1
|
Bailer M, Stein EM, Sprügel MI, Mestermann S, Spitzer P, Utz J, Zirlik S, Fuchs FS, Kornhuber J. Portable polygraphic device (Somnocheck micro CARDIO ®) provides accurate diagnostic information in psychiatric patients at risk for obstructive sleep apnoea: an observational cohort study. BMC Psychiatry 2024; 24:607. [PMID: 39256715 PMCID: PMC11389046 DOI: 10.1186/s12888-024-06049-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/26/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Symptoms of obstructive sleep apnoea (OSA) overlap significantly with those of psychiatric disorders, making accurate diagnosis of OSA challenging within psychiatric settings. Diagnosing OSA in psychiatric patients is crucial because untreated OSA can exacerbate psychiatric symptoms, reduce treatment efficacy, and impair overall quality of life. This study aimed to determine the diagnostic accuracy of a readily accessible procedure for psychiatric patients in a real-world clinical setting by comparing the Somnocheck micro CARDIO® (SCm) portable cardiorespiratory polygraphy device with the gold standard polysomnography (PSG). METHODS This observational cohort study included consecutive psychiatric patients at intermediate to high risk for OSA based on screening with the STOP-Bang questionnaire, admitted to a single tertiary care centre between June 1, 2016 and December 31, 2022. The Apnoea-Hypopnoea-Index (AHI), Apnoea-Index (AI), Oxygen-Desaturation-Index (ODI), and minimum oxygen saturation were measured sequentially by SCm and PSG. RESULTS A total of 57 patients were analysed (median age 62.0 [Interquartile Range (IQR), 51.5-72.5] years; 34 [59.6%] men). Regarding AHI, no significant differences (AHI measured by PSG, median, 16.6 [IQR, 6.2-26.7] vs. AHI measured by SCm, median, 14.9 [IQR, 10.0-22.8]; p = 0.812; r = 0.71) were found between SCm and PSG. AI, ODI and minimum oxygen saturation differed significantly between SCm and PSG. Using optimised cut-off values (any OSA: AHISCm ≥ 9.25), SCm showed high sensitivity (0.894) and high specificity (0.800) for the diagnosis of OSA, with an area under the receiver operating characteristic curve of 0.877. CONCLUSIONS This study found that the SCm portable device was accurate in identifying psychiatric patients with OSA. AHI measurement by SCm provided reliable diagnostic performance in comparison with the gold standard polysomnography. These findings support the integration of polygraphic measurements into the routine sleep assessment of psychiatric patients. Early and accurate diagnosis of OSA in this population can significantly improve the management of both sleep disorders and psychiatric conditions, potentially enhancing overall treatment outcomes and quality of life for these patients.
Collapse
Affiliation(s)
- Maximilian Bailer
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Eva M Stein
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Maximilian I Sprügel
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Mestermann
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Philipp Spitzer
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Janine Utz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Sabine Zirlik
- Department of Internal Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Florian S Fuchs
- Department of Internal Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| |
Collapse
|
2
|
Kaambwa B, Woods TJ, Natsky A, Bulamu N, Mpundu-Kaambwa C, Loffler KA, Sweetman A, Catcheside PG, Reynolds AC, Adams R, Eckert DJ. Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review. PHARMACOECONOMICS 2024; 42:507-526. [PMID: 38340220 PMCID: PMC11039546 DOI: 10.1007/s40273-023-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Assessment of quality of life (QoL) in people living with sleep disorders using questionnaires is necessary to compare intervention benefits. Knowledge of the content and concepts covered by specific QoL instruments is essential to determine which instruments are best suited for conducting economic evaluations of sleep-related interventions. OBJECTIVES This review aims to identify the QoL instruments that have been applied in economic evaluations of sleep disorder interventions and compare their conceptual overlap and content coverage using the framework of the International Classification of Functioning, Disability and Health (ICF). METHODS A systematic review of full economic evaluations in sleep published in peer-reviewed journals from conception to 30 May, 2023 was conducted. MEDLINE, PsychInfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare were searched for eligible studies. Studies incorporating either generic or sleep-specific QoL instruments as the primary or secondary measures of effectiveness within a full economic evaluation were included. Quality appraisal against the JBI Critical Appraisal Checklist for Economic Evaluations and EURONHEED checklists and mapping of QoL items to ICF categories were performed by two reviewers, with a third helping settle any potential differences. RESULTS Sixteen instruments were identified as having been used in sleep health economic evaluations. The EQ-5D-3L, Epworth Sleepiness Scale, and Insomnia Severity Index were the most widely used, but the latter two are predominantly diagnostic tools and not specifically designed to guide economic evaluations. Other instruments with broader ICF content coverage have been least used, and these include the Sleep Apnea Quality of Life Index, Functional Outcomes of Sleep Questionnaire, 15 Dimensions, Short-Form 6 Dimensions, 12-item Short Form Survey, 36-item Short Form Survey and the GRID Hamilton Rating Scale for Depression. CONCLUSIONS This study provides an overview of current QoL instruments used in economic evaluations of sleep with respect to their content coverage. A combination of generic and sleep-specific instruments with broader ICF content coverage is recommended for such evaluations.
