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Martinot JB, Le-Dong NN, Malhotra A, Pépin JL. Enhancing artificial intelligence-driven sleep apnea diagnosis: The critical importance of input signal proficiency with a focus on mandibular jaw movements. J Prosthodont 2024. [PMID: 39676388 DOI: 10.1111/jopr.14003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 11/22/2024] [Indexed: 12/17/2024] Open
Abstract
PURPOSE This review aims to highlight the pivotal role of the mandibular jaw movement (MJM) signal in advancing artificial intelligence (AI)-powered technologies for diagnosing obstructive sleep apnea (OSA). METHODS A scoping review was conducted to evaluate various aspects of the MJM signal and their contribution to improving signal proficiency for users. RESULTS The comprehensive literature analysis is structured into four key sections, each addressing factors essential to signal proficiency. These factors include (1) the comprehensiveness of research, development, and application of MJM-based technology; (2) the physiological significance of the MJM signal for various clinical tasks; (3) the technical transparency; and (4) the interpretability of the MJM signal. Comparisons with the photoplethysmography (PPG) signal are made where applicable. CONCLUSIONS Proficiency in biosignal interpretation is essential for the success of AI-driven diagnostic tools and for maximizing the clinical benefits through enhanced physiological insight. Through rigorous research ensuring an enhanced understanding of the signal and its extensive validation, the MJM signal sets a new benchmark for the development of AI-driven diagnostic solutions in OSA diagnosis.
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Affiliation(s)
- Jean-Benoit Martinot
- Sleep Laboratory, CHU Université catholique de Louvain (UCL), Namur Site Sainte-Elisabeth, Namur, Belgium
- Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, Brussels, Belgium
| | | | - Atul Malhotra
- University of California San Diego, La Jolla, California, USA
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France
- EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
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2
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Teixeira RC, Cahali MB. Evaluation of Minimum Recording Time and the Influence of Time in the Supine Position on Out-of-Center Sleep Tests. Int Arch Otorhinolaryngol 2024; 28:e662-e667. [PMID: 39464356 PMCID: PMC11511280 DOI: 10.1055/s-0043-1769495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/19/2023] [Indexed: 10/29/2024] Open
Abstract
Introduction The prevalence of moderate to severe sleep-disordered breathing is of 17% among men aged between 50 and 70-years, and of 9% among women in the same age group. In Brazil, obstructive sleep apnea (OSA) is also highly prevalent, and it is associated with metabolic and cardiovascular impacts, excessive daytime sleepiness, and increasing risk of traffic accidents. Laboratory-based polysomnography is the gold standard test for OSA diagnosis. However, its complexity has led to the search for alternatives to simplify the diagnosis, such as the out-of-center sleep test (OCST). Objectives To discusses the minimum OCST recording time and the potential effects of the supine position on this parameter. Data Synthesis We conducted a search on the PubMed, Web of Science, Scopus, and Embase databases to identify relevant studies on OCST recording time and a possible association with body position. We used a combination of terms, including Obstructive Sleep Apnea and Home Monitoring OR Home Care Services OR Portable Monitoring AND Supine OR Position OR Recording Time OR Positional Obstructive Sleep Apnea . The references of the selected articles were also reviewed to find other relevant studies. Through our approach, eighteen articles were retrieved and included in the present study. Conclusion Since OCSTs are conducted in an unattended environment, with potential signal loss during the night, it is crucial to determine the minimum recording time to validate the test and assess how the time spent in the supine position affects this parameter. After reviewing the literature, this topic remains to be clarified, and additional studies should focus on that matter.
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Affiliation(s)
- Raquel Chartuni Teixeira
- Department of Otolaryngology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Michel Burihan Cahali
- Department of Otolaryngology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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3
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Prasad S, Arunachalam S, Boillat T, Ghoneima A, Gandedkar N, Diar-Bakirly S. Wearable Orofacial Technology and Orthodontics. Dent J (Basel) 2023; 11:24. [PMID: 36661561 PMCID: PMC9858298 DOI: 10.3390/dj11010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
Wearable technology to augment traditional approaches are increasingly being added to the arsenals of treatment providers. Wearable technology generally refers to electronic systems, devices, or sensors that are usually worn on or are in close proximity to the human body. Wearables may be stand-alone or integrated into materials that are worn on the body. What sets medical wearables apart from other systems is their ability to collect, store, and relay information regarding an individual's current body status to other devices operating on compatible networks in naturalistic settings. The last decade has witnessed a steady increase in the use of wearables specific to the orofacial region. Applications range from supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and better understanding the jaw's functional and parafunctional activities. Orofacial wearable devices may be unimodal or incorporate multiple sensing modalities. The objective data collected continuously, in real time, in naturalistic settings using these orofacial wearables provide opportunities to formulate accurate and personalized treatment strategies. In the not-too-distant future, it is anticipated that information about an individual's current oral health status may provide patient-centric personalized care to prevent, diagnose, and treat oral diseases, with wearables playing a key role. In this review, we examine the progress achieved, summarize applications of orthodontic relevance and examine the future potential of orofacial wearables.
