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Levy J, Álvarez D, Del Campo F, Behar JA. Deep learning for obstructive sleep apnea diagnosis based on single channel oximetry. Nat Commun 2023; 14:4881. [PMID: 37573327 PMCID: PMC10423260 DOI: 10.1038/s41467-023-40604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a serious medical condition with a high prevalence, although diagnosis remains a challenge. Existing home sleep tests may provide acceptable diagnosis performance but have shown several limitations. In this retrospective study, we used 12,923 polysomnography recordings from six independent databases to develop and evaluate a deep learning model, called OxiNet, for the estimation of the apnea-hypopnea index from the oximetry signal. We evaluated OxiNet performance across ethnicity, age, sex, and comorbidity. OxiNet missed 0.2% of all test set moderate-to-severe OSA patients against 21% for the best benchmark.
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Affiliation(s)
- Jeremy Levy
- The Andrew and Erna Viterbi Faculty of Electrical & Computer Engineering, Technion-IIT, Haifa, Israel
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Daniel Álvarez
- Río Hortega University Hospital Valladolid, 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
| | - Félix Del Campo
- Río Hortega University Hospital Valladolid, 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
| | - Joachim A Behar
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel.
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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.
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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
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Tsai CY, Huang HT, Cheng HC, Wang J, Duh PJ, Hsu WH, Stettler M, Kuan YC, Lin YT, Hsu CR, Lee KY, Kang JH, Wu D, Lee HC, Wu CJ, Majumdar A, Liu WT. Screening for Obstructive Sleep Apnea Risk by Using Machine Learning Approaches and Anthropometric Features. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22228630. [PMID: 36433227 PMCID: PMC9694257 DOI: 10.3390/s22228630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 05/14/2023]
Abstract
Obstructive sleep apnea (OSA) is a global health concern and is typically diagnosed using in-laboratory polysomnography (PSG). However, PSG is highly time-consuming and labor-intensive. We, therefore, developed machine learning models based on easily accessed anthropometric features to screen for the risk of moderate to severe and severe OSA. We enrolled 3503 patients from Taiwan and determined their PSG parameters and anthropometric features. Subsequently, we compared the mean values among patients with different OSA severity and considered correlations among all participants. We developed models based on the following machine learning approaches: logistic regression, k-nearest neighbors, naïve Bayes, random forest (RF), support vector machine, and XGBoost. Collected data were first independently split into two data sets (training and validation: 80%; testing: 20%). Thereafter, we adopted the model with the highest accuracy in the training and validation stage to predict the testing set. We explored the importance of each feature in the OSA risk screening by calculating the Shapley values of each input variable. The RF model achieved the highest accuracy for moderate to severe (84.74%) and severe (72.61%) OSA. The level of visceral fat was found to be a predominant feature in the risk screening models of OSA with the aforementioned levels of severity. Our machine learning models can be employed to screen for OSA risk in the populations in Taiwan and in those with similar craniofacial structures.
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Affiliation(s)
- Cheng-Yu Tsai
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Huei-Tyng Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - Hsueh-Chien Cheng
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton CB10 1RQ, UK
| | - Jieni Wang
- Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB3 0AS, UK
| | - Ping-Jung Duh
- Cognitive Neuroscience, Division of Psychology and Language Science, University College London, London WC1H 0AP, UK
| | - Wen-Hua Hsu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Marc Stettler
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Yi-Chun Kuan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110301, Taiwan
- Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Yin-Tzu Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Chia-Rung Hsu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110301, Taiwan
| | - Dean Wu
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110301, Taiwan
- Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Arnab Majumdar
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
- Correspondence: (A.M.); (W.-T.L.)
| | - Wen-Te Liu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Correspondence: (A.M.); (W.-T.L.)
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A novel, simple, and accurate pulse oximetry indicator for screening adult obstructive sleep apnea. Sleep Breath 2022; 26:1125-1134. [PMID: 34554375 DOI: 10.1007/s11325-021-02439-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of the study was to develop a multiparametric oximetry indicator (IMp-SpO2) to diagnose obstructive sleep apnea in adults. MATERIAL AND METHOD This was an observational, retrospective study of diagnostic accuracy. We included adults who had had a diagnostic polysomnography with few artifacts and a total sleep time of at least 180 min in the sleep laboratory. Obstructive sleep apnea (OSA) was defined as an apnea-hypopnea index (AHI) ≥ 5. The database was randomly divided into an experimental (Exp-G) and validation (Val-G) group. The program calculated several parameters of oxygen saturation variability (Par-VarSpO2): (a) oxygen desaturation index (ODI ≥ 3, 4%) and (b) 90, 95, and 97.5 percentiles of both the number of oxygen desaturations ≥ 3 and 4% (P90-97.5 OD3/4 W5-60) and SpO2 standard deviations in moving windows from 5 to 60 min (P90-P97.5 SDSpO2 W5-10). Area under the ROC curve (AUC-ROC), sensitivity, specificity, positive/negative likelihood ratios, and accuracy were calculated. RESULTS Of 1141 adults included in the study, experimental (571) and validation group (570) were similar (women 47% vs 45%, BMI 27.5 kg/m2 vs 27.2 kg/m2, and AHI 11.7 vs 12, p NS). The IMp-SpO2 developed in the experimental group consisted of a combination of 10 parameters of oxygen saturation variability. The presence of at least one IMp-SpO2 variable had a high diagnostic performance for OSA (sensitivity/specificity/accuracy: Exp-G: 92.8/94/93.2%; Val-G: 93/95.2/93.7%). The IMp-SpO2 AUC-ROC was higher (Exp-G 0.934, Val-G 0.941) than most of the Par-VarSpO2 (0.898-0.929, p < 0.05). CONCLUSION The IMp-SpO2 showed a > 90% accuracy for OSA diagnosis in adults.
