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Wang Y, Fietze I, Salanitro M, Penzel T. Comparison of the value of the STOP-BANG questionnaire with oxygen desaturation index in screening obstructive sleep apnea in Germany. Sleep Breath 2023; 27:1315-1323. [PMID: 36269514 PMCID: PMC10427704 DOI: 10.1007/s11325-022-02727-7] [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: 04/10/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Despite polysomnography being the gold standard method of diagnosing obstructive sleep apnea (OSA), it is time-consuming and has long waiting lists. Alternative methods including questionnaires and portable sleep devices have been developed to increase the speed of diagnosis. However, most questionnaires such as the STOP-BANG questionnaire (SBQ) are limited due to low specificity. This study evaluated the value of SBQ to screen for OSA and compared it with the oxygen desaturation index (ODI) and their combination. METHODS This retrospective study included patients who completed the SBQ and underwent a night at the sleep lab or home sleep testing. The ODI was extracted from these sleep study reports. The combination of SBQ with ODI and their individual scores were compared with apnea-hypopnea index (AHI) in terms of their accuracy in diagnosing OSA. Sensitivity, specificity, and area under the curve (AUC) for different severities of OSA were calculated and compared. RESULTS Among 132 patients, SBQ showed a sensitivity of 0.9 and a specificity of 0.3 to screen for OSA. As the severity of OSA increased, the sensitivity increased whilst specificity decreased for both measurements. ODI achieved an increased specificity of 0.8 and could correctly diagnose OSA 86% of the time which was better than SBQ's 60%. For all severities of OSA, ODI alone displayed a larger AUC than SBQ and similar AUC to their combination. CONCLUSION ODI produced a higher specificity and AUC than SBQ. Furthermore, ODI combined with SBQ failed to increase diagnostic value. Therefore, ODI may be the preferred way to initially screen patients for OSA as an easy-to-use alternative compared to SBQ.
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Affiliation(s)
- Yan Wang
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
- The Federal State Autonomous Educational Institution of Higher Education, I.M Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Matthew Salanitro
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
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Champreeda V, Hu R, Chan B, Tomasek O, Lin YH, Weinberg L, Howard W, Tan CO. Nocturnal respiratory abnormalities among ward-level postoperative patients as detected by the Capnostream 20p monitor: A blinded observational study. PLoS One 2023; 18:e0280436. [PMID: 36662703 PMCID: PMC9858304 DOI: 10.1371/journal.pone.0280436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/01/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE This prospective observational study aimed to establish the frequency of postoperative nocturnal respiratory abnormalities among patients undergoing major surgery who received ward-level care. These abnormalities may have implications for postoperative pulmonary complications (PPCs). METHODS Eligible patients underwent blinded noninvasive continuous capnography with pulse oximetry using the Capnostream™ 20p monitor over the first postoperative night. All patients received oxygen supplementation and patient-controlled opioid analgesia. The primary outcome was the number of prolonged apnea events (PAEs), defined as end-tidal carbon dioxide (EtCO2) ≤5 mmHg for 30-120 seconds or EtCO2 ≤5 mmHg for >120 seconds with oxygen saturation (SpO2) <85%. Secondary outcomes were the proportion of recorded time that physiological indices were aberrant, including the apnea index (AI), oxygen desaturation index (ODI), integrated pulmonary index (IPI), and SpO2. Exploratory analysis was conducted to assess the associations between PAEs, PPCs, and pre-defined factors. RESULTS Among 125 patients who had sufficient data for analysis, a total of 1800 PAEs occurred in 67 (53.4%) patients. The highest quartile accounted for 89.1% of all events. Amongst patients who experienced any PAEs, the median (IQR) number of PAE/patient was four (2-12). As proportions of recorded time (median (IQR)), AI, ODI, and IPI were aberrant for 12.4% (0-43.2%), 19.1% (2.0-57.1%), and 11.5% (3.1-33.3%) respectively. Only age, ARISCAT, and opioid consumption/kg were associated with PPCs. CONCLUSIONS PAE and aberrant indices were frequently detected on the first postoperative night. However, they did not correlate with PPCs. Future research should investigate the significance of detected aberrations.