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Affiliation(s)
- Sabarinath Prasad
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
| | - Sivakumar Arunachalam
- Orthodontics and Dentofacial Orthopedics, School of Dentistry, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Thomas Boillat
- Design Lab, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
| | - Ahmed Ghoneima
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
| | - Narayan Gandedkar
- Discipline of Orthodontics & Paediatric Dentistry, School of Dentistry, University of Sydney, Sydney, NSW 2006, Australia
| | - Samira Diar-Bakirly
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
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4
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Portable evaluation of obstructive sleep apnea in adults: A systematic review. Sleep Med Rev 2023; 68:101743. [PMID: 36657366 DOI: 10.1016/j.smrv.2022.101743] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/10/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023]
Abstract
Obstructive sleep apnea (OSA) is a significant healthcare burden affecting approximately one billion people worldwide. The prevalence of OSA is rising with the ongoing obesity epidemic, a key risk factor for its development. While in-laboratory polysomnography (PSG) is the gold standard for diagnosing OSA, it has significant drawbacks that prevent widespread use. Portable devices with different levels of monitoring are available to allow remote assessment for OSA. To better inform clinical practice and research, this comprehensive systematic review evaluated diagnostic performances, study cost and patients' experience of different levels of portable sleep studies (type 2, 3, and 4), as well as wearable devices and non-contact systems, in adults. Despite varying study designs and devices used, portable diagnostic tests are found to be sufficient for initial screening of patients at risk of OSA. Future studies are needed to evaluate cost effectiveness with the incorporation of portable diagnostic tests into the diagnostic pathway for OSA, as well as their application in patients with chronic respiratory diseases and other comorbidities that may affect test performance.
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5
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Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Mei-Hsiang L, Ning-Hung C, Hsiao PR, Hsiu-Chin H. Factors Associated With Undiagnosed Obstructive Sleep Apnea in Overweight and Obese High-Tech Employees: A Multisite Cross-Sectional Study. Biol Res Nurs 2022; 24:400-409. [DOI: 10.1177/10998004221094109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Being overweight or obese is regarded as crucial risk factors for obstructive sleep apnea (OSA). Objectives: This study aimed to determine the influencing factors of overweight and obese employees with OSA in high-tech workplaces. Methods: A cross-sectional study design was employed. A total of 491 overweight and obese participants were recruited from a large-scale electronics industry. The Chinese version of Pittsburgh Sleep Quality Index, the Epworth Sleep Scale, and a portable sleep monitoring device were used for data collection. Logistic regression analysis was conducted to identify the factors affecting overweight and obese employees with OSA. This study was conducted from August 2019 to July 2020. Results: 60.5% of the overweight and obese participants were found to have OSA, of which 58.9% had mild and 18.5% had severe OSA, respectively. The results showed that age, neck circumference, snoring, and habitual drinking were the crucial factors affecting OSA. Remarkably, age and snoring times showed a significant correlation in predicting OSA of different severities. Neck circumference was an independent risk factor for moderate and severe OSA. Conclusion: More than 60% of the overweight and obese high-tech workplace employees were found to have OSA. We found that the older the age, the larger the neck circumference, a higher number of snoring instances, and drinking were important risk factors for predicting OSA in overweight high-tech employees. The healthcare providers should actively educate OSA-related information for employees in the workplace, and promote high-risk OSA groups to adopt screening based on at-home sleep apparatus.
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Affiliation(s)
- Lin Mei-Hsiang
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | | | - Ping-Ru Hsiao
- Department of Nursing, Chang Gung University of Science and Technology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsu Hsiu-Chin
- Department of Graduate Institute of Health Care, Chang Gung University of Science and Technology, Toa-Yuan, Taiwan
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Serrano Alarcón Á, Martínez Madrid N, Seepold R. A Minimum Set of Physiological Parameters to Diagnose Obstructive Sleep Apnea Syndrome Using Non-Invasive Portable Monitors. A Systematic Review. Life (Basel) 2021; 11:1249. [PMID: 34833126 PMCID: PMC8623368 DOI: 10.3390/life11111249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction. Despite its high accuracy, polysomnography (PSG) has several drawbacks for diagnosing obstructive sleep apnea (OSA). Consequently, multiple portable monitors (PMs) have been proposed. Objective. This systematic review aims to investigate the current literature to analyze the sets of physiological parameters captured by a PM to select the minimum number of such physiological signals while maintaining accurate results in OSA detection. Methods. Inclusion and exclusion criteria for the selection of publications were established prior to the search. The evaluation of the publications was made based on one central question and several specific questions. Results. The abilities to detect hypopneas, sleep time, or awakenings were some of the features studied to investigate the full functionality of the PMs to select the most relevant set of physiological signals. Based on the physiological parameters collected (one to six), the PMs were classified into sets according to the level of evidence. The advantages and the disadvantages of each possible set of signals were explained by answering the research questions proposed in the methods. Conclusions. The minimum number of physiological signals detected by PMs for the detection of OSA depends mainly on the purpose and context of the sleep study. The set of three physiological signals showed the best results in the detection of OSA.