Collapse
Affiliation(s)
- Billingsley Kaambwa
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, SA, 5042, Australia.
| | - Taylor-Jade Woods
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Andrea Natsky
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Norma Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Kelly A Loffler
- Health Data and Clinical Trials, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
3
|
Collard C, Regnier M, Maury G. CPAP adherence after ambulatory and in-hospital management in patients aged 65 years and older. Acta Clin Belg 2023; 78:467-477. [PMID: 37722390 DOI: 10.1080/17843286.2023.2260137] [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: 06/20/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES The aims of this study are to evaluate the early adherence to CPAP treatment in patients aged 65 years and older and to compare ambulatory (ACPAP) and in-hospital (HCPAP) management in starting CPAP treatment. METHODS Adherence to CPAP therapy at 3 months was retrospectively studied in patients on whom CPAP therapy was initiated between 1 January 2020 and 31 December 2021. Patients in the ACPAP group were selected based on the current Belgian reimbursement criteria (OAHI ≥30/h and few comorbidities). RESULTS 146 patients were studied (median OAHI 43.35/h [32.02; 57.40]; median age 69 [67.0; 73.0]): 116 (79.5%) patients in the HCPAP and 30 (20.5%) in the ACPAP group. Based on an adherence threshold of average CPAP use of ≥ 4 hours per day, 120 (82%) patients were adherent to the treatment; 94 (81%) patients in the HCPAP and 26 (86.7%) in the ACPAP group. The median CPAP use for the total population was 6.4 h/day [4.89; 7.34], reaching 6.3 h/d [4.79; 7.15] for the HCPAP group and 6.8 h/d [6.21; 8.06] for the ACPAP group (p = 0.019). Insomnia was a significant risk factor for non-adherence (OR 5.16 [1.64; 16.08], p = 0.0043) but the ACPAP method was not (OR 0.66 [0.18; 1.91], p = 0.4748). CONCLUSION Early CPAP adherence in patients ≥ 65 years old was good in terms of average use per day and proportion of adherent patients. ACPAP method was not a risk factor for lower CPAP adherence in patients presenting severe OSAS (OAHI ≥30/h) and few comorbidities.
Collapse
Affiliation(s)
- Charlène Collard
- Sleep Lab Unit, Pulmonology Department, CHU UCL Namur, Yvoir, Belgium
| | | | - Gisèle Maury
- Sleep Lab Unit, Pulmonology Department, CHU UCL Namur, Yvoir, Belgium
| |
Collapse
|
4
|
Testelmans D, Papadopoulos D, Kalkanis A, Jacobs A, Van Hende F, Vandebotermet M, Belge C, Buyse B. Telemonitoring-guided ambulatory fixed CPAP titration versus ambulatory APAP titration in moderate obstructive sleep apnea: A non-inferiority randomized controlled trial. J Sleep Res 2023; 32:e13887. [PMID: 36944532 DOI: 10.1111/jsr.13887] [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: 01/12/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
The present study aimed to evaluate whether titration of fixed continuous positive airway pressure at home using telemonitoring produces patient outcomes equal to auto-adjusting positive airway pressure titration at home for patients with moderate obstructive sleep apnea. Patients were randomized with a 1:1 allocation ratio to receive either auto-adjusting positive airway pressure titration based on the median of the 95th percentile pressure across seven nights or fixed continuous positive airway pressure titration based on a fixed calculated pressure and specific adaptations after telemonitoring of device data after 3 and 7 nights. The results of the ambulatory titration were evaluated with in-laboratory polysomnography after 2 weeks. We hypothesized that fixed continuous positive airway pressure titration would be non-inferior to auto-adjusting positive airway pressure titration in respect to continuous positive airway pressure adherence at a 3-month follow-up. A non-inferiority margin of -0.75 hr was prespecified. One-hundred and four patients were randomly allocated to fixed continuous positive airway pressure (n = 52) and auto-adjusting positive airway pressure (n = 52) titration. The mean difference and the 95% confidence intervals in continuous positive airway pressure adherence after 3 months between the two arms were 0.80 (-0.08, 1.69) hr. The non-inferiority hypothesis was confirmed as the lower one-sided 97.5% confidence interval for the mean difference was above the prespecified margin. Patients in the fixed continuous positive airway pressure titration arm were titrated at significantly lower pressure level and had a significantly lower amount of average leaks compared with auto-adjusting positive airway pressure-titrated patients, while there was no difference in residual obstructive apnea-hypopnea index on polysomnography. Telemonitoring enables ambulatory continuous positive airway pressure titration with fixed pressure that is non-inferior to ambulatory titration with auto-adjusting pressure in patients with moderate obstructive sleep apnea.
