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Shim, Jo, Kwon, Chae, Park, Lee, Rho, and Choi: Factors Related to Exertional Oxygen Desaturation in Patients with COPD
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 70(6): 498-503.

Published online: 30 June 2011

DOI: https://doi.org/10.4046/trd.2011.70.6.498

Factors Related to Exertional Oxygen Desaturation in Patients with COPD

Sang Woo Shim, M.D.1, Jun Yeon Jo, M.D.1, Yong Sik Kwon, M.D.1, Jin Nyeong Chae, M.D.1, Jie Hae Park, M.D.1, Mi-Young Lee, M.D.2, Byung Hak Rho, M.D.3, Won-Il Choi, M.D., Ph.D.1

1Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.

2Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, Korea.

3Department of Diagnostic Radiology, Keimyung University School of Medicine, Daegu, Korea.

Address for correspondence: Won-Il Choi, M.D., Ph.D. Department of Internal Medicine, Keimyung University School of Medicine, 216, Dalseong-ro, Jung-gu, Daegu 700-712, Korea. Phone: 82-53-250-7572, Fax: 82-53-250-7434, wichoi@dsmc.or.kr

Received 22 January 2011       Accepted 21 May 2011

Copyright © 2011. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

The causes of exertional desaturation in patients with COPD can be multifactorial. We aimed to investigate factors predict exertional desaturation in patients with moderate to severe COPD.

Methods

We tested 51 consecutive patients with stable COPD (FEV1/FVC, 40±13% predicted). Patients performed a six minute walk test (6MWT). Pulse oxymetric saturation (SpO2) and pulse rate were recorded.

Results

Oxygen desaturation was found in 15 subjects after 6MWT, while 36 subjects were not desaturated. Lung diffusing capacity was significantly lower in desaturation (DS) group (62±18% predicted) compared with not desaturated (ND) group (84±20, p<0.01). However there was no statistical difference of FEV1/FVC ratio or residual volume between two groups. The pulse rate change was significantly higher in the desaturated compared with the not desaturated group. Six minute walking distance, subjective dyspnea scale, airflow obstruction, and residual volume did not predict exertional oxygen desaturation. Independent factors assessed by multiple logistic regression revealed that a pulse rate increment (odd ratio [OR], 1.19; 95% confidence interval [CI], 1.01~1.40; p=0.02), a decrease in baseline PaO2 (OR, 1.105; 95% CI, 1.003~1.218; p=0.04) and a decrease in lung diffusing capacity (OR, 1.10; 95% CI, 1.01~1.19; p=0.01) were significantly associated with oxygen desaturation. Receiver operator characteristic (ROC) analysis showed that an absolute increment in pulse rate of 16/min gave optimal discrimination between desaturated and not desaturated patients after 6MWT.

Conclusion

Pulse rate increment and diffusion capacity can predict exertional oxygen desaturation in stable COPD patients with moderate to severe airflow obstruction.

Keywords: Pulmonary Disease, Chronic Obstructive, Heart Rate, Anoxia

Figures and Tables

Figure 1
Correlation between the change in oxygen saturation and pulse rate before and after 6-minute walk test.
trd-70-498-g001
Figure 2
ROC curve of pulse rate change. Area under the ROC curve=0.704 (95% CI, 0.56 to 0.82). ROC: receiver operating characteristic; CI: confidence interval.
trd-70-498-g002
Table 1
Patient characteristics and pulmonary function data
trd-70-498-i001

*Mean±SD, †Chi-square test for comparison.

COPD: chronic pulmonary obstructive disease; DS: desaturated; ND: not desaturated; BMI: body mass index; FEV1: forced expiratory volume in one second; FEV1/FVC: forced expiratory volume to forced vital capacity ratio; RV: residual volume; DLCO: diffusing capacity of the lung for carbon monoxide; SD: standard deviation.

Table 2
Oxygen saturation and pulse rate of pre and post 6MWT
trd-70-498-i002

Values are presented as Mean±SD unless otherwise indicated. COPD: chronic pulmonary obstructive disease; 6MWT: 6-minute walk test; 6MWD: 6-minute walk distance; MRC: medical research council; SD: standard deviation.

Table 3
Multiple logistic regression analysis for factors associated with oxygen desaturation in patients with COPD after 6-minute walk test
trd-70-498-i003

COPD: chronic pulmonary obstructive disease; OR: odd ratio; CI: confidence interval; FEV1: forced expiratory volume in 1 second; DLCO: diffusing capacity of the lung for carbon monoxide; RV: residual volume.

Table 4
Sensitivity, specificity of pulse rate increment after 6-minute walk test
trd-70-498-i004

Total number of patients is 51 and rates are represented as percent.

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