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Casal R, Di Persia LE, Schlotthauer G. Classifying sleep–wake stages through recurrent neural networks using pulse oximetry signals. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Overnight pulse oximetry (OPO) has proven to be an effective and beneficial technique to determine the cardiorespiratory status of patients in both the inpatient and outpatient settings. It is a cheap, safe, reliable, simple, and accurate method of patient monitoring as compared to the expensive and labor-intensive method of multichannel polysomnography for detecting sleep-disordered breathing. It provides accurate information about patient's oxygenation status and also helps in monitoring the response to continuous positive airway pressure and in the surgical treatment of obstructive sleep apnea (OSA). Nocturnal hypoxemia portends a poor prognosis in patients of chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and neuromuscular diseases. OPO can help its early detection and management.
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Affiliation(s)
- Shruti Singh
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Sara Z Khan
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Dilbagh Singh
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Sameer Verma
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Arunabh Talwar
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
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Casal R, Di Persia LE, Schlotthauer G. Sleep-wake stages classification using heart rate signals from pulse oximetry. Heliyon 2019; 5:e02529. [PMID: 31667382 PMCID: PMC6812238 DOI: 10.1016/j.heliyon.2019.e02529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 04/04/2019] [Accepted: 09/24/2019] [Indexed: 12/26/2022] Open
Abstract
The most important index of obstructive sleep apnea/hypopnea syndrome (OSAHS) is the apnea/hyponea index (AHI). The AHI is the number of apnea/hypopnea events per hour of sleep. Algorithms for the screening of OSAHS from pulse oximetry estimate an approximation to AHI counting the desaturation events without consider the sleep stage of the patient. This paper presents an automatic system to determine if a patient is awake or asleep using heart rate (HR) signals provided by pulse oximetry. In this study, 70 features are estimated using entropy and complexity measures, frequency domain and time-scale domain methods, and classical statistics. The dimension of feature space is reduced from 70 to 40 using three different schemes based on forward feature selection with support vector machine and feature importance with random forest. The algorithms were designed, trained and tested with 5000 patients from the Sleep Heart Health Study database. In the test stage, 10-fold cross validation method was applied obtaining performances up to 85.2% accuracy, 88.3% specificity, 79.0% sensitivity, 67.0% positive predictive value, and 91.3% negative predictive value. The results are encouraging, showing the possibility of using HR signals obtained from the same oximeter to determine the sleep stage of the patient, and thus potentially improving the estimation of AHI based on only pulse oximetry.
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Affiliation(s)
- Ramiro Casal
- Lab. de Señales y Dinámicas no Lineales, Facultad de Ingeniería, Universidad Nacional de Entre Ríos (UNER), Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.,Instituto de Investigación y Desarrollo en Bioingeniería y Bioinformática, UNER, CONICET, Argentina
| | - Leandro E Di Persia
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.,Instituto de Investigacion en Señales, Sistemas e Inteligencia Computacional, Universidad Nacional del Litoral, CONICET, Argentina
| | - Gastón Schlotthauer
- Lab. de Señales y Dinámicas no Lineales, Facultad de Ingeniería, Universidad Nacional de Entre Ríos (UNER), Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.,Instituto de Investigación y Desarrollo en Bioingeniería y Bioinformática, UNER, CONICET, Argentina
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Terrill PI. A review of approaches for analysing obstructive sleep apnoea‐related patterns in pulse oximetry data. Respirology 2019; 25:475-485. [DOI: 10.1111/resp.13635] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/28/2019] [Accepted: 06/12/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Philip I. Terrill
- School of Information Technology and Electrical EngineeringThe University of Queensland Brisbane QLD Australia
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"It is better to know some of the questions than all of the answers". The diagnosis of the Obstructive Sleep Apnea/Hypopnea Syndrome by questionnaires. Pulmonology 2019; 25:134-136. [PMID: 31176477 DOI: 10.1016/j.pulmoe.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lin SH, Branson C, Leung J, Park L, Doshi N, Auerbach SH. Oximetry as an Accurate Tool for Identifying Moderate to Severe Sleep Apnea in Patients With Acute Stroke. J Clin Sleep Med 2018; 14:2065-2073. [PMID: 30518446 DOI: 10.5664/jcsm.7538] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/16/2018] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is highly prevalent in patients with acute stroke. SDB is often underdiagnosed and associated with neurological deterioration and stroke recurrence. Polysomnography or home sleep apnea testing (HSAT) is typically used as the diagnostic modality; however, it may not be feasible to use regularly in patients with acute stroke. We investigated the predictive performance of pulse oximetry, a simpler alternative, to identify SDB. METHODS The records of 254 patients, who were admitted to Boston Medical Center for acute stroke and underwent HSAT, were retrospectively reviewed. Oxygen desaturation index (ODI) from pulse oximetry channel were compared to respiratory event index (REI) obtained from HSAT devices. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ODI were calculated, and different ODI cutoff values to predict SDB were proposed. RESULTS ODI had a strong correlation (r = .902) and agreement with REI. ODI was accurate in predicting SDB at different REI thresholds (REI ≥ 5, REI ≥ 15, and REI ≥ 30 events/h) with the area under the curve (AUC) of .965, .974, and .951, respectively. An ODI ≥ 5 events/h rules in the presence of SDB (specificity 91.7%, PPV 96.3%). An ODI ≥ 15 events/h rules in moderate to severe SDB (specificity 96.4%, PPV 95%) and an ODI < 5 events/h rules out moderate to severe SDB (sensitivity 100%, NPV 100%). CONCLUSIONS Nocturnal pulse oximetry has a high diagnostic accuracy in predicting moderate to severe SDB in patients with acute stroke. Oximetry can be a simple modality to rapidly recognize patients with more severe SDB and facilitate the referral to the confirmation sleep study.