Collapse
Affiliation(s)
- D Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - D Papadopoulos
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - A Kalkanis
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - A Jacobs
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - F Van Hende
- Department of Pneumology, AZ St-Dimpna, Geel, Belgium
| | | | - C Belge
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - B Buyse
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
Collapse
Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Wang Y, Schöbel C, Penzel T. Management of Obstructive Sleep Apnea in Patients With Heart Failure. Front Med (Lausanne) 2022; 9:803388. [PMID: 35252246 PMCID: PMC8894657 DOI: 10.3389/fmed.2022.803388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Sleep apnea is traditionally classified as obstructive sleep apnea (OSA), which occurs when the upper airway collapses due to the relaxation of oropharyngeal musculature, and central sleep apnea occurs when the brainstem cannot stimulate breathing. Most sleep apnea in patients with heart failure (HF) results from coexisting OSA and central sleep apnea (CSA), or complex sleep apnea syndrome. OSA and CSA are common in HF and can be involved in its progression by exposure to the heart to intermittent hypoxia, increased preload and afterload, activating sympathetic, and decreased vascular endothelial function. A majority of treatments have been investigated in patients with CSA and HF; however, less or short-term randomized trials demonstrated whether treating OSA in patients with HF could improve morbidity and mortality. OSA could directly influence the patient's recovery. This review will focus on past and present studies on the various therapies for OSA in patients with HF and summarize CSA treatment options for reasons of reference and completeness. More specifically, the treatment covered include surgical and non-surgical treatments and reported the positive and negative consequences for these treatment options, highlighting possible implications for clinical practice and future research directions.
Collapse
Affiliation(s)
- Youmeng Wang
- Sleep Medicine Center, Charité-Universitätsmedizin, Berlin, Germany
- *Correspondence: Youmeng Wang
| | - Christoph Schöbel
- Universitätsmedizin Essen, Ruhrlandklinik - Westdeutsches Lungenzentrum am Universitätsklinikum Essen GmbH, Essen, Germany
| | - Thomas Penzel
- Sleep Medicine Center, Charité-Universitätsmedizin, Berlin, Germany
- Thomas Penzel
| |
Collapse
|
7
|
Natsky AN, Vakulin A, Chai-Coetzer CL, McEvoy RD, Adams RJ, Kaambwa B. Economic evaluation of diagnostic sleep studies for obstructive sleep apnoea in the adult population: a systematic review. Sleep Med Rev 2022; 62:101608. [DOI: 10.1016/j.smrv.2022.101608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
|
8
|
Ji Y, Wang H, Liu M, Partridge MR. Use of the pictorial Sleepiness and Sleep Apnoea Scale in Chinese patients with suspected obstructive sleep apnoea syndrome. J Thorac Dis 2021; 13:6071-6081. [PMID: 34795953 PMCID: PMC8575826 DOI: 10.21037/jtd-20-2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/19/2021] [Indexed: 11/28/2022]
Abstract
Background Sleep related breathing disorders represent a significant health burden. Being able to stratify patients according to their need for differing types of investigation and predicting the likelihood of obstructive sleep apnoea syndrome (OSAS) is helpful. This study attempts to assess the value of a pictorial Sleepiness and Sleep Apnoea Scale (pSSAS) in this process. Methods A total of 126 sequential patients attending a sleep service with suspected OSAS completed the pSSAS, the Epworth Sleepiness Score (ESS), and the Berlin Questionnaire (BQ) prior to full polysomnography. Results With Apnoea-hypopnea index (AHI) >15 as the positive diagnostic criterion, the area under the receiver operating characteristic curve (AUC) of the BQ was the highest (0.683), followed by pSSAS and ESS (AUC 0.648 and 0.516, respectively). With AHI >30 as the positive diagnostic criterion, the AUC of pSSAS was the highest (0.696), followed by BQ and ESS (AUC 0.653 and 0.510, respectively). With MiniSO2 <80% as the positive diagnostic criterion, the AUC of pSSAS was the highest (0.736), followed by BQ and ESS (AUC 0.634 and 0.516, respectively). Conclusions This study shows that the pSSAS which was first tested in a European population performs equally well amongst a Chinese population. The pSSAS performed in a similar fashion to the BQ in predicting those likely to have OSAS and was superior at predicting those who have severe OSAS. Because it is a pictorial questionnaire, it has advantages for those who may have reduced health literacy, a problem which is under-recognized in most healthcare systems.
