Variations in physician interpretation of overnight pulse oximetry monitoring

Background: Overnight pulse oximetry is commonly used for hypoxemia evaluation in patients with COPD and sleep-disordered breathing. There is little information regarding its impact on physician decision making, and therefore an important measure of its clinical utility is untested and unknown. The aim of this study was to describe physician interpretation, use, and opinions regarding overnight pulse oximetry. Methods: Forty-one pulmonary physicians and fellows participated in structured interviews consisting of three oximetry record interpretations, oral responses to a standard question set, and a questionnaire. Qualitative data were analyzed using an open coding process. Quantitative data were assessed for distributions. Results: Four measures were consistently used by the majority of physicians in record interpretation: background information, arterial oxygen saturation measured by pulse oximetry (Spo(2)) waveform and pattern, and time spent with Spo(2) < 90%. An additional 10 measures were consistently used by 5 to 46% of physicians. No interpretation generated a recommendation with > 60% consensus. There was a wide range of opinions on important matters related to this test, including test utility, indications, variables considered most important for interpretation, and criteria for nocturnal oxygen prescription. Forty-one physicians provided 35 different opinions on when nocturnal supplemental oxygen should be initiated. Conclusions: The variation in physician interpretation, use, and opinions regarding overnight pulse oximetry calls into question its clinical utility and underscores a need for standardization of presentation, training, and interpretation.