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Affiliation(s)
- Ángel Serrano Alarcón
- School of Informatics, Reutlingen University, Alteburgstr. 150, 72762 Reutlingen, Germany;
| | - Natividad Martínez Madrid
- School of Informatics, Reutlingen University, Alteburgstr. 150, 72762 Reutlingen, Germany;
- Institute of Digital Medicine, I.M. Sechenov First Moscow State Medical University, 2-4 Bolshaya Pirogovskaya st., 119435 Moscow, Russian Federation;
| | - Ralf Seepold
- Institute of Digital Medicine, I.M. Sechenov First Moscow State Medical University, 2-4 Bolshaya Pirogovskaya st., 119435 Moscow, Russian Federation;
- HTWG Konstanz, Department of Computer Science, Alfred-Wachtel-Str. 8, 78462 Konstanz, Germany
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8
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Khokhrina A, Andreeva E, Degryse JM. The prevalence of sleep-disordered breathing in Northwest Russia: The ARKHsleep study. Chron Respir Dis 2020; 17:1479973120928103. [PMID: 32666810 PMCID: PMC7394028 DOI: 10.1177/1479973120928103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 11/17/2022] Open
Abstract
Sleep-disordered breathing (SDB) is a chronic condition characterized by repeated breathing pauses during sleep. The reported prevalence of SDB in the general population has increased over time. Furthermore, in the literature, a distinction is made between SDB, obstructive sleep apnea (OSA), and "OSA syndrome" (OSAS). Patients with SDB are at increased risk of comorbid cardiovascular diseases (CVDs). The aim of the ARKHsleep study was to assess the prevalence of SDB in general and of OSA and OSAS in particular. A total of 1050 participants aged 30-70 years, who were randomly selected from a population register, were evaluated for the probability of SDB using the Epworth Sleepiness Scale score and body mass index. Sleep was recorded for one night via home sleep apnea testing (Somnolter®). Medical conditions were determined from medical records. Additional data included background characteristics, anthropometric variables, blood pressure, and scores from four questionnaires. The survey sample consisted of 41.2% males and had a mean age of 53.1 ± 11.3 years. The prevalence of mild-to-severe, moderate-to-severe, and severe SDB was 48.9% [45.8-51.9], 18.1% [15.9-20.6], and 4.5% [3.2-5.8], respectively. Individuals reporting snoring or breathing pauses had a higher severity of SDB than individuals free of symptoms. The ARKHsleep study revealed a high burden of both SDB and CVD; however, more large-scale cohort studies and intervention studies are needed to better understand whether the early recognition and treatment of mild SDB with or without symptoms will improve cardiovascular prognosis and/or quality of life.
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Affiliation(s)
- Anna Khokhrina
- Institute of Health and Society, Université Catholique de Louvain, IRSS, Brussels, Belgium
- Northern State Medical University, av. Troitsky, Arkhangelsk, Russian Federation
| | - Elena Andreeva
- Northern State Medical University, av. Troitsky, Arkhangelsk, Russian Federation
| | - Jean-Marie Degryse
- Institute of Health and Society, Université Catholique de Louvain, IRSS, Brussels, Belgium
- Department of Public Health and Primary Health Care, K.U. Leuven, Leuven, Belgium
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9
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Martinot JB, Le-Dong NN, Crespeigne E, Silkoff PE, Cuthbert V, Denison S, Borel JC, Pépin JL. Mandibular Movement Analysis to Assess Efficacy of Oral Appliance Therapy in OSA. Chest 2018; 154:1340-1347. [DOI: 10.1016/j.chest.2018.08.1027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/01/2018] [Indexed: 11/29/2022] Open
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Bajantri B, Lvovsky D. A Case of Concomitant Obstructive Sleep Apnea and Non-Alcoholic Steatohepatitis Treated With CPAP Therapy. Gastroenterology Res 2018; 11:252-259. [PMID: 29915639 PMCID: PMC5997478 DOI: 10.14740/gr1033w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/09/2018] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea syndrome is a disorder of sleep breathing that is a result of recurrent and intermittent hypoxia during sleep induced by the repeated partial or complete collapse of the upper airway, eventually causing chronic intermittent hypoxia. Non-alcoholic fatty liver disease is divided into non-alcoholic fatty liver and non-alcoholic steatohepatitis. Animal and human studies showed that obesity is associated with chronic liver hypoxia, even in the presence of systemic normoxia causing inflammation and release of cytokines. A "two-hit" model has been proposed. The first hit is characterized by insulin resistance and excess hepatic lipid accumulation secondary to abnormal fatty acid metabolism. Oxidative stress and inflammation are thought to comprise the second hit. Gold standard for the diagnosis of non-alcoholic steatohepatitis is a liver biopsy. Many clinical scores and non-invasive tools are used for the diagnosis of non-alcoholic steatohepatitis. Conservative management with lifestyle modifications including diet, exercise and weight loss remains the therapy of choice today. We present a case report of a 39-year-old man who was diagnosed with concomitant non-alcoholic steatohepatitis and severe obstructive sleep apnea. He was started treatment with continuous positive airway pressure and demonstrated excellent adherence to therapy for 6 years, with concomitant obstructive sleep apnea and non-alcoholic steatohepatitis which reversed with prolonged optimal continuous positive airway pressure therapy. Physical examination remained unremarkable except for morbid obesity. His abdominal girth, as well as body mass index, remained unchanged. After 6 years of optimal continuous positive airway pressure therapy, liver enzymes and relevant lipid panel normalized, suggesting reversal of non-alcoholic steatohepatitis.