Collapse
Affiliation(s)
- Yang Ji
- Division of Respiratory Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Hongxia Wang
- Division of Respiratory Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Min Liu
- Division of Respiratory Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | | |
Collapse
|
9
|
Bosi M, Incerti Parenti S, Fiordelli A, Poletti V, Alessandri-Bonetti G. Upper airway collapsibility in patients with OSA treated with continuous positive airway pressure: a retrospective preliminary study. J Clin Sleep Med 2021; 16:1839-1846. [PMID: 32621580 DOI: 10.5664/jcsm.8674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVES To investigate the prevalence of mildly collapsible upper airways (defined by therapeutic continuous positive airway pressure [CPAP] values ≤ 8 cm H₂O) in moderate to severe obstructive sleep apnea patients treated with CPAP and to determine their clinical, functional, and nocturnal polysomnographic characteristics. METHODS Eighty-seven patients with moderate to severe obstructive sleep apnea consecutively treated with CPAP were retrospectively investigated. Two nocturnal home sleep portable monitoring studies were performed at baseline and during treatment. Participants were categorized according to therapeutic CPAP values: ≤ 8 cm H₂O (group 1), 8-12 cm H₂O (group 2), ≥ 12 cm H₂O (group 3). Anthropometric, awake respiratory function, symptoms, comorbidities, and nocturnal home sleep portable monitoring studies data were collected. RESULTS Mild upper airway collapsibility (therapeutic CPAP values ≤ 8 cm H₂O) was present in 25.3% of patients. They showed more favorable apnea-hypopnea index, oxygen desaturation index, mean nocturnal saturation, sleep time with oxygen saturation < 90%, desaturation nadir, and supine position. Oxygen desaturation index showed a weak association with anatomical collapsibility. Using the receiver operating characteristic curve, the area under the curve for the oxygen desaturation index vs CPAP pressure requirements ≤ 8 cm H₂O was low and oxygen desaturation index ≤ 40.8/h showed a sensitivity of 63.3% and a specificity of 69.2% to detect patients with mild collapsibility. CONCLUSIONS A quarter of moderate to severe patients under CPAP therapy had mild collapsibility and were likely to also be good candidates for alternative and better tolerated non-CPAP therapies. Baseline anthropometric, clinical, and respiratory function characteristics did not predict mild upper airway collapsibility determined by CPAP pressure requirements ≤ 8 cm H₂O.
Collapse
Affiliation(s)
- Marcello Bosi
- Department of Thoracic Diseases, Sleep Respiratory Unit, Umberto I Hospital, Lugo, Italy
| | - Serena Incerti Parenti
- Unit of Orthodontics, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Andrea Fiordelli
- Unit of Orthodontics, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Venerino Poletti
- Department of Thoracic Diseases, Pulmonary Operative Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Giulio Alessandri-Bonetti
- Unit of Orthodontics, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| |
Collapse
|
10
|
Initiation of therapy for obstructive sleep apnea syndrome: a randomized comparison of outcomes of telemetry-supported home-based vs. sleep lab-based therapy initiation. Sleep Breath 2021; 26:269-277. [PMID: 33993394 PMCID: PMC8857114 DOI: 10.1007/s11325-021-02371-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/01/2021] [Accepted: 04/02/2021] [Indexed: 11/23/2022]
Abstract
Purpose Diagnosis and treatment of obstructive sleep apnea are traditionally performed in sleep laboratories with polysomnography (PSG) and are associated with significant waiting times for patients and high cost. We investigated if initiation of auto-titrating CPAP (APAP) treatment at home in patients with obstructive sleep apnea (OSA) and subsequent telemonitoring by a homecare provider would be non-inferior to in-lab management with diagnostic PSG, subsequent in-lab APAP initiation, and standard follow-up regarding compliance and disease-specific quality of life. Methods This randomized, open-label, single-center study was conducted in Germany. Screening occurred between December 2013 and November 2015. Eligible patients with moderate-to-severe OSA documented by polygraphy (PG) were randomized to home management or standard care. All patients were managed by certified sleep physicians. The home management group received APAP therapy at home, followed by telemonitoring. The control group received a diagnostic PSG, followed by therapy initiation in the sleep laboratory. The primary endpoint was therapy compliance, measured as average APAP usage after 6 months. Results The intention-to-treat population (ITT) included 224 patients (110 home therapy, 114 controls); the per-protocol population (PP) included 182 patients with 6-month device usage data (89 home therapy, 93 controls). In the PP analysis, mean APAP usage at 6 months was not different in the home therapy and control groups (4.38 ± 2.04 vs. 4.32 ± 2.28, p = 0.845). The pre-specified non-inferiority margin (NIM) of 0.3 h/day was not achieved (p = 0.130); statistical significance was achieved in a post hoc analysis when NIM was set at 0.5 h/day (p < 0.05). Time to APAP initiation was significantly shorter in the home therapy group (7.6 ± 7.2 vs. 46.1 ± 23.8 days; p < 0.0001). Conclusion Use of a home-based telemonitoring strategy for initiation of APAP in selected patients with OSA managed by sleep physicians is feasible, appears to be non-inferior to standard sleep laboratory procedures, and facilitates faster access to therapy.
