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Tankéré P, Taillard J, Armeni MA, Petitjean T, Berthomier C, Strauss M, Peter-Derex L. Revisiting the maintenance of wakefulness test: from intra-/inter-scorer agreement to normative values in patients treated for obstructive sleep apnea. J Sleep Res 2024; 33:e13961. [PMID: 37287324 DOI: 10.1111/jsr.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/06/2023] [Accepted: 05/20/2023] [Indexed: 06/09/2023]
Abstract
The Maintenance of Wakefulness Test is widely used to objectively assess sleepiness and make safety-related decisions, but its interpretation is subjective and normative values remain debated. Our work aimed to determine normative thresholds in non-subjectively sleepy patients with well-treated obstructive sleep apnea, and to assess intra- and inter-scorer variability. We included maintenance of wakefulness tests of 141 consecutive patients with treated obstructive sleep apnea (90% men, mean (SD) age 47.5 (9.2) years, mean (SD) pre-treatment apnea-hypopnea index of 43.8 (20.3) events/h). Sleep onset latencies were independently scored by two experts. Discordant scorings were reviewed to reach a consensus and half of the cohort was double-scored by each scorer. Intra- and inter-scorer variability was assessed using Cohen's kappa for 40, 33, and 19 min mean sleep latency thresholds. Consensual mean sleep latencies were compared between four groups according to subjective sleepiness (Epworth Sleepiness Scale score < versus ≥11) and residual apnea-hypopnea index (< versus ≥15 events/h). In well-treated non-sleepy patients (n = 76), the consensual mean (SD) sleep latency was 38.4 (4.2) min (lower normal limit [mean - 2SD] = 30 min), and 80% of them did not fall asleep. Intra-scorer agreement on mean sleep latency was high but inter-scorer was only fair (Cohen's kappa 0.54 for 33-min threshold, 0.27 for 19-min threshold), resulting in changes in latency category in 4%-12% of patients. A higher sleepiness score but not the residual apnea-hypopnea index was significantly associated with a lower mean sleep latency. Our findings suggest a higher than usually accepted normative threshold (30 min) in this context and emphasise the need for more reproducible scoring approaches.
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Affiliation(s)
- Pierre Tankéré
- Reference Center for Rare Pulmonary Diseases, Pulmonary Medicine and Intensive Care Unit, Dijon University Hospital, Dijon, France
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jacques Taillard
- Sommeil, Addiction et Neuropsychiatrie, Université de Bordeaux, SANPSY, USR 3413, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Marc-Antoine Armeni
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thierry Petitjean
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Mélanie Strauss
- Hôpital Universitaire de Bruxelles, Site Erasme, Services de Neurologie, Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, Brussels, Belgium
- Neuropsychology and Functional Imaging Research Group (UR2NF), Center for Research in Cognition and Neurosciences and ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon Neuroscience Research Center, PAM Team, INSERM U1028, CNRS UMR 5292, Lyon, France
- Claude Bernard Lyon 1 University, Lyon, France
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Foresi A, Vitale T, Prestigiacomo R, Ranieri P, Bosi M. Accuracy of positive airway pressure titration through telemonitoring of auto-adjusting positive airway pressure device connected to a pulse oximetry in patients with obstructive sleep apnea. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:740-747. [PMID: 37385297 PMCID: PMC10435960 DOI: 10.1111/crj.13658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE In COVID-19 era, all forms of access of patients to the sleep units should be reduced as much as possible when implementing telemedicine. In the field of obstructive sleep apnea (OSA) therapy with positive airway pressure (PAP) devices, telemedicine includes the use of built-in software (BIS) and storage of PAPs and remote-controlled data (BISrc data) that are processed and transmitted daily to sleep units. We compared two methods of evaluating the final residual severity of OSA patients in home PAP titration: BISrc data versus nocturnal portable multichannel monitoring (PM) data in PAP (reference method) and to verify whether the efficacy PAP therapy guided by BISrc data was clinically adequate. METHODS We conducted a real-life prospective study in newly diagnosed patients with OSA. Patients used an auto-adjusting positive airway pressure (AirSense 10 ResMed) with a pulse oximeter that allows daily transfer of BISrc data (apnea hypopnea index [AHI] and SaO2 ) and remote changes in ventilator setting. Once the PAP titration was completed, the pressure value or ranges were kept constant for 3 days and home PM was repeated. RESULTS There were 41 patients with moderate to severe OSA who completed the study. When considering AHI only, the diagnostic accuracy of BISrc on the third day was equal to 97.5%; when considering AHI > 10/h, ODI > 10/h, and SaO2 < 90%, the diagnostic accuracy slightly decreased to 90.2%. CONCLUSION In clinical practice, the two measurement methods are equivalent. The use of BISrc data for home titration would reduce the access to sleep units. We urge that widespread use of BISrc be promoted in the current practice of management of OSA.