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Affiliation(s)
- Shih Hao Lin
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Chantale Branson
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Jamie Leung
- Boston University School of Medicine, Boston, Massachusetts
| | - Lisa Park
- Boston University School of Medicine, Boston, Massachusetts
| | - Nirmita Doshi
- Boston University School of Medicine, Boston, Massachusetts
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Del Campo F, Crespo A, Cerezo-Hernández A, Gutiérrez-Tobal GC, Hornero R, Álvarez D. Oximetry use in obstructive sleep apnea. Expert Rev Respir Med 2018; 12:665-681. [PMID: 29972344 DOI: 10.1080/17476348.2018.1495563] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Overnight oximetry has been proposed as an accessible, simple, and reliable technique for obstructive sleep apnea syndrome (OSAS) diagnosis. From visual inspection to advanced signal processing, several studies have demonstrated the usefulness of oximetry as a screening tool. However, there is still controversy regarding the general application of oximetry as a single screening methodology for OSAS. Areas covered: Currently, high-resolution portable devices combined with pattern recognition-based applications are able to achieve high performance in the detection of this disease. In this review, recent studies involving automated analysis of oximetry by means of advanced signal processing and machine learning algorithms are analyzed. Advantages and limitations are highlighted and novel research lines aimed at improving the screening ability of oximetry are proposed. Expert commentary: Oximetry is a cost-effective tool for OSAS screening in patients showing high pretest probability for the disease. Nevertheless, exhaustive analyses are still needed to further assess unattended oximetry monitoring as a single diagnostic test for sleep apnea, particularly in the pediatric population and in populations with significant comorbidities. In the following years, communication technologies and big data analyses will overcome current limitations of simplified sleep testing approaches, changing the detection and management of OSAS.
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Affiliation(s)
- Félix Del Campo
- a Pneumology Service , Río Hortega University Hospital , Valladolid , Spain.,b Biomedical Engineering Group , University of Valladolid , Valladolid , Spain
| | - Andrea Crespo
- a Pneumology Service , Río Hortega University Hospital , Valladolid , Spain.,b Biomedical Engineering Group , University of Valladolid , Valladolid , Spain
| | | | | | - Roberto Hornero
- b Biomedical Engineering Group , University of Valladolid , Valladolid , Spain
| | - Daniel Álvarez
- a Pneumology Service , Río Hortega University Hospital , Valladolid , Spain.,b Biomedical Engineering Group , University of Valladolid , Valladolid , Spain
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12
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Bianchi MT. Sleep devices: wearables and nearables, informational and interventional, consumer and clinical. Metabolism 2018; 84:99-108. [PMID: 29080814 DOI: 10.1016/j.metabol.2017.10.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 12/16/2022]
Abstract
The field of sleep is in many ways ideally positioned to take full advantage of advancements in technology and analytics that is fueling the mobile health movement. Combining hardware and software advances with increasingly available big datasets that contain scored data obtained under gold standard sleep laboratory conditions completes the trifecta of this perfect storm. This review highlights recent developments in consumer and clinical devices for sleep, emphasizing the need for validation at multiple levels, with the ultimate goal of using personalized data and advanced algorithms to provide actionable information that will improve sleep health.
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Affiliation(s)
- Matt T Bianchi
- Neurology Department, Massachusetts General Hospital, Wang 720, Boston, MA 02114, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, United States.
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13
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Hornero R, Kheirandish-Gozal L, Gutiérrez-Tobal GC, Philby MF, Alonso-Álvarez ML, Álvarez D, Dayyat EA, Xu Z, Huang YS, Tamae Kakazu M, Li AM, Van Eyck A, Brockmann PE, Ehsan Z, Simakajornboon N, Kaditis AG, Vaquerizo-Villar F, Crespo Sedano A, Sans Capdevila O, von Lukowicz M, Terán-Santos J, Del Campo F, Poets CF, Ferreira R, Bertran K, Zhang Y, Schuen J, Verhulst S, Gozal D. Nocturnal Oximetry-based Evaluation of Habitually Snoring Children. Am J Respir Crit Care Med 2017; 196:1591-1598. [PMID: 28759260 DOI: 10.1164/rccm.201705-0930oc] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE The vast majority of children around the world undergoing adenotonsillectomy for obstructive sleep apnea-hypopnea syndrome (OSA) are not objectively diagnosed by nocturnal polysomnography because of access availability and cost issues. Automated analysis of nocturnal oximetry (nSpO2), which is readily and globally available, could potentially provide a reliable and convenient diagnostic approach for pediatric OSA. METHODS Deidentified nSpO2 recordings from a total of 4,191 children originating from 13 pediatric sleep laboratories around the world were prospectively evaluated after developing and validating an automated neural network algorithm using an initial set of single-channel nSpO2 recordings from 589 patients referred for suspected OSA. MEASUREMENTS AND MAIN RESULTS The automatically estimated apnea-hypopnea index (AHI) showed high agreement with AHI from conventional polysomnography (intraclass correlation coefficient, 0.785) when tested in 3,602 additional subjects. Further assessment on the widely used AHI cutoff points of 1, 5, and 10 events/h revealed an incremental diagnostic ability (75.2, 81.7, and 90.2% accuracy; 0.788, 0.854, and 0.913 area under the receiver operating characteristic curve, respectively). CONCLUSIONS Neural network-based automated analyses of nSpO2 recordings provide accurate identification of OSA severity among habitually snoring children with a high pretest probability of OSA. Thus, nocturnal oximetry may enable a simple and effective diagnostic alternative to nocturnal polysomnography, leading to more timely interventions and potentially improved outcomes.