Collapse
|
11
|
Natsky AN, Vakulin A, Coetzer CLC, McEvoy RD, Adams RJ, Kaambwa B. Economic evaluation of diagnostic sleep studies for obstructive sleep apnoea: a systematic review protocol. Syst Rev 2021; 10:104. [PMID: 33836806 PMCID: PMC8035771 DOI: 10.1186/s13643-021-01651-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a significant public health problem affecting a large proportion of the population and is associated with adverse health consequences and a substantial economic burden. Despite the existence of effective treatment, undiagnosed OSA remains a challenge. The gold standard diagnostic tool is polysomnography (PSG), yet the test is expensive, labour intensive and time-consuming. Home-based, limited channel sleep study testing (levels 3 and 4) can advance and widen access to diagnostic services. This systematic review aims to summarise available evidence regarding the cost-effectiveness of limited channel tests compared to laboratory and home PSG in diagnosing OSA. METHODS Eligible studies will be identified using a comprehensive strategy across the following databases from inception onwards: MEDLINE, PsychINFO, SCOPUS, CINAHL, Cochrane Library, Emcare and Web of Science Core Collection and ProQuest databases. The search will include a full economic evaluation (i.e. cost-effectiveness, cost-utility, cost-benefit, cost-consequences and cost-minimisation analysis) that assesses limited channel tests and PSG. Two reviewers will screen, extract data for included studies and critically appraise the articles for bias and quality. Meta-analyses will be conducted if aggregation of outcomes can be performed. Qualitative synthesis using a dominance ranking matrix will be performed for heterogeneous data. DISCUSSION This systematic review protocol uses a rigorous, reproducible and transparent methodology and eligibility criteria to provide the current evidence relating to the clinical and economic impact of limited channel and full PSG OSA diagnostic tests. Evidence will be examined using standardised tools specific for economic evaluation studies. TRIAL REGISTRATION PROSPERO (CRD42020150130).
Collapse
Affiliation(s)
- Andrea N Natsky
- Department of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia. .,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.
| | - Andrew Vakulin
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.,Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia
| | - Ching Li Chai Coetzer
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.,Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Bedford Park, South Australia, Australia
| | - R D McEvoy
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.,Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Bedford Park, South Australia, Australia
| | - Robert J Adams
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.,Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Bedford Park, South Australia, Australia
| | - Billingsley Kaambwa
- Department of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia
| |
Collapse
|
12
|
Braganza MV, Hanly PJ, Fraser KL, Tsai WH, Pendharkar SR. Predicting CPAP failure in patients with suspected sleep hypoventilation identified on ambulatory testing. J Clin Sleep Med 2020; 16:1555-1565. [PMID: 32501210 DOI: 10.5664/jcsm.8616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Home sleep apnea testing (HSAT) is commonly used to diagnose obstructive sleep apnea, but its role in identifying patients with suspected hypoventilation or predicting their response to continuous positive airway pressure (CPAP) therapy has not been assessed. The primary objective was to determine if HSAT, combined with clinical variables, could predict the failure of CPAP to correct nocturnal hypoxemia during polysomnography in a population with suspected hypoventilation. Secondary objectives were to determine if HSAT and clinical parameters could predict awake or sleep hypoventilation. METHODS A retrospective review was performed of 142 consecutive patients who underwent split-night polysomnography for suspected hypoventilation after clinical assessment by a sleep physician and review of HSAT. We collected quantitative indices of nocturnal hypoxemia, patient demographics, medications, pulmonary function tests, as well as arterial blood gas data from the night of the polysomnography . CPAP failure was defined as persistent obstructive sleep apnea, hypoxemia (oxygen saturation measured by pulse oximetry < 85%), or hypercapnia despite maximal CPAP. RESULTS Failure of CPAP was predicted by awake oxygen saturation and arterial blood gas results but not by HSAT indices of nocturnal hypoxemia. Awake oxygen saturation ≥ 94% ruled out CPAP failure, and partial pressure of oxygen measured by arterial blood gas ≥ 68 mmHg decreased the likelihood of CPAP failure significantly. CONCLUSIONS In patients with suspected hypoventilation based on clinical review and HSAT interpretation by a sleep physician, awake oxygen saturation measured by pulse oximetry and partial pressure of oxygen measured by arterial blood gas can reliably identify patients in whom CPAP is likely to fail. Additional research is required to determine the role of HSAT in the identification and treatment of patients with hypoventilation.