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Affiliation(s)
- Bharat Bajantri
- Division of Pulmonary Critical Care, Department of Medicine, Bronx Care Health System, Bronx, NY 10457, USA
| | - Dmitry Lvovsky
- Division of Pulmonary Critical Care, Department of Medicine, Bronx Care Health System, Bronx, NY 10457, USA.,Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, NY 10457, USA
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11
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Mendonça F, Mostafa SS, Ravelo-García AG, Morgado-Dias F, Penzel T. Devices for home detection of obstructive sleep apnea: A review. Sleep Med Rev 2018; 41:149-160. [PMID: 30149930 DOI: 10.1016/j.smrv.2018.02.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 01/16/2018] [Accepted: 02/09/2018] [Indexed: 01/15/2023]
Abstract
One of the most common sleep-related disorders is obstructive sleep apnea, characterized by a reduction of airflow while breathing during sleep and cause significant health problems. This disorder is mainly diagnosed in sleep labs with polysomnography, involving high costs and stress for the patient. To address this situation multiple systems have been proposed to conduct the examination and analysis in the patient's home, using sensors to detect physiological signals that are examined by algorithms. The objective of this research is to review publications that show the performance of different devices for ambulatory diagnosis of sleep apnea. Commercial systems that were examined by an independent research group and validated research projects were selected. In total 117 articles were analysed, including a total of 50 commercial devices. Each article was evaluated according to diagnostic elements, level of automatisation implemented and the deducted level of evidence and quality rating. Each device was categorized using the SCOPER categorization system, including an additional proposed category, and a final comparison was performed to determine the sensors that provided the best results.
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Affiliation(s)
- Fábio Mendonça
- Madeira Interactive Technologies Institute, Portugal; Universidade de Lisboa, Instituto Superior Técnico, Portugal
| | - Sheikh Shanawaz Mostafa
- Madeira Interactive Technologies Institute, Portugal; Universidade de Lisboa, Instituto Superior Técnico, Portugal
| | - Antonio G Ravelo-García
- Universidad de Las Palmas de Gran Canaria, Institute for Technological Development and Innovation in Communications, Spain.
| | - Fernando Morgado-Dias
- Madeira Interactive Technologies Institute, Portugal; Universidade da Madeira, Portugal
| | - Thomas Penzel
- Charité Universitatsmedizin, Sleep Center, Germany; International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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12
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Martinot JB, Borel JC, Le-Dong NN, Guénard HJP, Cuthbert V, Silkoff PE, Gozal D, Pepin JL. Monitoring mandibular movements to detect Cheyne-Stokes Breathing. Respir Res 2017; 18:66. [PMID: 28427400 PMCID: PMC5399309 DOI: 10.1186/s12931-017-0551-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/12/2017] [Indexed: 12/01/2022] Open
Abstract
Background The patterns of mandibular movements (MM) during sleep can be used to identify increased respiratory effort periodic large-amplitude MM (LPM), and cortical arousals associated with “sharp” large-amplitude MM (SPM). We hypothesized that Cheyne Stokes breathing (CSB) may be identified by periodic abnormal MM patterns. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard. Methods In 573 consecutive patients attending an in-laboratory PSG for suspected sleep disordered breathing (SDB), MM signals were acquired using magnetometry and scored manually while blinded from the PSG signal. Data analysis aimed to verify the concordance between the CSB identified by PSG and the presence of LPM or SPM. The data were randomly divided into training and validation sets (985 5-min segments/set) and concordance was evaluated using 2 classification models. Results In PSG, 22 patients (mean age ± SD: 65.9 ± 15.0 with a sex ratio M/F of 17/5) had CSB (mean central apnea hourly indice ± SD: 17.5 ± 6.2) from a total of 573 patients with suspected SDB. When tested on independent subset, the classification of CSB based on LPM and SPM is highly accurate (Balanced-accuracy = 0.922, sensitivity = 0.922, specificity = 0.921 and error-rate = 0.078). Logistic models based odds-ratios for CSB in presence of SPM or LPM were 172.43 (95% CI: 88.23–365.04; p < 0.001) and 186.79 (95% CI: 100.48–379.93; p < 0.001), respectively. Conclusion CSB in patients with sleep disordered breathing could be accurately identified by a simple magnetometer device recording mandibular movements.
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Affiliation(s)
- Jean-Benoît Martinot
- Centre du Sommeil et de la Vigilance, CHU UCL Namur Site Ste Elisabeth, 15, Place Louise Godin, 5000, Namur, Belgium.
