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

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.