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Affiliation(s)
- Roberto Hornero
- 1 Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
| | - Leila Kheirandish-Gozal
- 2 Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois
| | | | - Mona F Philby
- 2 Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - María Luz Alonso-Álvarez
- 3 Unidad Multidisciplinar del Sueño, Centro de Investigación Biomédica en Red Respiratorio, Hospital Universitario de Burgos, Burgos, Spain
| | - Daniel Álvarez
- 1 Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,4 Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain
| | - Ehab A Dayyat
- 5 Division of Child Neurology, Department of Pediatrics, LeBonheur Children's Hospital, University of Tennessee Health Science Center, School of Medicine, Memphis, Tennessee
| | - Zhifei Xu
- 6 Sleep Unit, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yu-Shu Huang
- 7 Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | | | - Albert M Li
- 9 Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Annelies Van Eyck
- 10 Laboratory of Experimental Medicine and Pediatrics and.,11 Department of Pediatrics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Pablo E Brockmann
- 12 Sleep Medicine Center, Department of Pediatric Cardiology and Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Zarmina Ehsan
- 13 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Narong Simakajornboon
- 13 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Athanasios G Kaditis
- 14 Pediatric Pulmonology Unit, Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Andrea Crespo Sedano
- 4 Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain
| | - Oscar Sans Capdevila
- 15 Sleep Unit, Department of Neurology, Sant Joan de Deu, Barcelona Children's Hospital, Barcelona, Spain
| | - Magnus von Lukowicz
- 16 Department of Neonatology and Sleep Unit, University of Tubingen, Tubingen, Germany; and
| | - Joaquín Terán-Santos
- 3 Unidad Multidisciplinar del Sueño, Centro de Investigación Biomédica en Red Respiratorio, Hospital Universitario de Burgos, Burgos, Spain
| | - Félix Del Campo
- 1 Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,4 Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain
| | - Christian F Poets
- 16 Department of Neonatology and Sleep Unit, University of Tubingen, Tubingen, Germany; and
| | - Rosario Ferreira
- 17 Pediatric Respiratory Unit, Department of Pediatrics, Hospital de Santa Maria, Academic Medical Center of Lisbon, Lisbon, Portugal
| | - Katalina Bertran
- 15 Sleep Unit, Department of Neurology, Sant Joan de Deu, Barcelona Children's Hospital, Barcelona, Spain
| | - Yamei Zhang
- 6 Sleep Unit, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - John Schuen
- 8 Spectrum Health, Michigan State University, Grand Rapids, Michigan
| | - Stijn Verhulst
- 10 Laboratory of Experimental Medicine and Pediatrics and.,11 Department of Pediatrics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - David Gozal
- 2 Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois
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14
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The watch-pat in pediatrics sleep disordered breathing: Pilot study on children with negative nocturnal pulse oximetry. Int J Pediatr Otorhinolaryngol 2017; 97:245-250. [PMID: 28483245 DOI: 10.1016/j.ijporl.2017.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The main purpose of this study was to determine the efficacy of Watch-PAT in Pediatric Sleep Disordered Breathing (PSDB) diagnosis in children with symptoms suggestive of PSDB, in which the nocturnal pulse oximetry was negative according to the Brouilette criteria. METHODS We enrolled 28 patients aged between 5 and 12 years (mean age: 7.75 ± 1.69), who underwent the registration with Watch-PAT, that utilizes the Peripheral Arterial Tone (PAT), AHI, RDI, body position, snoring, pulse oximetry and actigraphy. RESULTS Recording Watch-PAT was indicative of PSDB in 10/28 (35.7%) patients; when it was placed the threshold of AHI > 1 the number of positive patients for PSDB increased to 17/28 (60.7%). Exists a positive correlation between pat-RDI (rho = 0.798, p = 0.005) and the snoring > 40% of the time (rho = 0.656, p < 0.001) were correlated with the pat-AHI values. CONCLUSION The recording Watch-PAT appears to permit the defection of a certain number of SDB that might escape to the clinical evaluation and pulse oximetry only.
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15
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Álvarez D, Alonso-Álvarez ML, Gutiérrez-Tobal GC, Crespo A, Kheirandish-Gozal L, Hornero R, Gozal D, Terán-Santos J, Del Campo F. Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings. J Clin Sleep Med 2017; 13:693-702. [PMID: 28356177 DOI: 10.5664/jcsm.6586] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/09/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Nocturnal oximetry has become known as a simple, readily available, and potentially useful diagnostic tool of childhood obstructive sleep apnea (OSA). However, at-home respiratory polygraphy (HRP) remains the preferred alternative to polysomnography (PSG) in unattended settings. The aim of this study was twofold: (1) to design and assess a novel methodology for pediatric OSA screening based on automated analysis of at-home oxyhemoglobin saturation (SpO2), and (2) to compare its diagnostic performance with HRP. METHODS SpO2 recordings were parameterized by means of time, frequency, and conventional oximetric measures. Logistic regression models were optimized using genetic algorithms (GAs) for three cutoffs for OSA: 1, 3, and 5 events/h. The diagnostic performance of logistic regression models, manual obstructive apnea-hypopnea index (OAHI) from HRP, and the conventional oxygen desaturation index ≥ 3% (ODI3) were assessed. RESULTS For a cutoff of 1 event/h, the optimal logistic regression model significantly outperformed both conventional HRP-derived ODI3 and OAHI: 85.5% accuracy (HRP 74.6%; ODI3 65.9%) and 0.97 area under the receiver operating characteristics curve (AUC) (HRP 0.78; ODI3 0.75) were reached. For a cutoff of 3 events/h, the logistic regression model achieved 83.4% accuracy (HRP 85.0%; ODI3 74.5%) and 0.96 AUC (HRP 0.93; ODI3 0.85) whereas using a cutoff of 5 events/h, oximetry reached 82.8% accuracy (HRP 85.1%; ODI3 76.7) and 0.97 AUC (HRP 0.95; ODI3 0.84). CONCLUSIONS Automated analysis of at-home SpO2 recordings provide accurate detection of children with high pretest probability of OSA. Thus, unsupervised nocturnal oximetry may enable a simple and effective alternative to HRP and PSG in unattended settings.