| | - Jean-Christian Borel
- AGIR à dom. Association, 38240, Meylan, France.,University Grenoble Alpes, HP2 INSERM U1042, 38000, Grenoble, France
| | | | | | - Valerie Cuthbert
- Centre du Sommeil et de la Vigilance, CHU UCL Namur Site Ste Elisabeth, 15, Place Louise Godin, 5000, Namur, Belgium
| | | | | | - Jean-Louis Pepin
- University Grenoble Alpes, HP2 INSERM U1042, 38000, Grenoble, France.,CHU de Grenoble, Laboratoire EFCR, Pôle THORAX et VAISSEAUX, Grenoble, France
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13
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Chakar B, Senny F, Poirrier AL, Cambron L, Fanielle J, Poirrier R. Validation of midsagittal jaw movements to measure sleep in healthy adults by comparison with actigraphy and polysomnography. ACTA ACUST UNITED AC 2017; 10:122-127. [PMID: 29410741 PMCID: PMC5699855 DOI: 10.5935/1984-0063.20170021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In a device based on midsagittal jaw movements analysis, we assessed a
sleep-wake automatic detector as an objective method to measure sleep in
healthy adults by comparison with wrist actigraphy against polysomnography
(PSG). METHODS Simultaneous and synchronized in-lab PSG, wrist actigraphy and jaw movements
were carried out in 38 healthy participants. Epoch by epoch analysis was
realized to assess the ability to sleep-wake distinction. Sleep parameters
as measured by the three devices were compared. This included three
regularly reported parameters: total sleep time, sleep onset latency, and
wake after sleep onset. Also, two supplementary parameters, wake during
sleep period and latency time, were added to measure quiet wakefulness
state. RESULTS The jaw movements showed sensitivity level equal to actigraphy 96% and
higher specificity level (64% and 48% respectively). The level of agreement
between the two devices was high (87%). The analysis of their disagreement
by discrepant resolution analysis used PSG as resolver revealed that jaw
movements was right (58.9%) more often than actigraphy (41%). In sleep
parameters comparison, the coefficient correlation of jaw movements was
higher than actigraphy in all parameters. Moreover, its ability to distinct
sleep-wake state allowed for a more effective estimation of the parameters
that measured the quiet wakefulness state. CONCLUSIONS Midsagittal jaw movements analysis is a reliable method to measure sleep. In
healthy adults, this device proved to be superior to actigraphy in terms of
estimation of all sleep parameters and distinction of sleep-wake status.
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Affiliation(s)
- Bassam Chakar
- University Hospital of Liege, Sleep Center - Department of Neurology - Liège - Liège - Belgium
| | - Frédéric Senny
- High School HELMo-Gramme, Electronic and Informatic Unit - Liège - Liège - Belgium
| | - Anne-Lise Poirrier
- University Hospital of Liege, Rhinology and Facial Plastic Surgery - Liège - Liège - Belgium
| | - Laurent Cambron
- University Hospital of Liege, Sleep Center - Department of Neurology - Liège - Liège - Belgium
| | - Julien Fanielle
- University Hospital of Liege, Sleep Center - Department of Neurology - Liège - Liège - Belgium
| | - Robert Poirrier
- University Hospital of Liege, Sleep Center - Department of Neurology - Liège - Liège - Belgium
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Martinot JB, Borel JC, Cuthbert V, Guénard HJP, Denison S, Silkoff PE, Gozal D, Pepin JL. Mandibular position and movements: Suitability for diagnosis of sleep apnoea. Respirology 2016; 22:567-574. [DOI: 10.1111/resp.12929] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jean-Christian Borel
- ‘AGIR à dom’ Association, La Tronche; Grenoble France
- University Grenoble Alpes; Grenoble France
| | | | | | | | - Philip E. Silkoff
- Department of Physiology; Temple University; Philadelphia Pennsylvania USA
| | - David Gozal
- Department of Medicine; University of Chicago; Chicago Illinois USA
| | - Jean-Louis Pepin
- University Grenoble Alpes; Grenoble France
- Sleep and Exercise Laboratory; Thorax and Vessels Division, Grenoble Alpes University Hospital; Grenoble France
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15
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Diagnostic Accuracy of Obstructive Airway Adult Test for Diagnosis of Obstructive Sleep Apnea. BIOMED RESEARCH INTERNATIONAL 2015; 2015:915185. [PMID: 26636102 PMCID: PMC4618120 DOI: 10.1155/2015/915185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/06/2015] [Accepted: 08/09/2015] [Indexed: 11/18/2022]
Abstract
Rationale. The gold standard for the diagnosis of Obstructive Sleep Apnea (OSA) is polysomnography, whose access is however reduced by costs and limited availability, so that additional diagnostic tests are needed. Objectives. To analyze the diagnostic accuracy of the Obstructive Airway Adult Test (OAAT) compared to polysomnography for the diagnosis of OSA in adult patients. Methods. Ninety patients affected by OSA verified with polysomnography (AHI ≥ 5) and ten healthy patients, randomly selected, were included and all were interviewed by one blind examiner with OAAT questions. Measurements and Main Results. The Spearman rho, evaluated to measure the correlation between OAAT and polysomnography, was 0.72 (p < 0.01). The area under the ROC curve (95% CI) was the parameter to evaluate the accuracy of the OAAT: it was 0.91 (0.81–1.00) for the diagnosis of OSA (AHI ≥ 5), 0.90 (0.82–0.98) for moderate OSA (AHI ≥ 15), and 0.84 (0.76–0.92) for severe OSA (AHI ≥ 30). Conclusions. The OAAT has shown a high correlation with polysomnography and also a high diagnostic accuracy for the diagnosis of OSA. It has also been shown to be able to discriminate among the different degrees of severity of OSA. Additional large studies aiming to validate this questionnaire as a screening or diagnostic test are needed.