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Affiliation(s)
- Vichaya Champreeda
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Raymond Hu
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Brandon Chan
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Owen Tomasek
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Yuan-Hong Lin
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Laurence Weinberg
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Will Howard
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Chong O. Tan
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
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Portable evaluation of obstructive sleep apnea in adults: A systematic review. Sleep Med Rev 2023; 68:101743. [PMID: 36657366 DOI: 10.1016/j.smrv.2022.101743] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/10/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023]
Abstract
Obstructive sleep apnea (OSA) is a significant healthcare burden affecting approximately one billion people worldwide. The prevalence of OSA is rising with the ongoing obesity epidemic, a key risk factor for its development. While in-laboratory polysomnography (PSG) is the gold standard for diagnosing OSA, it has significant drawbacks that prevent widespread use. Portable devices with different levels of monitoring are available to allow remote assessment for OSA. To better inform clinical practice and research, this comprehensive systematic review evaluated diagnostic performances, study cost and patients' experience of different levels of portable sleep studies (type 2, 3, and 4), as well as wearable devices and non-contact systems, in adults. Despite varying study designs and devices used, portable diagnostic tests are found to be sufficient for initial screening of patients at risk of OSA. Future studies are needed to evaluate cost effectiveness with the incorporation of portable diagnostic tests into the diagnostic pathway for OSA, as well as their application in patients with chronic respiratory diseases and other comorbidities that may affect test performance.
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Addressing rural health disparity with a novel hospital sleep apnea screening: Precision of a high-resolution pulse oximeter in screening for sleep-disordered breathing. Sleep Breath 2022; 26:1821-1828. [DOI: 10.1007/s11325-021-02559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022]
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Devani N, Pramono RXA, Imtiaz SA, Bowyer S, Rodriguez-Villegas E, Mandal S. Accuracy and usability of AcuPebble SA100 for automated diagnosis of obstructive sleep apnoea in the home environment setting: an evaluation study. BMJ Open 2021; 11:e046803. [PMID: 34933855 PMCID: PMC8693096 DOI: 10.1136/bmjopen-2020-046803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Obstructive sleep apnoea (OSA) is a heavily underdiagnosed condition, which can lead to significant multimorbidity. Underdiagnosis is often secondary to limitations in existing diagnostic methods. We conducted a diagnostic accuracy and usability study, to evaluate the efficacy of a novel, low-cost, small, wearable medical device, AcuPebble_SA100, for automated diagnosis of OSA in the home environment. SETTINGS Patients were recruited to a standard OSA diagnostic pathway in an UK hospital. They were trained on the use of type-III-cardiorespiratory polygraphy, which they took to use at home. They were also given AcuPebble_SA100; but they were not trained on how to use it. PARTICIPANTS 182 consecutive patients had been referred for OSA diagnosis in which 150 successfully completed the study. PRIMARY OUTCOME MEASURES Efficacy of AcuPebble_SA100 for automated diagnosis of moderate-severe-OSA against cardiorespiratory polygraphy (sensitivity/specificity/likelihood ratios/predictive values) and validation of usability by patients themselves in their home environment. RESULTS After returning the systems, two expert clinicians, blinded to AcuPebble_SA100's output, manually scored the cardiorespiratory polygraphy signals to reach a diagnosis. AcuPebble_SA100 generated automated diagnosis corresponding to four, typically followed, diagnostic criteria: Apnoea Hypopnoea Index (AHI) using 3% as criteria for oxygen desaturation; Oxygen Desaturation Index (ODI) for 3% and 4% desaturation criteria and AHI using 4% as desaturation criteria. In all cases, AcuPebble_SA100 matched the experts' diagnosis with positive and negative likelihood ratios over 10 and below 0.1, respectively. Comparing against the current American Academy of Sleep Medicine's AHI-based criteria demonstrated 95.33% accuracy (95% CI (90·62% to 98·10%)), 96.84% specificity (95% CI (91·05% to 99·34%)), 92.73% sensitivity (95% CI (82·41% to 97·98%)), 94.4% positive-predictive value (95% CI (84·78% to 98·11%)) and 95.83% negative-predictive value (95% CI (89·94% to 98·34%)). All patients used AcuPebble_SA100 correctly. Over 97% reported a strong preference for AcuPebble_SA100 over cardiorespiratory polygraphy. CONCLUSIONS These results validate the efficacy of AcuPebble_SA100 as an automated diagnosis alternative to cardiorespiratory polygraphy; also demonstrating that AcuPebble_SA100 can be used by patients without requiring human training/assistance. This opens the doors for more efficient patient pathways for OSA diagnosis. TRIAL REGISTRATION NUMBER NCT03544086; ClinicalTrials.gov.