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Affiliation(s)
- Daniel Álvarez
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
| | - María L Alonso-Álvarez
- Unidad Multidisciplinar de Sueño, CIBER Respiratorio, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Andrea Crespo
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
| | - Leila Kheirandish-Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
| | - David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Joaquín Terán-Santos
- Unidad Multidisciplinar de Sueño, CIBER Respiratorio, Hospital Universitario de Burgos, Burgos, Spain
| | - Félix Del Campo
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
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16
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Ng Y, Joosten SA, Edwards BA, Turton A, Romios H, Samarasinghe T, Landry S, Mansfield DR, Hamilton GS. Oxygen Desaturation Index Differs Significantly Between Types of Sleep Software. J Clin Sleep Med 2017; 13:599-605. [PMID: 28212692 DOI: 10.5664/jcsm.6552] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/19/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to compare the oxygen desaturation index (ODI) generated by two different sleep software systems. METHODS Participants undergoing diagnostic polysomnography for suspected obstructive sleep apnea underwent simultaneous oximetry recording using the ResMed ApneaLink Plus device (AL) and Compumedics Profusion PSG3 system (Comp). The ODI was calculated by the algorithms in the respective software of each system. To determine if differences were due to algorithm or recording devices, the Comp software was also used to generate ODI values using oximetry data from the AL. RESULTS In 106 participants, there was good correlation but poor agreement in the ODI generated by the two systems. AL ODI values tended to be higher than Comp ODI values, but with significant variability. For ODI4%, bias was 4.4 events/h (95% limits of agreement -5.8 to 14.6 events/h). There was excellent correlation and agreement when the same oximetry raw data was analyzed by both systems. For ODI4%, bias was 0.03 events/h (95% limits of agreement -2.7 to 2.8 events/h). Similar results were evident when the ODI3% was used. CONCLUSIONS There is a clinically significant difference in ODI values generated by the two systems, likely due to device signal processing, rather than difference in ODI calculation algorithms.
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Affiliation(s)
- Yvonne Ng
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia
| | - Simon A Joosten
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,School of Clinical Sciences, Monash University, Victoria, Australia.,Monash Partners, Epworth, Victoria, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Anthony Turton
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia
| | - Helen Romios
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia
| | - Thilini Samarasinghe
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,Hudson Institute of Medical Research, Victoria, Australia
| | - Shane Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Darren R Mansfield
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,Monash Partners, Epworth, Victoria, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Garun S Hamilton
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,School of Clinical Sciences, Monash University, Victoria, Australia.,Monash Partners, Epworth, Victoria, Australia
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17
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Suliman LA, Shalabi NM, Elmorsy SA, Moawad MMK. Effectiveness of nocturnal oximetry in predicting obstructive sleep apnea hypopnea syndrome: value of nocturnal oximetry in prediction of obstructive sleep apnea hypopnea syndrome. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.193647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Arnardottir ES, Bjornsdottir E, Olafsdottir KA, Benediktsdottir B, Gislason T. Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms. Eur Respir J 2015; 47:194-202. [PMID: 26541533 DOI: 10.1183/13993003.01148-2015] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/25/2015] [Indexed: 11/05/2022]
Abstract
The aim was to assess the prevalence of obstructive sleep apnoea (OSA) as defined by an apnoea-hypopnea index (AHI) ≥15 in the middle-aged general population, and the interrelationship between OSA, sleep-related symptoms, sleepiness and vigilance.A general population sample of 40-65-year-old Icelanders was invited to participate in a study protocol that included a type 3 sleep study, questionnaire and a psychomotor vigilance test (PVT).Among the 415 subjects included in the study, 56.9% had no OSA (AHI <5), 24.1% had mild OSA (AHI 5-14.9), 12.5% had moderate OSA (AHI 15-29.9), 2.9% had severe OSA (AHI ≥30) and 3.6% were already diagnosed and receiving OSA treatment. However, no significant relationship was found between AHI and subjective sleepiness or clinical symptoms. A relationship with objective vigilance assessed by PVT was only found for those with AHI ≥30. Subjects already on OSA treatment and those accepting OSA treatment after participating in the study were more symptomatic and sleepier than others with similar OSA severity, as assessed by the AHI.In a middle-aged general population, approximately one in five subjects had moderate-to-severe OSA, but the majority of them were neither symptomatic nor sleepy and did not have impaired vigilance.
