Learn About Oxygen Desaturation Index (ODI) in Sleep

If you have had a sleep study to evaluate for obstructive sleep apnea, you no doubt have some questions about some of the terminology used in the report describing the test results. One possible measurement that can be included, called the oxygen desaturation index (ODI), may be particularly perplexing. What is the oxygen desaturation index?

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Learn how this measure may be helpful to identify more severe sleep apnea that may be associated with oxygen level drops and other long-term health consequences such as cardiac disease and dementia.

What Is the ODI?

The oxygen desaturation index is the number of times per hour of sleep that the blood's oxygen level drop by a certain degree from baseline. These drops in oxygen levels are called desaturations.

The ODI is typically measured as part of standard sleep studies, such as a diagnostic polysomnogram, home sleep apnea testing, or with overnight oximetry.

It may not be as accurate if sleep stages are not measured with the testing as the index may be averaged over the total recording time instead, which may include time spent awake.

ODI is measured by an oximeter, which is a device typically placed on the fingertip that shines a red light on the skin and can estimate the amount of oxygen in the peripheral blood. Newer technology may allow this to be measured in different ways through the surface of the skin.

Scoring Guidelines

The degree of change from baseline can be measured in two different ways. The criteria used to determine the index may vary depending on the scoring rules used.

According to guidelines from the American Academy of Sleep Medicine, any respiratory event during sleep with a 3% drop in blood oxygen levels is counted towards the total. For example, a change from 95% to 92% would be an event that is counted toward the index's total.

However, Medicare and some other insurances still rely on older scoring rules and require a 4% change for an event to be counted toward the index.

Apnea and Hypopnea

When breathing becomes disrupted during sleep, as may occur in obstructive sleep apnea, the oxygen levels of the blood may repeatedly fall. These drops (desaturations) are typically associated with collapses of the upper airway, events called either an apnea or hypopnea. (A hypopnea represents a partial collapse of the airway.)

Oxygen drops occur less frequently in snoring or upper airway resistance syndrome (UARS), two conditions in which breathing is disturbed, yet to a lesser degree. Sleep fragmentation may result without the associated desaturations.

It is important to understand that the ODI differs from another measurement called the apnea-hypopnea index (AHI). The AHI also includes events that may cause arousals or awakenings from sleep without affecting oxygen levels.

The ODI also does not reflect the absolute minimum blood oxygen level measured, which may be called the minimum oxygen saturation or the oxygen nadir of the study.

If the oxygen levels are low enough (often less than 88% is the threshold) and sustained for more than five minutes, hypoxemia may be diagnosed.

What Causes Worsened ODI?

ODI may be worsened in people with underlying lung disease, including chronic obstructive pulmonary disease (COPD), and congestive heart failure.

With decreased reserves, the collapse of the upper airway may lead the blood's oxygen levels to drop more quickly. This may also be associated with an increased level of carbon dioxide, such as in obesity hypoventilation syndrome.

Health Consequences

It is believed that an elevation in ODI may lead to increased oxidative stress and free radicals in the body that may predispose people to long-term cardiovascular risks, including high blood pressure (hypertension), heart attack, stroke, arrhythmias like atrial fibrillation, and memory loss associated with dementia.

Associated bursts of cortisol may lead to insulin resistance and worsen the risk for, and severity of, diabetes. These consequences are an active area of sleep research.

A Word From Verywell

Fortunately, effective treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) can normalize breathing and reduce the long-term risks associated with untreated sleep apnea.

As part of reviewing your sleep study results, speak with your board-certified sleep doctor about the best treatments for your condition. Resolving sleep-disordered breathing may benefit both sleep quality and long-term health.

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  2. U.S. Centers for Medicare & Medicaid Services. CPAP For Obstructive Sleep Apnea. Updated February 25, 2016.

  3. Kryger, M.H. et al. "Principles and Practice of Sleep Medicine." ExpertConsult, 6th edition, 2017.