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Therefore, we aimed to develop a machine learning approach focused on screening to identify patients at increased risk of EID.Methods: We analyzed data from the nationwide, multicenter Korea COPD Subgroup Study. EID was defined as a peripheral oxygen saturation (SpO2) &lt;90% with a decrease of \u22654%p. The cohort was divided into training (80%) and test (20%) sets. Candidate predictors were selected using the Boruta algorithm, and models were developed using multivariable logistic regression, extreme gradient boosting (XGB), random forest, and support vector classification, employing a screening-oriented threshold strategy that prioritized sensitivity.Results: Among 1,788 patients with COPD, 185 (10.3%) exhibited EID. All models demonstrated a high precision-recall area under the curve (PR-AUC) during internal validation. The predictors selected by the Boruta algorithm included body mass index, COPD Assessment Test, St. George\u2019s Respiratory Questionnaire for COPD patients, mental health indicators, pulmonary function parameters, X-ray-identified bronchiectasis, and hemoglobin level. In the independent test set, PR-AUC decreased across models, while calibration metrics showed modest differences between datasets. The XGB model achieved the highest sensitivity during internal validation, and both its sensitivity and specificity remained relatively stable in the test set. Baseline SpO2 and diffusion capacity of the lung for carbon monoxide were the most influential predictors.Conclusion: A screening-oriented machine learning approach utilizing routinely available variables may facilitate targeted referral for the 6MWT in COPD patients.<\/jats:p>","DOI":"10.4046\/trd.2026.0041","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:21:57Z","timestamp":1784532117000},"page":"506-516","update-policy":"https:\/\/doi.org\/10.4046\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a Screening Model for Exercise-Induced Desaturation by Machine Learning Method"],"prefix":"10.4046","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4229-4671","authenticated-orcid":true,"given":"Seung Ju","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Ha","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Yong","family":"Moon","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Youl","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo-Jung","family":"Um","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Yong","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary and Critical Care Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyoung Kyu","family":"Yoon","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Critical Care and Sleep Medicine, Department of Internal Medicine, Yeouido St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwang Ha","family":"Yoo","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4533-7937","authenticated-orcid":true,"given":"Chin Kook","family":"Rhee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5461-6770","authenticated-orcid":true,"given":"Won-Yeon","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical 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