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Affiliation(s)
- Erna S Arnardottir
- Dept of Respiratory Medicine and Sleep, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Erla Bjornsdottir
- Dept of Respiratory Medicine and Sleep, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
| | - Kristin A Olafsdottir
- Dept of Respiratory Medicine and Sleep, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
| | - Bryndis Benediktsdottir
- Dept of Respiratory Medicine and Sleep, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Dept of Respiratory Medicine and Sleep, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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19
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Riha RL. Diagnostic approaches to respiratory sleep disorders. J Thorac Dis 2015; 7:1373-84. [PMID: 26380763 DOI: 10.3978/j.issn.2072-1439.2015.08.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/13/2015] [Indexed: 12/18/2022]
Abstract
Sleep disordered breathing (SDB) comprises a number of breathing disturbances occurring during sleep including snoring, the obstructive sleep apnoea/hypopnea syndrome (OSAHS), central sleep apnoea (CSA) and hypoventilation syndromes. This review focuses on sleep disordered breathing and diagnostic approaches in adults, in particular clinical assessment and overnight assessment during sleep. Although diagnostic approaches to respiratory sleep disorders are reasonably straightforward, they do require a degree of clinical acumen when it comes to assessing severity and management options. Diagnosing respiratory sleep disorders on clinical features alone has limitations. Monitoring and measuring respiration during sleep has undergone many advances in the last 40 years in respect of quality and validity, largely regarding OSAHS. Despite the improvement in our diagnostic standards and recognition of sleep disordered breathing, many limitations still need to be overcome. Apart from assessing the individual patient, population screening for sleep disorders continues to preoccupy health professionals and policy makers in many countries. Research in the field is pushing current boundaries in terms of simplifying diagnosis and enhancing screening for sleep disordered breathing in large populations. At present, a number of these newer approaches require further validation.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, Scotland, UK
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20
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Arnardottir ES, Verbraecken J, Gonçalves M, Gjerstad MD, Grote L, Puertas FJ, Mihaicuta S, McNicholas WT, Parrino L. Variability in recording and scoring of respiratory events during sleep in Europe: a need for uniform standards. J Sleep Res 2015; 25:144-57. [DOI: 10.1111/jsr.12353] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/24/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Erna S. Arnardottir
- Department of Respiratory Medicine and Sleep; Landspitali-The National University Hospital of Iceland; Reykjavik Iceland
- Faculty of Medicine; University of Iceland; Reykjavik Iceland
| | - Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre; Antwerp University Hospital and University of Antwerp; Antwerp Belgium
| | - Marta Gonçalves
- Centro de Medicina do Sono; Hospital Cuf Porto; Porto Portugal
| | - Michaela D. Gjerstad
- Competence Center for Sleep Disorders; Haukeland University Hospital; Bergen Norway
- Department of Neurology; Stavanger University Hospital; Stavanger Norway
| | - Ludger Grote
- Sleep Disorders Center; Sahlgrenska University Hospital; Gothenburg Sweden
- Center for Sleep and Wakefulness Disorders; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Francisco Javier Puertas
- Sleep Unit; Neurophysiology Department; La Ribera University Hospital; Valencia Spain
- Physiology Department; University of Valencia; Valencia Spain
| | - Stefan Mihaicuta
- Pulmonology Department; University of Medicine and Pharmacy ‘Victor Babes’; Sleep Medicine Laboratory; Cardioprevent Foundation; Timisoara Romania
| | - Walter T. McNicholas
- Department of Respiratory and Sleep Medicine; University College Dublin; St Vincent's University Hospital; Dublin Ireland
- On behalf of the European Sleep Research Society (ESRS); Regensburg Germany
| | - Liborio Parrino
- Department of Neurosciences; Sleep Disorders Center; University of Parma; Parma Italy
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21
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Dawson A, Loving RT, Gordon RM, Abel SL, Loewy D, Kripke DF, Kline LE. Type III home sleep testing versus pulse oximetry: is the respiratory disturbance index better than the oxygen desaturation index to predict the apnoea-hypopnoea index measured during laboratory polysomnography? BMJ Open 2015; 5:e007956. [PMID: 26129636 PMCID: PMC4486950 DOI: 10.1136/bmjopen-2015-007956] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In its guidelines on the use of portable monitors to diagnose obstructive sleep apnoea, the American Academy of Sleep Medicine endorses home polygraphy with type III devices recording at a minimum airflow the respiratory effort and pulse oximetry, but advises against simple pulse oximetry. However, oximetry is widely available and simple to use in the home. This study was designed to compare the ability of the oxygen desaturation index (ODI) based on oximetry alone with a stand-alone pulse oximeter (SPO) and from the oximetry channel of the ApneaLink Plus (ALP), with the respiratory disturbance index (RDI) based on four channels from the ALP to predict the apnoea-hypopnoea index (AHI) from laboratory polysomnography. DESIGN Cross-sectional diagnostic accuracy study. SETTING Sleep medicine practice of a multispecialty clinic. PARTICIPANTS Patients referred for laboratory polysomnography with suspected sleep apnoea. We enrolled 135 participants with 123 attempting the home sleep testing and 73 having at least 4 hours of satisfactory data from SPO and ALP. INTERVENTIONS Participants had home testing performed simultaneously with both a SPO and an ALP. The 2 oximeter probes were worn on different fingers of the same hand. The ODI for the SPO was calculated using Profox software (ODI(SOX)). For the ALP, RDI and ODI were calculated using both technician scoring (RDI(MAN) and ODI(MAN)) and the ALP computer scoring (RDI(RAW) and ODI(RAW)). RESULTS The receiver-operator characteristic areas under the curve for AHI ≥ 5 were RDI(MAN) 0.88 (95% confidence limits 0.81-0.96), RDI(RAW) 0.86 (0.76-0.94), ODI(MAN) 0.86 (0.77-0.95), ODI(RAW) 0.84 (0.75-0.93) and ODI(SOX) 0.83 (0.73-0.93). CONCLUSIONS We conclude that the RDI and the ODI, measured at home on the same night, give similar predictions of the laboratory AHI, measured on a different night. The differences between the two methods are small compared with the reported night-to-night variation of the AHI.
