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Clements F, Makris A, Chung Y, Poh J, Marshall NS, Melehan K, Shanmugalingam R, Hennessy A, Vedam H. Validation of self-applied unattended polysomnography using Somte V2 PSG (Somte) for diagnosis of obstructive sleep apnoea (OSA) in pregnant women in early to mid-gestation. Sleep Breath 2024; 28:1575-1587. [PMID: 38662312 PMCID: PMC11303494 DOI: 10.1007/s11325-024-03025-0] [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: 02/12/2024] [Revised: 03/07/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Polysomnography (PSG) may be completed in the home environment (unattended), and when self-applied, allow the collection of data with minimal healthcare worker intervention. Self-applied, unattended PSG in the home environment using Somte PSG V2 (Somte) has not been validated in pregnant women in early to mid-gestation. We undertook a study to evaluate the accuracy of Somte compared to attended PSG. The agreement between apnoea hypopnea index (AHI) and respiratory disturbance index (RDI) scores in Somte and PSG in early to mid-gestation were assessed. METHODS Pregnant women (≤ 24 weeks gestation) were scheduled for PSG and Somte within a 7-day window, in any order. Somte were self-applied and completed in the home. Somte were scored blinded to PSG result. AHI was the primary outcome of interest, though an AHI ≥ 5 or RDI ≥ 5 on PSG was considered diagnostic of Obstructive Sleep Apnoea (OSA). AHI, RDI, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) was calculated and receiver operating characteristic (ROC) curves were produced. Bland-Altman plots were used to determine agreement. Technical issues occurring during tests were explored. RESULTS Twenty-four participants successfully completed both tests between March 2021 and January 2023. PSG were completed at around 14.1 weeks' gestation (IQR 13.4, 15.7). The time interval between Somte and PSG was a median of 4 days (IQR 2, 7 (range 1-12)). Five (20.8%) women had OSA on PSG at AHI ≥ 5 and 10 (41.6%) women had OSA on PSG at RDI ≥ 5. Somte and PSG did not differ in the measurement of AHI ((1.8, 1.6, p = 0.09) or RDI (3.3, 3.5), p = 0.73). At AHI ≥ 5, diagnostic test accuracy (area under the ROC curve) of Somte was 0.94, sensitivity 80.0%, specificity 94.7%, PPV and NPV were 80.0% and 94.7% respectively. At RDI ≥ 5, diagnostic test accuracy (area under the ROC curve) was 0.95, sensitivity 60.0%, specificity 93.0% and PPV and NPV were 85.7% and 76.4% respectively. The confidence limits of Bland-Altman plots were 6.37 to - 8.89 at cut off AHI ≥ 5 and 8.89 to - 10.43 at cut off RDI ≥ 5. Somte failed to start in four tests. Technical issues were reported in both Somte (n = 13, 54.2%) and PSG (n = 6, 25.0%). CONCLUSION Self-applied, unattended Somte may provide an acceptable substitute to attended PSG in the identification of OSA in pregnant women in early to mid-gestation in this small sample but may fail to detect cases of OSA, particularly when using RDI as the diagnostic marker.
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Affiliation(s)
- Frances Clements
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.
