-hour 30% 24-hour 17%
(2008) [3]
66 (60–70) 37 (16–64) Daytime 25% Daytime 15%
45 (32–57) Nighttime 45% Nighttime 23%
Trauer (2012) [5] 35 outpts 56–70 mmHg None Mean ± SD Mean ± SD Mean ± SD 24-hour 54% 24-hour 41.9%
64.1 ± 4.5 37.5 ± 13.2 27.1 ± 7.0 Daytime 40% Daytime 30.9%
44.2 ± 6.0 Nighttime 77% Nighttime 60.6%
This study 39 outpts Not defined None Mean ± SD Mean ± SD Mean ± SD Daytime 0% Daytime 3.0%
78.2 ± 8.9 50.9 ± 18.5 23.1 ± 3.8 Nighttime 8% Nighttime 7.4%
39.1 ± 4.9
9 outpts** 60–70 mmHg None 66.2 ± 3.0 37.0 ± 14.6 23.9 ± 4.8 Daytime 0% Daytime 8.4%
38.0 ± 5.4 Nighttime 22% Nighttime 20.2%
*Three patients had not previously received supplemental oxygen therapy, but started nocturnal oxygen therapy during admission to a pulmonary
rehabilitation programme.
**Nine patients in this study had more severe COPD with mild-to-moderate hypoxaemia (PaO2 60–70 mmHg).
BMI, body mass index; FEV1, Forced expiratory volume in one second; Inpts, inpatients; Outpts, outpatients; PaO2, partial pressure of arterial oxygen; Ref,
Reference; SD, Standard deviation; SpO2, Oxygen saturation by pulse oximetry.

large enough to detect differences, and 4) low ambulatory in daily life [25], and that the reduction in physical activity
oxygen saturation reflected greater levels of physical acti- starts in the early stages of the disease, even before COPD
vity. In the present study, the lack of association between is diagnosed [26]. It is therefore possible that the minimal
oximetry results and the risk of exacerbation may be desaturations recorded in this study reflected reduced ac-
related to the small sample size, as the patients had mild tivity levels. Use of motion sensors such as accelerometers
COPD and therefore had lower rates of exacerbation and seems to be a promising alternative to patient-reported ac-
death than in the study by Trauer et al. [12]. However, the tivity logs. Only one previous study reported concomitant
CAT score may be an independent predictor of exacerba- measurement of SpO2 and physical activity by oximeter,
tion, as also recently reported in other studies [22,23]. accelerometry and actigraphy, respectively [27]. However,
This study has some limitations. First, despite using an the analysis in this study divided activities into only four
activity log, it was not possible to accurately determine categories: walking, slow-intermittent-walking, active-not-
the patients’ physical activities at specific times. It is walking, and resting. These broad classifications are not
difficult for patients to accurately record activities by the sufficient for linking desaturation profiles with activities of
minute, or accurately recall activities over longer periods daily living. Second, the influence of COHb on SpO2
of time [24]. Most patients in this study had inaccurate values in the 12 current smokers was not assessed, be-
recordings, and patients frequently forgot to record any cause the COHb concentrations were not measured.
activities at all. The resulting activity logs were not useful Therefore, we excluded the current smokers from our
for comparison with pulse oximetry results. It has been analyses, and it remains unknown whether ambulatory
reported that patients with COPD are markedly inactive oximetry monitoring is reliable in smokers. Finally,
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doi:10.1186/2049-6958-9-24
Cite this article as: Minami et al.: Ambulatory pulse oximetry monitoring
in Japanese COPD outpatients not receiving oxygen therapy.
Multidisciplinary Respiratory Medicine 2014 9:24.

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