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Affiliation(s)
- Arthur Dawson
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Richard T Loving
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Robert M Gordon
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Susan L Abel
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Derek Loewy
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Daniel F Kripke
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Lawrence E Kline
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
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22
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Use of oximetry as a screening tool for obstructive sleep apnea: a case study in Taiwan. J Med Syst 2015; 39:29. [PMID: 25677955 DOI: 10.1007/s10916-015-0195-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 01/13/2015] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is a relatively common disease in the general population. Patients with OSA have a high risk of various comorbid medical diseases. Polysomnography (PSG) is the current gold standard for diagnosing OSA but is time consuming and expensive. This study aims to identify a sensitive screening parameter that can be used by clinicians to determine the time of referral for PSG examination in Taiwan. Eighty-seven patients, including 67 males and 20 females, were included in this study. We divided the patients into two groups: training data (n = 58) and testing group (n = 29). Pearson χ(2) test was used to perform bivariate analysis, and a decision tree was used to build a model. The decision model selected the frequency of desaturation > 4% per hour (DI4) as the indicator of OSA influence. The testing data accuracy of the C4.5 decision tree was 82.80%. External data were also used to validate the model reliability. The accuracy of the external data was 95.96%. Approximately one-third of patients with DI4 between 11 and 33 suffered from OSA. This population requires further diagnosis. Oximetry is an important and widely available screening method in Taiwan. This study proposes the need for PSG referral if DI4 is between 11 and 33.
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Manin G, Pons A, Baltzinger P, Moreau F, Iamandi C, Wilhelm JM, Lenoble P, Kessler L, Kessler R. Obstructive sleep apnoea in people with Type 1 diabetes: prevalence and association with micro- and macrovascular complications. Diabet Med 2015; 32:90-6. [PMID: 25186832 DOI: 10.1111/dme.12582] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/11/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Abstract
AIMS Few reports have assessed the relationship between Type 1 diabetes and sleep disorders. The purposes of our study were to determine the prevalence of obstructive sleep apnoea in Type 1 diabetes and to compare the clinical profile of people with Type 1 diabetes with or without obstructive sleep apnoea. METHODS In this cross sectional study of 67 consecutive people with Type 1 diabetes, we performed polysomnography as part of their yearly check-ups. RESULTS In our cohort, with a mean BMI of 25.8 ± 4.7 kg/m(2), the prevalence of obstructive sleep apnoea [apnoea-hypopnoea index (AHI) > 10/h] was 46%. Severe obstructive sleep apnoea (AHI ≥ 30/h) was present in 19% of the patients. We found no significant differences in age, sex, body mass index, HbA1c or Epworth sleepiness scale score between people with or without obstructive sleep apnoea. People with obstructive sleep apnoea had a longer course of diabetes mellitus (P < 0.01) and a higher prevalence of retinopathy (P < 0.01), neuropathy (P = 0.05), cardiovascular disease (P < 0.01) and hypertension (P < 0.01). The occurrence of macrovascular complications was independently associated with the presence of OSA [odds ratio (OR) 8.28; 95% confidence interval (CI), 1.56-43.97; P = 0.013] and the duration of diabetes (OR 1.08; 95% CI, 1.02-1.15; P = 0.01). Moreover, retinopathy was independently associated with OSA (OR 4.54; 95% CI, 1.09-18.82; P = 0.04) and the duration of diabetes (OR 1.09; 95% CI, 1.04-1.15; P = 0.001). CONCLUSIONS The prevalence of obstructive sleep apnoea was high in people with Type 1 diabetes. Obstructive sleep apnoea was independently associated with macrovascular complications and retinopathy. Obesity and excessive daytime sleepiness were uncommon in this population.
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Affiliation(s)
- G Manin
- Department of Pneumology, Hôpitaux universitaires de Strasbourg, Strasbourg, France
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Abstract
The rapid expansion of consumer sleep devices is outpacing the validation data necessary to assess the potential use of these devices in clinical and research settings. Common sleep monitoring devices utilize a variety of sensors to track movement as well as cardiac and respiratory physiology. The variety of sensors and user-specific factors offer the potential, at least theoretically, for clinically relevant information. We describe the current challenges for interpretation of consumer sleep monitoring data, since the devices are mainly used in non-medical contexts (consumer use) although medically-definable sleep disorders may commonly occur in this setting. A framework for addressing questions of how certain devices might be useful is offered. We suggest that multistage validation efforts are crucially needed, from the level of sensor data and algorithm output, to extrapolations beyond healthy adults and into other populations and real-world environments.
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Affiliation(s)
- Kathryn Russo
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Balaji Goparaju
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Matt T Bianchi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA ; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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Schlotthauer G, Di Persia LE, Larrateguy LD, Milone DH. Screening of obstructive sleep apnea with empirical mode decomposition of pulse oximetry. Med Eng Phys 2014; 36:1074-80. [PMID: 24931493 DOI: 10.1016/j.medengphy.2014.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/25/2014] [Accepted: 05/11/2014] [Indexed: 10/25/2022]
Abstract
Detection of desaturations on the pulse oximetry signal is of great importance for the diagnosis of sleep apneas. Using the counting of desaturations, an index can be built to help in the diagnosis of severe cases of obstructive sleep apnea-hypopnea syndrome. It is important to have automatic detection methods that allows the screening for this syndrome, reducing the need of the expensive polysomnography based studies. In this paper a novel recognition method based on the empirical mode decomposition of the pulse oximetry signal is proposed. The desaturations produce a very specific wave pattern that is extracted in the modes of the decomposition. Using this information, a detector based on properly selected thresholds and a set of simple rules is built. The oxygen desaturation index constructed from these detections produces a detector for obstructive sleep apnea-hypopnea syndrome with high sensitivity (0.838) and specificity (0.855) and yields better results than standard desaturation detection approaches.