| | - Angela Makris
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Yewon Chung
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jonathon Poh
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Nathaniel S Marshall
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Macquarie University, Sydney, New South Wales, Australia
- Department of Health Sciences, Macquarie University, Sydney, Australia
| | - Kerri Melehan
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Renuka Shanmugalingam
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Annemarie Hennessy
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Hima Vedam
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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Farid S, Giunio-Zorkin M, Schust DJ, Cortese R. Obstructive sleep apnea in pregnancy: A review of the literature from the obstetrics practitioner's view and a proposed clinical approach. Eur J Obstet Gynecol Reprod Biol 2024; 300:29-34. [PMID: 38981308 DOI: 10.1016/j.ejogrb.2024.06.046] [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: 05/22/2024] [Accepted: 06/30/2024] [Indexed: 07/11/2024]
Abstract
Obstructive sleep apnea (OSA) is a frequent condition during pregnancy and its occurrence is increased in obese women. There are growing concerns about both pre-existing OSA and the development of gestational OSA and their effect on maternal pregnancy outcomes, fetal development, and even early childhood. A strong body of research has revealed maternal complications of OSA, but far fewer studies explore its impact on the developing fetus, highlighting an important area of future research. As evidence in both areas mounts about the negative reproductive impact of OSA, studies have emerged that explore the limitations of current diagnostic criteria and screening tools for this disorder in pregnancy which, in turn, limit the practitioner's ability to appropriately refer patients for OSA diagnosis and treatment. This expert review summarizes the current data regarding OSA screening tools in pregnancy, the limitations of these tools, and available OSA treatments and their efficacies. Our objective is to develop recommendations for how to best screen and manage OSA in pregnancy. We conclude that improved understanding of available tools and treatments will allow the obstetric practitioner to better counsel patients and help mitigate the deleterious effects of OSA on mother and fetus. We herein propose a clinical approach for the screening and management of OSA in pregnancy.
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Affiliation(s)
- Sophie Farid
- Department of Gynecology, Obstetrics and Women's Health, University of Missouri, Columbia, MO 65212, USA
| | - Mackenzie Giunio-Zorkin
- Department of Gynecology, Obstetrics and Women's Health, University of Missouri, Columbia, MO 65212, USA
| | - Danny J Schust
- Department of Gynecology, Obstetrics and Women's Health, University of Missouri, Columbia, MO 65212, USA; Department of Gynecology and Obstetrics, Duke University, Durham, NC 27708, USA
| | - Rene Cortese
- Department of Gynecology, Obstetrics and Women's Health, University of Missouri, Columbia, MO 65212, USA.
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Clements F, Makris A, Chung Y, Marshall NS, Melehan K, Shanmugalingam R, Hennessy A, Vedam H. Validation of the Apnealink Air for diagnosis of obstructive sleep apnoea (OSA) in pregnant women in early-mid gestation. Sleep Breath 2024; 28:1207-1216. [PMID: 38294625 DOI: 10.1007/s11325-023-02975-1] [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: 11/15/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE The detection of obstructive sleep apnoea (OSA) in pregnant women in early-mid gestation is logistically difficult. Accurate alternates to polysomnography (PSG) in early pregnancy are not well identified. We compared the agreement between Apnealink Air (AL) and existing screening questionnaires to PSG in pregnant women ≤ 24-week gestation. METHODS Pregnant women (≤ 24-week gestation) underwent AL at home plus attended PSG in any order, completed within 7 days where practicable. AL was manually scored (AL(M)) and automatically scored (AL(A)). An apnoea-hypopnea index (AHI) ≥ 5 was considered diagnostic of OSA and an AHI ≥ 15 considered at least moderate OSA. Diagnostic analysis was undertaken (sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)) by generating receiver operating characteristic (ROC) curves and an area under the curve (AUC) (95% CI). Bland-Altman plots were used to plot agreement. Screening questionnaires (Epworth sleepiness score (ESS), STOP-BANG, calculated pregnancy-specific screening tool) were compared to PSG. RESULTS A total of 49 participants successfully completed both tests at around 14-weeks gestation (IQR 12.9, 17.1). The time interval between AL and PSG was a median of 2 days (IQR 1, 5 (range 1-11)). A total of 14 (29%) participants had OSA. The median AHI of AL(A) (3.1(IQR 0.85,4.6)) and AL(M) (IQR2.4(0.65,4.8)) did not differ from PSG (1.7(IQR1.0,6.1)). AL(A) and AL(M) compared to PSG demonstrated diagnostic test accuracy (area under curve (ROC)) of 0.94(95% CI 0.87-1.0) and 0.92(95% CI 0.85-1.0) respectively. Apnealink Air outperformed screening questionnaires tested. CONCLUSION The findings suggest that Apnealink may provide a substitute to attended PSG identification of OSA in pregnant women in early-mid gestation using both manual and auto-scoring methods.