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16
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Alvarez-Estevez D, Moret-Bonillo V. Computer-Assisted Diagnosis of the Sleep Apnea-Hypopnea Syndrome: A Review. SLEEP DISORDERS 2015; 2015:237878. [PMID: 26266052 PMCID: PMC4523666 DOI: 10.1155/2015/237878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/15/2015] [Accepted: 06/21/2015] [Indexed: 02/07/2023]
Abstract
Automatic diagnosis of the Sleep Apnea-Hypopnea Syndrome (SAHS) has become an important area of research due to the growing interest in the field of sleep medicine and the costs associated with its manual diagnosis. The increment and heterogeneity of the different techniques, however, make it somewhat difficult to adequately follow the recent developments. A literature review within the area of computer-assisted diagnosis of SAHS has been performed comprising the last 15 years of research in the field. Screening approaches, methods for the detection and classification of respiratory events, comprehensive diagnostic systems, and an outline of current commercial approaches are reviewed. An overview of the different methods is presented together with validation analysis and critical discussion of the current state of the art.
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Affiliation(s)
| | - Vicente Moret-Bonillo
- Laboratory for Research and Development in Artificial Intelligence (LIDIA), Department of Computer Science, University of A Coruña, 15071 A Coruña, Spain
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17
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Lebret M, Arnol N, Contal O, Martinot JB, Tamisier R, Pepin JL, Borel JC. Nasal obstruction and male gender contribute to the persistence of mouth opening during sleep in CPAP-treated obstructive sleep apnoea. Respirology 2015; 20:1123-30. [DOI: 10.1111/resp.12584] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/02/2015] [Accepted: 03/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Marius Lebret
- University Pierre and Marie Curie-Paris VI; Paris France
- AGIR à dom. Association; La Tronche France
| | - Nathalie Arnol
- AGIR à dom. Association; La Tronche France
- HP2 laboratory INSERM U1042; University Grenoble Alpes; Grenoble France
| | - Olivier Contal
- University of Health Sciences (HESAV); University of Applied Sciences and Arts of Western Switzerland (HES-SO); Lausanne Switzerland
| | | | - Renaud Tamisier
- HP2 laboratory INSERM U1042; University Grenoble Alpes; Grenoble France
- Department of Physiology and Sleep; Albert Michallon Hospital; Grenoble France
| | - Jean-Louis Pepin
- HP2 laboratory INSERM U1042; University Grenoble Alpes; Grenoble France
- Department of Physiology and Sleep; Albert Michallon Hospital; Grenoble France
| | - Jean-Christian Borel
- AGIR à dom. Association; La Tronche France
- HP2 laboratory INSERM U1042; University Grenoble Alpes; Grenoble France
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18
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Shigemoto S, Shigeta Y, Nejima J, Ogawa T, Matsuka Y, Clark GT. Diagnosis and treatment for obstructive sleep apnea: Fundamental and clinical knowledge in obstructive sleep apnea. J Prosthodont Res 2015; 59:161-71. [PMID: 25944119 DOI: 10.1016/j.jpor.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE This review article covers the diagnosis and treatment of obstructive sleep apnea (OSA) from a dental perspective. It addresses the issue of when and how to screen for and then, if indicated, refer the patient for a more comprehensive. STUDY SELECTION Our focus in this article was on identifying current unanswered questions that relevant to OSA problems that dental scientists have to pursue and on providing valuable information on that problems, consequently the previous studies which investigated or reviewed the diagnosis and treatment of OSA were included. In addition, we included studies on jaw movements during sleep and on the use of a lateral cephalometric film related to the diagnosis and treatment of OSA. RESULTS The role of portable sleep monitoring devices versus full laboratory polysomnography is discussed. This review also describes what is known about the efficacy of mandibular advancement devices and when and how they fit in to a treatment program for a patient with obstructive sleep apnea. Finally some basic research is presented on jaw movements during sleep and how a lateral cephalometric film can be used to assess the changes of the airway with body posture and head posture. CONCLUSION This article provides the valuable suggestions for the clinical questions in the diagnosis and treatment of OSA.
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Affiliation(s)
- Shuji Shigemoto
- Department of Fixed Prosthodontics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan; Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Yuko Shigeta
- Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
| | - Jun Nejima
- Department of Internal Medicine, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Takumi Ogawa
- Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Yoshizo Matsuka
- Department of Fixed Prosthodontics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Glenn T Clark
- Orofacial Pain/Oral Medicine Center, Division of Diagnostic Sciences, Ostrow School of Dentistry, University of Southern California, Los Angeles, USA
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Martinot JB, Senny F, Denison S, Cuthbert V, Gueulette E, Guénard H, Pépin JL. Mandibular movements identify respiratory effort in pediatric obstructive sleep apnea. J Clin Sleep Med 2015; 11:567-74. [PMID: 25766710 DOI: 10.5664/jcsm.4706] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/19/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea-hypopnea (OAH) diagnosis in children is based on the quantification of flow and respiratory effort (RE). Pulse transit time (PTT) is one validated tool to recognize RE. Pattern analysis of mandibular movements (MM) might be an alternative method to detect RE. We compared several patterns of MM to concomittant changes in PTT during OAH in children with adenotonsillar hypertrophy. METHODS PARTICIPANTS 33 consecutive children with snoring and symptoms/signs of OAH. MEASUREMENTS MMs were measured during polysomnography with a magnetometer device (Brizzy Nomics, Liege, Belgium) placed on the chin and forehead. Patterns of MM were evaluated representing peak to peak fluctuations > 0.3 mm in mandibular excursion (MML), mandibular opening (MMO), and sharp MM (MMS), which closed the mouth on cortical arousal (CAr). RESULTS The median (95% CI) hourly rate of at least 1 MM (MML, or MMO, or MMS) was 18.1 (13.2-36.3) and strongly correlated with OAHI (p = 0.003) but not with central apnea-hypopnea index (CAHI; p = 0.292). The durations when the MM amplitude was > 0.4 mm and PTT > 15 ms were strongly correlated (p < 0.001). The mean (SD) of MM peak to peak amplitude was larger during OAH than CAH (0.9 ± 0.7 mm and 0.2 ± 0.3 mm; p < 0.001, respectively). MMS at the termination of OAH had larger amplitude compared to MMS with CAH (1.5 ± 0.9 mm and 0.5 ± 0.7 mm, respectively, p < 0.001). CONCLUSIONS MM > 0.4 mm occurred frequently during periods of OAH and were frequently terminated by MMS corresponding to mouth closure on CAr. The MM findings strongly correlated with changes in PTT. MM analysis could be a simple and accurate promising tool for RE characterization and optimization of OAH diagnosis in children.