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Affiliation(s)
- Antonio Foresi
- Lung Function and Sleep UnitASST Nord‐Milano, Sesto San Giovanni HospitalMilanItaly
| | - Tommaso Vitale
- Lung Function and Sleep UnitASST Nord‐Milano, Sesto San Giovanni HospitalMilanItaly
| | | | - Piera Ranieri
- Department of Medicine and RehabilitationIstituto Clinico Sant'AnnaBresciaItaly
| | - Marcello Bosi
- Sleep UnitVilla Igea, Ospedali Privati ForlìForlìItaly
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Craig S, Pépin JL, Randerath W, Caussé C, Verbraecken J, Asin J, Barbé F, Bonsignore MR. Investigation and management of residual sleepiness in CPAP-treated patients with obstructive sleep apnoea: the European view. Eur Respir Rev 2022; 31:31/164/210230. [PMID: 35613742 DOI: 10.1183/16000617.0230-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnoea (OSA), defined as the inability to stay awake during the day. Its clinical descriptors remain elusive, and the pathogenesis is complex, with disorders such as insufficient sleep and depression commonly associated. Subjective EDS can be evaluated using the Epworth Sleepiness Scale, in which the patient reports the probability of dozing in certain situations; however, its reliability has been challenged. Objective tests such as the multiple sleep latency test or the maintenance of wakefulness test are not commonly used in patients with OSA, since they require nocturnal polysomnography, daytime testing and are expensive. Drugs for EDS are available in the United States but were discontinued in Europe some time ago. For European respiratory physicians, treatment of EDS with medication is new and they may lack experience in pharmacological treatment of EDS, while novel wake-promoting drugs have been recently developed and approved for clinical use in OSA patients in the USA and Europe. This review will discuss 1) the potential prognostic significance of EDS in OSA patients at diagnosis, 2) the prevalence and predictors of residual EDS in treated OSA patients, and 3) the evolution of therapy for EDS specifically for Europe.
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Affiliation(s)
- Sonya Craig
- Liverpool Sleep and Ventilation Centre, University Hospital Aintree, Liverpool University Foundation Trust, Liverpool, UK
| | - Jean-Louis Pépin
- University Grenoble Alpes, HP2 Laboratory INSERM U1042, Grenoble, France
| | - Winfried Randerath
- Bethanien Hospital, Institute of Pneumonology, University of Cologne, Solingen, Germany
| | | | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem-Antwerp, Belgium
| | - Jerryll Asin
- Amphia Ziekenlius, AFD, Longziekten, Breda, The Netherlands
| | - Ferran Barbé
- Respiratory Dept, Institut Ricerca Biomedica de Vilanova, Lleida, Spain
| | - Maria R Bonsignore
- PROMISE Dept, University of Palermo; Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
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Telemonitoring for the Follow-Up of Obstructive Sleep Apnea Patients Treated with CPAP: Accuracy and Impact on Therapy. SENSORS 2022; 22:s22072782. [PMID: 35408395 PMCID: PMC9002933 DOI: 10.3390/s22072782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 12/28/2022]
Abstract
Continuous positive airway pressure (CPAP) telemonitoring (TMg) has become widely implemented in routine clinical care. Objective measures of CPAP compliance, residual respiratory events, and leaks can be easily monitored, but limitations exist. This review aims to assess the role of TMg in CPAP-treated obstructive sleep apnea (OSA) patients. We report recent data related to the accuracy of parameters measured by CPAP and try to determine the role of TMg in CPAP treatment follow-up, from the perspective of both healthcare professionals and patients. Measurement and accuracy of CPAP-recorded data, clinical management of these data, and impacts of TMg on therapy are reviewed in light of the current literature. Moreover, the crucial questions of who and how to monitor are discussed. TMg is a useful tool to support, fine-tune, adapt, and control both CPAP efficacy and compliance in newly-diagnosed OSA patients. However, clinicians should be aware of the limits of the accuracy of CPAP devices to measure residual respiratory events and leaks and issues such as privacy and cost-effectiveness are still a matter of concern. The best methods to focus our efforts on the patients who need TMg support should be properly defined in future long-term studies.
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Ni YN, Thomas RJ. A longitudinal study of the accuracy of positive pressure therapy machine-detected apnea-hypopnea events. J Clin Sleep Med 2021; 18:1121-1134. [PMID: 34886948 DOI: 10.5664/jcsm.9814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVES During positive airway pressure (PAP) therapy for sleep apnea syndromes, the machine detected respiratory event index (REIFLOW) is an important method for clinicians to evaluate the beneficial effects of PAP. There are concerns about the accuracy of this detection, which also confounds a related question-how common and severe are residual events on PAP. METHODS Subjects with OSA who underwent a split night polysomnography were recruited prospectively. Those treated with PAP and tracked by the EncoreAnywhere system were analyzed. The ones who stopped PAP within one month were excluded for this analysis. Compliance, therapy data and waveform data were analyzed. Machine detected versus manually scored events were compared at the 1st, 3rd, 6th and 12th month from PAP initiation. Logistic regression was used to determine factors associated with a high REIFLOW difference. RESULTS One hundred and seventy-nine patients with a mean age 59.06 ± 13.97 years old, median body mass index 33.60 (29.75-38.75) kg/m2, and median baseline AHI 46.30 (31.50-65.90) times/hour were included. The difference between the machine detected REIFLOW and manually scored REIFLOW was 10.72 ±8.43 in the first month and remained stable for up to 12 months. Male sex and large leak ≥ 1.5% were more frequent in patients who had an REIFLOW difference of ≥ 5 / hour of use. A titration arousal index ≥ 15/ hour of sleep, and higher ratio of unstable to stable breathing were also associated with an REIFLOW difference ≥ 5 times/hour of use. CONCLUSIONS There is a substantial and sustained difference between manual and automated event estimates during PAP therapy, and some associated factors were identified.
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Affiliation(s)
- Yue-Nan Ni
- Department of Respiratory, Critical Care and Sleep Medicine, West China School of Medicine and West China Hospital, Sichuan University, China
| | - Robert Joseph Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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