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Affiliation(s)
- Nikesh Devani
- Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Renard Xaviero Adhi Pramono
- Wearable Technologies Lab, Department of Electrical and Electronic Engineering, Imperial College of Science Technology and Medicine, London, UK
| | - Syed Anas Imtiaz
- Wearable Technologies Lab, Department of Electrical and Electronic Engineering, Imperial College of Science Technology and Medicine, London, UK
| | - Stuart Bowyer
- Wearable Technologies Lab, Department of Electrical and Electronic Engineering, Imperial College of Science Technology and Medicine, London, UK
| | - Esther Rodriguez-Villegas
- Wearable Technologies Lab, Department of Electrical and Electronic Engineering, Imperial College of Science Technology and Medicine, London, UK
| | - Swapna Mandal
- Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK
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Chavoshan B, Dungan G, Liu PY. Contact-free screening for obstructive sleep apnea: comfort, especially in a physically distanced brave new world. J Clin Sleep Med 2021; 17:873-874. [PMID: 33688825 DOI: 10.5664/jcsm.9238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bahman Chavoshan
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, California.,Department of Postgraduate Medical Education, St. Mary Medical Center, Long Beach, California.,Contributed equally
| | - George Dungan
- Science & Innovation, Vapotherm, Inc., Exeter, New Hampshire.,School of Education and Human Services-Respiratory Care, Canisius College, Buffalo, New York.,Contributed equally
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, California
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7
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Chen L, Tang W, Wang C, Chen D, Gao Y, Ma W, Zha P, Lei F, Tang X, Ran X. Diagnostic Accuracy of Oxygen Desaturation Index for Sleep-Disordered Breathing in Patients With Diabetes. Front Endocrinol (Lausanne) 2021; 12:598470. [PMID: 33767667 PMCID: PMC7985532 DOI: 10.3389/fendo.2021.598470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/01/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Polysomnography (PSG) is the gold standard for diagnosis of sleep-disordered breathing (SDB). But it is impractical to perform PSG in all patients with diabetes. The objective was to develop a clinically easy-to-use prediction model to diagnosis SDB in patients with diabetes. METHODS A total of 440 patients with diabetes were recruited and underwent overnight PSG at West China Hospital. Prediction algorithms were based on oxygen desaturation index (ODI) and other variables, including sex, age, body mass index, Epworth score, mean oxygen saturation, and total sleep time. Two phase approach was employed to derivate and validate the models. RESULTS ODI was strongly correlated with apnea-hypopnea index (AHI) (rs = 0.941). In the derivation phase, the single cutoff model with ODI was selected, with area under the receiver operating characteristic curve (AUC) of 0.956 (95%CI 0.917-0.994), 0.962 (95%CI 0.943-0.981), and 0.976 (95%CI 0.956-0.996) for predicting AHI ≥5/h, ≥15/h, and ≥30/h, respectively. We identified the cutoff of ODI 5/h, 15/h, and 25/h, as having important predictive value for AHI ≥5/h, ≥15/h, and ≥30/h, respectively. In the validation phase, the AUC of ODI was 0.941 (95%CI 0.904-0.978), 0.969 (95%CI 0.969-0.991), and 0.949 (95%CI 0.915-0.983) for predicting AHI ≥5/h, ≥15/h, and ≥30/h, respectively. The sensitivity of ODI ≥5/h, ≥15/h, and ≥25/h was 92%, 90%, and 93%, respectively, while the specificity was 73%, 89%, and 85%, respectively. CONCLUSIONS ODI is a sensitive and specific tool to predict SDB in patients with diabetes.