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Affiliation(s)
- Gastón Schlotthauer
- Lab. of Signals and Nonlinear Dynamics, Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina.
| | - Leandro E Di Persia
- Research Center for Signals, Systems and Computational Intelligence (sinc(i)), Facultad de Ingeniería y Ciencias Hídricas, Universidad Nacional del Litoral, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
| | | | - Diego H Milone
- Research Center for Signals, Systems and Computational Intelligence (sinc(i)), Facultad de Ingeniería y Ciencias Hídricas, Universidad Nacional del Litoral, Argentina; National Council of Scientific and Technical Research (CONICET), Argentina
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Bianchi MT, Lipoma T, Darling C, Alameddine Y, Westover MB. Automated sleep apnea quantification based on respiratory movement. Int J Med Sci 2014; 11:796-802. [PMID: 24936142 PMCID: PMC4057486 DOI: 10.7150/ijms.9303] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 05/23/2014] [Indexed: 11/26/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent and treatable disorder of neurological and medical importance that is traditionally diagnosed through multi-channel laboratory polysomnography(PSG). However, OSA testing is increasingly performed with portable home devices using limited physiological channels. We tested the hypothesis that single channel respiratory effort alone could support automated quantification of apnea and hypopnea events. We developed a respiratory event detection algorithm applied to thoracic strain-belt data from patients with variable degrees of sleep apnea. We optimized parameters on a training set (n=57) and then tested performance on a validation set (n=59). The optimized algorithm correlated significantly with manual scoring in the validation set (R2=0.73 for training set, R2=0.55 for validation set; p<0.05). For dichotomous classification, the AUC was >0.92 and >0.85 using apnea-hypopnea index cutoff values of 5 and 15, respectively. Our findings demonstrate that manually scored AHI values can be approximated from thoracic movements alone. This finding has potential applications for automating laboratory PSG analysis as well as improving the performance of limited channel home monitors.
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Affiliation(s)
- M T Bianchi
- 1. Neurology Department, Sleep Division, Massachusetts General Hospital, Boston MA, USA ; 2. Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - T Lipoma
- 3. Rest Devices, Boston, MA, USA
| | | | - Y Alameddine
- 1. Neurology Department, Sleep Division, Massachusetts General Hospital, Boston MA, USA
| | - M B Westover
- 1. Neurology Department, Sleep Division, Massachusetts General Hospital, Boston MA, USA
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Morillo DS, Gross N, León A, Crespo LF. Automated frequency domain analysis of oxygen saturation as a screening tool for SAHS. Med Eng Phys 2011; 34:946-53. [PMID: 22137675 DOI: 10.1016/j.medengphy.2011.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 10/28/2011] [Accepted: 10/28/2011] [Indexed: 11/28/2022]
Abstract
Sleep apnea-hypopnea syndrome (SAHS) is significantly underdiagnosed and new screening systems are needed. The analysis of oxygen desaturation has been proposed as a screening method. However, when oxygen saturation (SpO(2)) is used as a standalone single channel device, algorithms working in time domain achieve either a high sensitivity or a high specificity, but not usually both. This limitation arises from the dependence of time-domain analysis on absolute SpO(2) values and the lack of standardized thresholds defined as pathological. The aim of this study is to assess the degree of concordance between SAHS screening using offline frequency domain processing of SpO(2) signals and the apnea-hypopnea index (AHI), and the diagnostic performance of such a new method. SpO(2) signals from 115 subjects were analyzed. Data were divided in a training data set (37) and a test set (78). Power spectral density was calculated and related to the desaturation index scored by physicians. A frequency desaturation index (FDI) was then estimated and its accuracy compared to the classical desaturation index and to the apnea-hypopnea index. The findings point to a high diagnostic agreement: the best sensitivity and specificity values obtained were 83.33% and 80.44%, respectively. Moreover, the proposed method does not rely on absolute SpO(2) values and is highly robust to artifacts.
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Affiliation(s)
- Daniel Sánchez Morillo
- Universidad de Cádiz-Escuela Superior de Ingeniería, Dpto. de Ingeniería de Sistemas y Automática, C/Chile s/n, CP 11002 Cádiz, Spain.
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Panaree B, Chantana M, Wasana S, Chairat N. Effects of obstructive sleep apnea on serum brain-derived neurotrophic factor protein, cortisol, and lipid levels. Sleep Breath 2010; 15:649-56. [PMID: 20865453 DOI: 10.1007/s11325-010-0415-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 07/31/2010] [Accepted: 09/06/2010] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is a sleep-disordered breathing leading to vascular endothelial cells dysfunction, cognitive impairment, and abnormal lipid metabolism. serum brain-derived neurotrophic factor (BDNF) protein, cortisol, and lipid levels in OSA were investigated. MATERIALS AND METHODS All middle-aged subjects including healthy individuals without signs and symptoms of apnea-hypopnea and ear nose throat (ENT) outpatients were randomly recruited and screened by overnight polysomnogram (PSG). Apnea-hypopnea index (AHI) was used as a criteria to determine subjects to enroll in this program. According to AHI, they were separated into control and OSA groups. A group of 39 OSA patients (AHI ≥ 10 events/h) and 24 control subjects (AHI < 5 events/h) were selected. Serum BDNF protein was analyzed by enzyme-linked immunosorbent assay (ELISA) from venous blood collection at 8:00 a.m. following PSG. Serum cortisol was assayed by enzyme-chemiluminescense immuno assay (ECLIA). Serum lipid profile levels were determined by enzymatic colorimetric and homogeneous method. RESULTS Characteristics of OSA patients and control groups including gender, age, AHI, body weight, height, and BMI showed significant differences. Serum BDNF protein, cortisol, triglyceride, and total cholesterol levels in OSA and control groups were not significantly different. High density lipoprotein-cholesterol (HDL-c) in OSA was significantly lower than that of control (p = 0.008) while low density lipoprotein-cholesterol (LDL-c) was significantly higher than that of control (p = 0.04). CONCLUSIONS OSA had no significant effect on serum BDNF, cortisol, triglyceride, or total cholesterol levels while LDL-c and HDL-c levels in OSA patients compared to control were significantly different at p = 0.04, and p = 0.008, respectively.
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Affiliation(s)
- Busarakumtragul Panaree
- Department of Physiology, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand.
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