Collapse
Affiliation(s)
- Michael V Braganza
- Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick J Hanly
- Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kristin L Fraser
- Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Willis H Tsai
- Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sachin R Pendharkar
- Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
13
|
Álvarez D, Cerezo-Hernández A, Crespo A, Gutiérrez-Tobal GC, Vaquerizo-Villar F, Barroso-García V, Moreno F, Arroyo CA, Ruiz T, Hornero R, Del Campo F. A machine learning-based test for adult sleep apnoea screening at home using oximetry and airflow. Sci Rep 2020; 10:5332. [PMID: 32210294 PMCID: PMC7093547 DOI: 10.1038/s41598-020-62223-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
The most appropriate physiological signals to develop simplified as well as accurate screening tests for obstructive sleep apnoea (OSA) remain unknown. This study aimed at assessing whether joint analysis of at-home oximetry and airflow recordings by means of machine-learning algorithms leads to a significant diagnostic performance increase compared to single-channel approaches. Consecutive patients showing moderate-to-high clinical suspicion of OSA were involved. The apnoea-hypopnoea index (AHI) from unsupervised polysomnography was the gold standard. Oximetry and airflow from at-home polysomnography were parameterised by means of 38 time, frequency, and non-linear variables. Complementarity between both signals was exhaustively inspected via automated feature selection. Regression support vector machines were used to estimate the AHI from single-channel and dual-channel approaches. A total of 239 patients successfully completed at-home polysomnography. The optimum joint model reached 0.93 (95%CI 0.90–0.95) intra-class correlation coefficient between estimated and actual AHI. Overall performance of the dual-channel approach (kappa: 0.71; 4-class accuracy: 81.3%) significantly outperformed individual oximetry (kappa: 0.61; 4-class accuracy: 75.0%) and airflow (kappa: 0.42; 4-class accuracy: 61.5%). According to our findings, oximetry alone was able to reach notably high accuracy, particularly to confirm severe cases of the disease. Nevertheless, oximetry and airflow showed high complementarity leading to a remarkable performance increase compared to single-channel approaches. Consequently, their joint analysis via machine learning enables accurate abbreviated screening of OSA at home.
Collapse
Affiliation(s)
- Daniel Álvarez
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain. .,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain. .,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain.
| | | | - Andrea Crespo
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain.,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
| | - Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
| | | | | | - Fernando Moreno
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
| | - C Ainhoa Arroyo
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
| | - Tomás Ruiz
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
| | - Félix Del Campo
- Pneumology Department, Río Hortega University Hospital, Valladolid, Spain.,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
| |
Collapse
|
14
|
Zhang Z, Zhang J, Zhang H, Wang H, Hu Z, Xuan W, Dong S, Luo J. A Portable Triboelectric Nanogenerator for Real-Time Respiration Monitoring. NANOSCALE RESEARCH LETTERS 2019; 14:354. [PMID: 31781944 PMCID: PMC6882997 DOI: 10.1186/s11671-019-3187-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/17/2019] [Indexed: 05/04/2023]
Abstract
As a reliable indicator of human physiological health, respiratory rate has been utilized in more and more cases for prediction and diagnosis of potential respiratory diseases and the respiratory dysfunction caused by cystic fibrosis. However, compared with smart mobile electronics, traditional clinical respiration monitoring systems is not convenient to work as a household wearable device for real-time respiration monitoring in daily life due to its cumbersome structure, complex operability, and reliance on external power sources. Thus, we propose a wearable wireless respiration sensor based on lateral sliding mode triboelectric nanogenerator (TENG) to monitor respiratory rates by sensing the variation of the abdominal circumference. In this paper, we validate the possibility of the device as a respiration monitoring sensor via an established theoretical model and investigate the output performance of the sensor via a series of mechanical tests. Furtherly, the applications of the respiration sensor in different individuals, different breathing rhythms, different active states, and wireless transmission have been verified by a lot of volunteer tests. All the results demonstrate the potential of the proposed wearable sensor as a new alternative for detecting and monitoring real-time respiratory rates with general applicability and sensitivity.