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Affiliation(s)
- Jean-Benoît Martinot
- Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium
| | | | - Stéphane Denison
- Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium
| | - Valérie Cuthbert
- Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium
| | - Emmanuelle Gueulette
- Départements de Pneumologie et de Pédiatrie, Clinique et Maternité St Elisabeth, Namur, Belgium
| | - Hervé Guénard
- Laboratoire de Physiologie et CHU de Bordeaux, France
| | - Jean-Louis Pépin
- Université Grenoble Alpes, HP2; Inserm U1042, Grenoble, France. CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole THORAX et VAISSEAUX Grenoble, France
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Cattrysse F, Peeters M, Calaerts S, Ferson K, Degryse JM. Detection of sleep apnea by case-finding and home monitoring with Somnolter®: a pilot study. BMC Res Notes 2014; 7:616. [PMID: 25200902 PMCID: PMC4174633 DOI: 10.1186/1756-0500-7-616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea and hypopnea syndrome (OSAHS) is a disorder that causes clinical symptoms (e.g. snoring, excessive daytime sleepiness and impaired concentration) that may increase the risk of traffic accidents, cardiovascular disease, type 2 diabetes and reduce the quality of life. A recently developed device (Somnolter®) detects apneas and hypopneas in a home setting, allowing to detect OSAHS in a more comfortable environment compared to the gold standard polysomnography. The aim of our study was to investigate whether the Somnolter® is useful in family practice to identify patients with OSAHS. METHODS Questionnaires were offered to patients in five general practitioner (GP) practices.Based on the questionnaire and body mass index, patients with an increased risk of OSAHS were contacted to collaborate in the study. In this convenience sample, 18 patients were successfully tested with the Somnolter® measuring SaO2, mandibular movements, body position, heart rate, nasal air flow and thoracic and abdominal breathing movements. The Somnolter® automatically analyses the data and different parameters to detect OSAHS. Afterwards, the data were manually revised by the researchers. RESULTS Out of 365 subjects, 31 met the inclusion criteria and 18 were successfully tested at home. Sixteen out of 18 patients had an Apnea Hypopnea Index (AHI) ≥ 5, ten of them had mild OSAHS, 3 were categorized as moderate OSAHS and finally 3 matched the criteria of severe OSAHS. CONCLUSION The proposed case-finding strategy still needs optimization, but is considered helpful in selecting patients at high risk of OSAHS. OSAHS was detected in 14 out of 18 patients tested with the Somnolter®. In the future the Somnolter® might be a feasible alternative to diagnose OSAHS.
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Affiliation(s)
- Fabienne Cattrysse
- />Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
| | - Mathias Peeters
- />Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
| | - Sanne Calaerts
- />Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
| | - Karen Ferson
- />Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
| | - Jean-Marie Degryse
- />Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
- />Institut de Recherche Santé et Société, Université Catholique de Louvain (UCL), Brussels, Belgium
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El Shayeb M, Topfer LA, Stafinski T, Pawluk L, Menon D. Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ 2014; 186:E25-51. [PMID: 24218531 PMCID: PMC3883848 DOI: 10.1503/cmaj.130952] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Greater awareness of sleep-disordered breathing and rising obesity rates have fueled demand for sleep studies. Sleep testing using level 3 portable devices may expedite diagnosis and reduce the costs associated with level 1 in-laboratory polysomnography. We sought to assess the diagnostic accuracy of level 3 testing compared with level 1 testing and to identify the appropriate patient population for each test. METHODS We conducted a systematic review and meta-analysis of comparative studies of level 3 versus level 1 sleep tests in adults with suspected sleep-disordered breathing. We searched 3 research databases and grey literature sources for studies that reported on diagnostic accuracy parameters or disease management after diagnosis. Two reviewers screened the search results, selected potentially relevant studies and extracted data. We used a bivariate mixed-effects binary regression model to estimate summary diagnostic accuracy parameters. RESULTS We included 59 studies involving a total of 5026 evaluable patients (mostly patients suspected of having obstructive sleep apnea). Of these, 19 studies were included in the meta-analysis. The estimated area under the receiver operating characteristics curve was high, ranging between 0.85 and 0.99 across different levels of disease severity. Summary sensitivity ranged between 0.79 and 0.97, and summary specificity ranged between 0.60 and 0.93 across different apnea-hypopnea cut-offs. We saw no significant difference in the clinical management parameters between patients who underwent either test to receive their diagnosis. INTERPRETATION Level 3 portable devices showed good diagnostic performance compared with level 1 sleep tests in adult patients with a high pretest probability of moderate to severe obstructive sleep apnea and no unstable comorbidities. For patients suspected of having other types of sleep-disordered breathing or sleep disorders not related to breathing, level 1 testing remains the reference standard.