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Affiliation(s)
- Frances Clements
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Angela Makris
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Yewon Chung
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Nathaniel S Marshall
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Macquarie University, Sydney, New South Wales, Australia
- Department of Health Sciences, Macquarie University, Macquarie Park, Australia
| | - Kerri Melehan
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Renuka Shanmugalingam
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Annemarie Hennessy
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Hima Vedam
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Women's Health Initiative Translational Unit, Ingham Institute for Medical Research, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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Xu X, Peng Q, Meng L, Yang H, Wang Y, Luo Y, Dong M, Wang C, Wang M. Quality assessment of clinical practice guidelines for adult obstructive sleep apnea: A systematic review. Sleep Med 2024; 118:16-28. [PMID: 38581804 DOI: 10.1016/j.sleep.2024.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/03/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Clinical Practice Guidelines (CPGs) are crucial in standardizing the management of obstructive sleep apnea (OSA) in adults. However, there has been insufficient evaluation of the overall quality of CPGs for adult OSA. This review aimed to comprehensively assess the overall quality of CPGs in the field of adult OSA. METHODS A systematic search was conducted on various literature databases, guideline-related databases, and academic websites from January 2013 to December 2023 to select CPGs relevant to adult OSA. The methodological and reporting quality of the eligible CPGs were thoroughly appraised by three reviewers using the AGREE II instrument and RIGHT checklist, respectively. RESULTS This review included 44 CPGs, consisting of 42 CPGs in English and 2 CPGs in Chinese. The assessment of methodological quality revealed that four domains attained an average standardized score above 60%. Among the domains, "clarity of presentation" received the highest standardized score of 85.10%, while the lowest standardized score was observed in the "rigor of development" domain with the value of 56.77%. The evaluation of reporting quality indicated an overall reporting rate of 51.30% for the eligible CPGs, with only three domains achieving an average reporting rate higher than 50%. The domain with the highest reporting rate was "basic information" at 60.61%, while the domain with the lowest reporting rate was "review and quality assurance" at 15.91%. Furthermore, a significantly positive correlation was found between the AGREE II standardized scores and the RIGHT reporting rates (r = 0.808, P < 0.001). CONCLUSIONS The overall quality of the currently available guidelines for adult OSA demonstrated considerable variability. Researchers should prioritize the utilization of evidence-based methods and adhere to the items listed in the RIGHT checklist when developing CPGs to enhance efficient clinical decision-making and promote the translation of evidence into practice.
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Affiliation(s)
- Xiaopan Xu
- Department of Respiratory and Critical Care Medicine, Lu'an Hospital of Anhui Medical University, Lu'an, China
| | - Qianqian Peng
- Department of Graduate School, Wannan Medical College, Wuhu, China
| | - Ling Meng
- Department of Nursing, Jining NO.1 People's Hospital, Jining, China
| | - Hualu Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Regions, China; Department of Nursing, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Yingzhen Wang
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Luo
- School of Nursing, Zhuhai Campus of the Zunyi Medical University, Zhuhai, China
| | - Min Dong
- School of Nursing, Zhuhai Campus of the Zunyi Medical University, Zhuhai, China
| | - Changyu Wang
- Department of Respiratory and Critical Care Medicine, Lu'an Hospital of Anhui Medical University, Lu'an, China.
| | - Mian Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Regions, China.
