Novel Event-Based Peripheral Oxygen Saturation Metrics Provide Complementary Information for OSA Classification

OBJECTIVE: The Apnea-Hypopnea Index (AHI) serves as the primary metric for Obstructive Sleep Apnea (OSA) severity but quantifies only event frequency, lacking critical information on the slope and temporal morphology of oxygen desaturation. METHODS: To quantify the desaturation and reoxygenation dynamics during apneic episodes across sleep stages, we develop a geometric modeling framework to extract three groups of event-based features from individual desaturation events: Event Falling Rate (EFR), Event Recovery Rate (ERR), and Event Baseline Shift (EBS). Using 800 polysomnography recordings from the Sleep Heart Health Study, these features are evaluated against and integrated with established oximetry indices using machine learning classifiers. RESULTS: Spearman correlation analysis reveals significant associations between the proposed event-based features and OSA severity (p < 0.001). The integrated model achieved accuracies of 88% (binary), 76% (three-class), and 72% (four-class). Notably, SHAP interpretability analysis identified EFR and ERR as top-ranking event-based features in OSA stratification, outperforming several traditional global metrics. CONCLUSION: The proposed event-based features capture the rate and stability of hypoxic transitions, providing subtle diagnostic information complementary to AHI. SIGNIFICANCE: This framework offers interpretable, physiologically grounded features that enhance OSA stratification and phenotyping using accessible pulse oximetry, facilitating personalized OSA health assessment.