Collapse
Affiliation(s)
- Zhicheng Zhang
- College of Civil Engineering & Architecture, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058 China
| | - Jiwei Zhang
- College of Civil Engineering & Architecture, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058 China
| | - He Zhang
- College of Civil Engineering & Architecture, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058 China
| | - Huagang Wang
- College of Civil Engineering & Architecture, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058 China
| | - Zhiwei Hu
- Ministry of Education Key Lab. of RF Circuits and Systems, College of Electronics & Information Hangzhou Dianzi University, Hangzhou, 310018 China
| | - Weipeng Xuan
- Ministry of Education Key Lab. of RF Circuits and Systems, College of Electronics & Information Hangzhou Dianzi University, Hangzhou, 310018 China
| | - Shurong Dong
- College of Information Science & Electronic Engineering, Zhejiang University, 38 Zheda Road, Hangzhou, 310027 China
| | - Jikui Luo
- Ministry of Education Key Lab. of RF Circuits and Systems, College of Electronics & Information Hangzhou Dianzi University, Hangzhou, 310018 China
- Institute of Renewable Energy & Environmental Technology, Bolton University, Deane Road, Bolton, BL3 5AB UK
| |
Collapse
|
15
|
Miyata S, Otake H, Ando M, Okuda M, Fujishiro H, Iwamoto K, Noda A, Sone M, Ozaki N. Patient characteristics affecting accurate detection of sleep apnea using a bed sheet-type portable monitor. Sleep Breath 2019; 24:783-790. [DOI: 10.1007/s11325-019-01963-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/11/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
|
16
|
Hui DS, Ng SS, Tam WWS. Home-based Approach Noninferior to Hospital-based Approach in Managing Patients with Suspected Obstructive Sleep Apnea Syndrome. Am J Respir Crit Care Med 2019; 197:1233-1234. [PMID: 29216445 DOI: 10.1164/rccm.201711-2185le] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- David S Hui
- 1 Chinese University of Hong Kong Hong Kong and
| | | | | |
Collapse
|
17
|
Ng SS, Tam W, Chan TO, To KW, Ngai J, Chan KKP, Yip WH, Lo RL, Yiu K, Ko FW, Hui DS. Use of Berlin questionnaire in comparison to polysomnography and home sleep study in patients with obstructive sleep apnea. Respir Res 2019; 20:40. [PMID: 30795760 PMCID: PMC6387538 DOI: 10.1186/s12931-019-1009-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/18/2019] [Indexed: 01/16/2023] Open
Abstract
Background Obstructive sleep apnea syndrome (OSAS) is a common disorder with significant morbidity and mortality. We aimed to evaluate the predictive accuracy of the Berlin questionnaire in patients with suspected OSAS undergoing PSG in the sleep laboratory setting against those going through the Embletta™ portable diagnostic system (Embletta PDS) at home. Methods Patients with suspected OSAS were recruited from respiratory clinics to complete Berlin questionnaire and Epworth Sleepiness Score (ESS). Patients were randomized to undergo either home-based sleep test (group A) or hospital-based polysomnography (PSG) (group B). Results Three hundreds and sixteen subjects with newly referred suspected OSAS were recruited and randomized into group A (n = 157) and group B (n = 159). The prevalence of moderate to severe OSAS defined as apnea-hypopnea index (AHI) ≥ 15/h was 54%. The Berlin questionnaire identified 69.7% (n = 99) of subjects as high risk in group A and 77.5% (n = 100) in group B. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the questionnaire to predict an AHI ≥ 15/h as diagnosed by PSG was 78, 23, 67 and 35%. When compared with Embletta PDS, the specificity and NPV increased to 48 and 63%. The area under the Receiver Operator Curve (ROC) based on PSG (AUC = 0.539, 95%CI 0.417, 0.661) and based on home Embletta (AUC = 0.712, 95%CI 0.617, 0.907). Conclusions The questionnaire was not reliable in predicting OSAS through PSG AHI whereas there was some predictive ability in discriminating patients with OSAS from normal subjects based on home Embletta sleep test. Trial registration The study was registered at ClinicalTrials.gov (Identifier: NCT01828216) on 10 April 2013.
Collapse
Affiliation(s)
- Susanna S Ng
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Wilson Tam
- Alice Lee Centre for Nursing Studises, National University of Singapore, Singapore, Singapore
| | - Tat-On Chan
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Kin-Wang To
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jenny Ngai
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Ken K P Chan
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Wing-Ho Yip
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Rachel L Lo
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Karen Yiu
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Fanny W Ko
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.,SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - David S Hui
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong. .,SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Sha Tin, Hong Kong. .,Alice Lee Centre for Nursing Studises, National University of Singapore, Singapore, Singapore. .,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, N.T, Hong Kong.
| |
Collapse
|
18
|
Tam W, Ng SS, To K, Ko FW, Hui DS. The interaction between hypertension and obstructive sleep apnea on subjective daytime sleepiness. J Clin Hypertens (Greenwich) 2019; 21:390-396. [DOI: 10.1111/jch.13485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Wilson Tam
- Alice Lee Centre for Nursing StudiesNational University of Singapore Singapore
| | - Susanna S. Ng
- Department of Medicine & Therapeutics The Chinese University of Hong Kong New Territories Hong Kong
| | - Kin‐Wang To
- Department of Medicine & Therapeutics The Chinese University of Hong Kong New Territories Hong Kong
| | - Fanny W. Ko
- Department of Medicine & Therapeutics The Chinese University of Hong Kong New Territories Hong Kong
| | - David S. Hui
- Department of Medicine & Therapeutics The Chinese University of Hong Kong New Territories Hong Kong
- SH Ho Sleep Apnoea Management Center The Chinese University of Hong Kong New Territories Hong Kong
| |
Collapse
|
19
|
Lipatov K, Hayek A, Ghamande S, Boethel C, Chen W, Jones S. Predictors of Obstructive Sleep Apnea on a Home Sleep Apnea Test After a Negative Attended Polysomnography. J Clin Sleep Med 2018; 14:1889-1894. [PMID: 30373689 DOI: 10.5664/jcsm.7486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/27/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES A home sleep apnea test (HSAT) is an acceptable alternative to polysomnography (PSG) for the diagnosis of obstructive sleep apnea (OSA) in patients with high pretest probability without certain comorbidities, such as severe pulmonary disease, congestive heart failure, or neuromuscular weakness. Current guidelines recommend repeat in-laborataory PSG in those with an initial negative PSG and high clinical suspicion for OSA. This retrospective study evaluated predictors of OSA on HSAT in patients who had a negative PSG. METHODS Electronic medical records were reviewed on 206 patients who underwent an in-laboratory PSG followed by HSAT at the Baylor Scott and White Sleep Institute. Of these patients, 141 were included in the study. Clinical patient characteristics, PSG data, and HSAT data were obtained. RESULTS A total of 141 patients had a negative PSG and underwent a subsequent HSAT. Of these patients, 83.7% had a positive diagnosis on HSAT, as defined by respiratory event index greater than or equal to 5 events/h, using the 4% oxygen desaturation criteria, (64.5% mild, 17.7% moderate, 1.4% severe) and 16.3% had a negative HSAT. Older age and hypertension predicted the diagnosis of OSA made on HSAT in patients with an initial negative PSG. CONCLUSIONS This retrospective study illustrates that there are patients for whom PSG gave a false-negative study. Patients who had negative PSG and positive HSAT are more likely to be older and have the diagnosis of hypertension. Sleep physicians may consider repeat testing with HSAT in patients with a negative PSG and clinical symptoms of OSA. COMMENTARY A commentary on this article appears in this issue on page 1839.