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Affiliation(s)
- Lihong Chen
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Weiwei Tang
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Chun Wang
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Dawei Chen
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Gao
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Wanxia Ma
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Panpan Zha
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Lei
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Xingwu Ran
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xingwu Ran,
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8
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Usefulness of Home Overnight Pulse Oximetry in Patients with Suspected Sleep-Disordered Breathing. Can Respir J 2020; 2020:1891285. [PMID: 33273990 PMCID: PMC7676978 DOI: 10.1155/2020/1891285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/28/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
Methods Prospective study conducted in a university hospital. Subjects with a clinical suspicion of SAHS were included. All of them underwent home polygraphy and oximetry on the same night. A correlation was made between the apnea-hypopnea index (AHI) and the oximetry variables. The variable with the highest diagnostic value was calculated using the area under the curve (AUC), and the best cut-off point for discriminating between patients with SAHS and severe SAHS was identified. Results One hundred and four subjects were included; 73 were men (70%); mean age was 52 ± 10.1 years; body mass index was 30 ± 4.1, and AHI = 29 ± 23.2/h. A correlation was observed between the AHI and oximetry variables, particularly ODI3 (r = 0.850; P < 0.001) and ODI4 (r = 0.912; P < 0.001). For an AHI ≥ 10/h, the ODI3 had an AUC = 0.941 (95% confidence interval (CI) = 0.899–0.982) and the ODI4, an AUC = 0.984 (95% CI = 0.964–1), with the ODI4 having the best cut-off point (5.4/h). Similarly, for an AHI ≥ 30/h, the ODI4 had an AUC = 0.922 (95% CI = 0.859–0.986), with the best cut-off point being 10.5/h. Conclusion Nocturnal oximetry is useful for diagnosing and evaluating the severity of SAHS. The ODI4 variable was most closely correlated with AHI for both diagnosis.
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Rolon R, Gareis I, Larrateguy L, Di Persia L, Spies R, Rufiner H. Automatic scoring of apnea and hypopnea events using blood oxygen saturation signals. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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10
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Rashid NHA, Zaghi S, Scapuccin M, Camacho M, Certal V, Capasso R. The Value of Oxygen Desaturation Index for Diagnosing Obstructive Sleep Apnea: A Systematic Review. Laryngoscope 2020; 131:440-447. [DOI: 10.1002/lary.28663] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/07/2020] [Accepted: 03/13/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Nur HA Rashid
- Unit of Otorhinolaryngology, Department of Surgery, Faculty of Medicine and Health Sciences Universiti Putra Malaysia Serdang Malaysia
| | - Soroush Zaghi
- University of California Los Angeles (UCLA) Medical Center, Santa Monica Santa Monica California USA
| | - Marcelo Scapuccin
- Department of Otorhinolaryngology‐Head and Neck Surgery Santa Casa School of Medicine Sao Paulo Brazil
| | - Macario Camacho
- Division of Sleep Surgery and Medicine, Department of Otolaryngology‐Head and Neck Surgery Tripler Army Medical Center Honolulu Hawaii USA
| | - Victor Certal
- Department of Otorhinolaryngology Sleep Medicine Centre, Hospital CUF Porto Porto Portugal
| | - Robson Capasso
- Division of Sleep Surgery Department of Otolaryngology‐Head & Neck Surgery, Stanford University School of Medicine