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Panyarath P, Goldscher N, Pamidi S, Daskalopoulou SS, Gagnon R, Dayan N, Raiche K, Olha A, Geater SL, Benedetti A, Kimoff RJ. Positive Airway Pressure Treatment of Obstructive Sleep Apnea-Hypopnea in Hypertensive Disorders of Pregnancy: A Pilot Randomized Proof-of-Concept Clinical Trial. Ann Am Thorac Soc 2024; 21:803-813. [PMID: 38252423 DOI: 10.1513/annalsats.202310-863oc] [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: 10/11/2023] [Accepted: 01/19/2024] [Indexed: 01/23/2024] Open
Abstract
Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). OSAH treatment with positive airway pressure (PAP) in the general population lowers blood pressure (BP). However, there are limited data on the effects of PAP therapy in maternal OSAH. Objectives: Our primary objective was to assess the feasibility of recruitment to a pilot randomized trial and adherence to PAP therapy for OSAH in women with HDP. Secondary objectives included assessment of PAP effects on 24-h BP, arterial stiffness, and maternal and fetal outcomes. Methods: Women with singleton pregnancies at ⩾12 weeks' gestation and hypertension underwent home level 2 polysomnography; those with mild to moderate OSAH (apnea-hypopnea index ⩾ 5 events/h; women with severe OSAH with apnea-hypopnea index > 30 events/h and oxygen desaturation index > 30 were excluded) were randomized to either PAP or nasal dilator strip (NDS; control) therapy. After PAP education, adherence was monitored online with episodic phone or in-person support by research personnel. Twenty-four-hour BP and arterial stiffness were assessed at baseline and before delivery. Maternal and fetal outcomes were also recorded. Results: Of 105 potentially eligible participants, 67 agreed to undergo screening for OSAH over 38 months; 48 women meeting OSAH inclusion criteria were randomized to PAP (n = 27) or NDS (n = 21) therapy. Of these, 14 PAP (52%) and 13 NDS (62%) participants completed all predelivery measurements, with lack of completion due to urgent delivery (19% in the PAP group, 14% in the NDS group), PAP intolerance at initiation (19%), or other factors. Mean PAP use was 3.1 ± 2.5 h/night, with use ⩾4 h/night on 38.4 ± 33.7% of nights during 9.6 ± 4.0 weeks of treatment. BP was controlled within the target range in most participants. There were no differences in mean change in 24-hour BP or arterial stiffness measurements or in adverse maternal and fetal outcomes between the PAP and NDS groups in either intention-to-treat or per-protocol analyses. Conclusions: PAP adherence was suboptimal in this HDP cohort despite education and troubleshooting. Further work is required to identify optimal OSAH treatment strategies during pregnancy. Clinical trial registered with www.clinicaltrials.gov (NCT03309826).
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Affiliation(s)
- Pattaraporn Panyarath
- Respiratory Division and Sleep Laboratory
- Division of Respiratory and Respiratory Critical Care Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; and
| | | | - Sushmita Pamidi
- Respiratory Division and Sleep Laboratory
- Respiratory Epidemiology Research Unit, Center for Research Outcomes Evaluation
| | - Stella S Daskalopoulou
- Respiratory Epidemiology Research Unit, Center for Research Outcomes Evaluation
- Division of Internal Medicine, Department of Medicine, and
| | - Robert Gagnon
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Natalie Dayan
- Division of Internal Medicine, Department of Medicine, and
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | | | - Allen Olha
- Respiratory Division and Sleep Laboratory
| | - Sarayut L Geater
- Division of Respiratory and Respiratory Critical Care Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; and
| | - Andrea Benedetti
- Respiratory Epidemiology Research Unit, Center for Research Outcomes Evaluation
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - R John Kimoff
- Respiratory Division and Sleep Laboratory
- Respiratory Epidemiology Research Unit, Center for Research Outcomes Evaluation
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Richardson K, Collop N. Sleep medicine clinical pearls: understanding the dynamic changes in sleep apnea during pregnancy due to hormonal shifts. J Clin Sleep Med 2024; 20:663-666. [PMID: 38169442 PMCID: PMC10985303 DOI: 10.5664/jcsm.10940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Kendra Richardson
- Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy Collop
- Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia
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