Collapse
Affiliation(s)
- Katie Lipatov
- Baylor Scott and White Health, Central Division, Temple, Texas
| | - Adam Hayek
- Baylor Scott and White Health, Central Division, Temple, Texas
| | | | - Carl Boethel
- Baylor Scott and White Health, Central Division, Temple, Texas
| | - Wencong Chen
- Baylor Scott and White Health, Central Division, Temple, Texas
| | - Shirley Jones
- Baylor Scott and White Health, Central Division, Temple, Texas
| |
Collapse
|
20
|
Araújo I, Marques F, André S, Araújo M, Marques S, Ferreira R, Moniz P, Proença M, Borrego P, Fonseca C. Diagnosis of sleep apnea in patients with stable chronic heart failure using a portable sleep test diagnostic device. Sleep Breath 2018; 22:749-755. [PMID: 29344749 DOI: 10.1007/s11325-017-1607-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 11/13/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE ApneaLink is a portable device for the screening of sleep apnea, a prevalent and underdiagnosed comorbidity in heart failure patients. A prospective cross-sectional study in patients with chronic heart failure was carried out to assess the sensitivity and specificity of apnea-hypopnea index (AHI) measurements using ApneaLink against the standard polysomnography test. METHODS Adult patients with a prior hospitalization in an acute heart failure hospital unit were recruited for the study. All participants were tested for sleep apnea using ApneaLink and polysomnography simultaneously during an overnight stay at a sleep laboratory. Global sleep apnea was evaluated according to the AHI, which was analyzed and compared. Subpopulation comparison based on ejection fraction was not realized due to population size. RESULTS Thirty-five patients with stable chronic heart failure completed the study (mean age 70.9 ± 10.5 years and body mass index 30.0 ± 4.7 kg/m2). Two patients were excluded due to insufficient study duration. ApneaLink had a sensitivity greater than 80% for all AHI measurements, and a specificity greater than 80% for all AHI measurements, except for AHI ≥ 5 events/h (61.5%). The results showed higher sensitivities and specificities at AHI values of ≥ 10 events/h (sensitivity 81.3% and specificity 84.2%) and ≥ 15 events/h (sensitivity 83.3% and specificity 91.3%). Correlation analysis showed that AHI measurements using ApneaLink and polysomnography had a strong and significant correlation (r = 0.794; P < 0.001). CONCLUSIONS Our results suggest that ApneaLink could be used in clinical practice to identify heart failure patients with high (AHI ≥ 15 events/h) and low (AHI < 5 events/h) probability of having sleep apnea, sparing the need for a diagnostic polysomnography and thus potentially impacting prognosis by providing a more cost-effective and timely diagnosis of this non-cardiac comorbidity.
Collapse
Affiliation(s)
- Inês Araújo
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal. .,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
| | - Filipa Marques
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Sandra André
- Polysomnography Laboratory, Pneumology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019, Lisbon, Portugal
| | - Manuel Araújo
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Sara Marques
- Polysomnography Laboratory, Pneumology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019, Lisbon, Portugal
| | - Rita Ferreira
- Polysomnography Laboratory, Pneumology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019, Lisbon, Portugal
| | - Patrícia Moniz
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Margarida Proença
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Pedro Borrego
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.,Centre for Public Administration and Public Policies (CAPP), Instituto Superior de Ciências Sociais e Políticas (ISCSP), Universidade de Lisboa, Rua Almerindo Lessa, 1300-663, Lisbon, Portugal
| | - Cândida Fonseca
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| |
Collapse
|