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Subramony SH, Wymer JP, Pinto BS, Wang ET. Sleep disorders in myotonic dystrophies. Muscle Nerve 2020; 62:309-320. [DOI: 10.1002/mus.26866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Sub H. Subramony
- Department of NeurologyUniversity of Florida College of Medicine, McKnight Brain Institute Gainesville Florida
| | - James P. Wymer
- Department of NeurologyUniversity of Florida College of Medicine, McKnight Brain Institute Gainesville Florida
| | - Belinda S. Pinto
- Department of Molecular Genetics & Microbiology, Center for NeuroGenetics, UF Genetics InstituteUniversity of Florida College of Medicine Gainesville Florida
| | - Eric T. Wang
- Department of Molecular Genetics & Microbiology, Center for NeuroGenetics, UF Genetics InstituteUniversity of Florida College of Medicine Gainesville Florida
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13
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Ayache M, Rosen CL, Chiang A, Little JA, Strohl KP. Overnight oxygen desaturation index in sickle cell disease: prediction of sleep apnea. Sleep Med 2019; 64:12-14. [PMID: 31655319 DOI: 10.1016/j.sleep.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Mirna Ayache
- Division of Pulmonary, Critical Care and Sleep Medicine, Metrohealth Medical Center, United States.
| | - Carol L Rosen
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, United States; Division of Pediatric Pulmonary and Sleep Medicine, Rainbow Babies and Children's Hospital, United States
| | - Ambrose Chiang
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, United States
| | - Jane A Little
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, United States
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes Veterans Affair Medical Center, United States
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Behar JA, Palmius N, Li Q, Garbuio S, Rizzatti FP, Bittencourt L, Tufik S, Clifford GD. Feasibility of Single Channel Oximetry for Mass Screening of Obstructive Sleep Apnea. EClinicalMedicine 2019; 11:81-88. [PMID: 31317133 PMCID: PMC6611093 DOI: 10.1016/j.eclinm.2019.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The growing awareness for the high prevalence of obstructive sleep apnea (OSA) coupled with the dramatic proportion of undiagnosed individuals motivates the elaboration of a simple but accurate screening test. This study assesses, for the first time, the performance of oximetry combined with demographic information as a screening tool for identifying OSA in a representative (i.e. non-referred) population sample. METHODS A polysomnography (PSG) clinical database of 887 individuals from a representative population sample of São Paulo's city (Brazil) was used. Using features derived from the oxygen saturation signal during sleep periods and demographic information, a logistic regression model (termed OxyDOSA) was trained to distinguish between non-OSA and OSA individuals (mild, moderate, and severe). The OxyDOSA model performance was assessed against the PSG-based diagnosis of OSA (AASM 2017) and compared to the NoSAS and STOP-BANG questionnaires. FINDINGS The OxyDOSA model had mean AUROC = 0.94 ± 0.02, Se = 0.87 ± 0.04 and Sp = 0.85 ± 0.03. In particular, it did not miss any of the 75 severe OSA individuals. In comparison, the NoSAS questionnaire had AUROC = 0.83 ± 0.03, and missed 23/75 severe OSA individuals. The STOP-BANG had AUROC = 0.77 ± 0.04 and missed 14/75 severe OSA individuals. INTERPRETATION We provide strong evidence on a representative population sample that oximetry biomarkers combined with few demographic information, the OxyDOSA model, is an effective screening tool for OSA. Our results suggest that sleep questionnaires should be used with caution for OSA screening as they fail to identify many moderate and even some severe cases. The OxyDOSA model will need to be further validated on data recorded using overnight portable oximetry.