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Affiliation(s)
- Mohamed El Shayeb
- Health Technology and Policy Unit, School of Public Health (El Shayeb, Topfer, Stafinski, Menon); Sleep Medicine Program (Pawluk), Department of Psychiatry, University of Alberta, Edmonton, Alta
| | - Leigh-Ann Topfer
- Health Technology and Policy Unit, School of Public Health (El Shayeb, Topfer, Stafinski, Menon); Sleep Medicine Program (Pawluk), Department of Psychiatry, University of Alberta, Edmonton, Alta
| | - Tania Stafinski
- Health Technology and Policy Unit, School of Public Health (El Shayeb, Topfer, Stafinski, Menon); Sleep Medicine Program (Pawluk), Department of Psychiatry, University of Alberta, Edmonton, Alta
| | - Lawrence Pawluk
- Health Technology and Policy Unit, School of Public Health (El Shayeb, Topfer, Stafinski, Menon); Sleep Medicine Program (Pawluk), Department of Psychiatry, University of Alberta, Edmonton, Alta
| | - Devidas Menon
- Health Technology and Policy Unit, School of Public Health (El Shayeb, Topfer, Stafinski, Menon); Sleep Medicine Program (Pawluk), Department of Psychiatry, University of Alberta, Edmonton, Alta
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Home sleep study characteristics in patients with mucopolysaccharidosis. Sleep Breath 2013; 18:143-9. [PMID: 23690022 DOI: 10.1007/s11325-013-0862-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 03/26/2013] [Accepted: 05/03/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage disorders caused by the deficiency of hydrolases involved in the degradative pathway of glycosaminoglycans. In MPS, upper airway obstruction may result from multiple causative factors which may impact severely upon morbidity and mortality. METHODS We evaluated upper airway obstructive disease and related clinical findings through home sleep study in 19 patients (11 with MPS VI, 4 with MPS I, 4 with MPS II) with MPS followed at Gazi University Pediatric Metabolic Unit. Patients underwent home-based sleep measurements, and sleep respiratory problems were asked in a detailed clinical history. Measurements of apnea, apnea-hypopnea index (AHI), hypopnea index, oxygen desaturation index, and minimal oxygen saturation were obtained through home sleep study. RESULTS For 19 children, the disorder was normal in 1, mild (AHI=1.5-5/h) in 5, moderate (AHI=5-10/h) in 2, and severe (AHI>10/h) in 11. The prevalence of OSA was 94.7 % (18/19) in patients with MPS. Snoring, witnessed apnea, pectus carinatum, and macroglossia were the main clinical findings. Echocardiograms showed evidence of pulmonary hypertension in 13 patients. CONCLUSION Home sleep study is a quick and accessible screening test to determine the abnormalities of breathing during sleep and enables clinicians to take necessary action for patients with severe manifestations.
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Musso G, Cassader M, Olivetti C, Rosina F, Carbone G, Gambino R. Association of obstructive sleep apnoea with the presence and severity of non-alcoholic fatty liver disease. A systematic review and meta-analysis. Obes Rev 2013; 14:417-31. [PMID: 23387384 DOI: 10.1111/obr.12020] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnoea syndrome (OSAS) and non-alcoholic fatty liver disease (NAFLD) are common in clinical practice. NAFLD encompasses simple steatosis and non-alcoholic steatohepatitis (NASH): both confer an increased risk of cardiovascular disease and diabetes; NASH increases also liver-related risk. Growing experimental evidence connects chronic intermittent hypoxia of OSAS to NAFLD. We reviewed English and non-English articles and international meeting abstracts through December 2012. Observational studies were included if they assessed OSAS by polysomnography and NAFLD by histological, radiological or biochemical criteria. Two reviewers evaluated retrieved articles by appropriate quality scores. Main outcomes were pooled using random- or fixed-effects models. The effect of age, sex and body mass index (BMI) on effect estimates was assessed by meta-regression. Eighteen cross-sectional studies (2,183 participants) were included. Pooled odds ratios (ORs) of OSAS for the presence of NAFLD, as defined by histology, radiology, and AST or ALT elevation, were 2.01(95% CI: 1.36-2.97), 2.99(1.79-4.99), 2.36(1.46-3.82) and 2.60(1.88-3.61), respectively. Pooled ORs of OSAS for NASH, fibrosis-any stage, or advanced fibrosis in biopsy-proven NAFLD patients were 2.37(1.59-3.51), 2.16(1.45-3.20) and 2.30(1.21-4.38). The magnitude and direction of effects were unaffected by age, sex and BMI. In conclusion, OSAS is associated with an increased risk of NAFLD, NASH and fibrosis. OSAS patients should be screened for the presence and severity of NAFLD.
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Affiliation(s)
- G Musso
- Gradenigo Hospital, Turin, Italy.
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