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Affiliation(s)
- Joachim A. Behar
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Qiao Li
- Departments of Biomedical Informatics & Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta, GA, USA
| | - Silverio Garbuio
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Departamento de Medicina, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gari D. Clifford
- Departments of Biomedical Informatics & Biomedical Engineering, Emory University & Georgia Institute of Technology, Atlanta, GA, USA
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15
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Combination of oximetry and sleep questionnaires as screening tools for CPAP initiation in patients with obstructive sleep apnea. Pulmonology 2019; 25:137-142. [DOI: 10.1016/j.pulmoe.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/22/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022] Open
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16
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Deviaene M, Testelmans D, Buyse B, Borzee P, Van Huffel S, Varon C. Automatic Screening of Sleep Apnea Patients Based on the SpO2 Signal. IEEE J Biomed Health Inform 2019; 23:607-617. [DOI: 10.1109/jbhi.2018.2817368] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Margot Deviaene
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, and imec, KU Leuven, Leuven, Belgium
| | | | - Bertien Buyse
- Department of Pneumology, UZ Leuven, Leuven, Belgium
| | - Pascal Borzee
- Department of Pneumology, UZ Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, and imec, KU Leuven, Leuven, Belgium
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Kum RO, Kundi FCS, Baklacı D, Kum NY, Güler İ, Yılmaz YF, Özcan M. Predicting Severe Sleep Apnea in Patients with Complaints: Pulse Oximetry and Body Mass Index. Turk Arch Otorhinolaryngol 2018; 56:149-154. [PMID: 30319871 DOI: 10.5152/tao.2018.2928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 05/04/2018] [Indexed: 11/22/2022] Open
Abstract
Objective An adequate evaluation combined with an easily accessible test would be a useful way to direct the appropriate patients to sleep centers in circumstances with a limited opportunity for polysomnography (PSG). For this reason, it is necessary to use a screening method prior to PSG evaluation. The aim of the present study was to investigate whether the use of body mass index (BMI) and pulse oximetry is sufficient to predict the severity of obstructive sleep apnea syndrome (OSAS) without PSG. Methods A total of 956 patients who were admitted to a tertiary referral center with complaints of witnessed apnea, excessive daytime sleepiness, and previously performed PSG were included in the study. Data of PSG (included pulse oximetry) and BMI were investigated for the determination of cut-off points for parameters in the patients. Results Based on the presence of severe OSAS, the cut-off points were ≥31.7 kg/m2 for BMI, <81% for minimum oxygen saturation (Min O2), and ≥14.1 min for sleep time with oxygen saturation <90% (ST90). Severe OSAS risk was found to be higher in patients with BMI ≥31.7 kg/m2, ST90 ≥14.1 min, and Min O2 ≤81% than in those without (OR: 37.173; 95% CI: 22.465-61.510, p=0.001). Specificity and accuracy were 94.85% and 72.49%, respectively, when all three cut-off scores were provided. Conclusion The appropriate cut-off values obtained from combining BMI and pulse oximetry data can provide accurate results for predicting the severity of OSAS.
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Affiliation(s)
- Rauf Oğuzhan Kum
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Fatma Cemre Sazak Kundi
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Deniz Baklacı
- Department of Otorhinolaryngology, Kahramankazan State Hospital, Ankara, Turkey
| | - Nurcan Yurtsever Kum
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - İsmail Güler
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Yavuz Fuat Yılmaz
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Müge Özcan
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Ayache M, Strohl KP. High Interrater Reliability of Overnight Pulse Oximetry Interpretation Among Inexperienced Physicians Using a Structured Template. J Clin Sleep Med 2018; 14:541-548. [PMID: 29609721 DOI: 10.5664/jcsm.7040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the interrater reliability and accuracy of overnight pulse oximetry (OPO) interpretations by pulmonary fellows using a comprehensive structured template and after a brief educational session. METHODS Using the template, four pulmonary and critical care (PCC) fellows interpreted OPO saturation waveforms and parameters extracted from 50 adult consecutive in-laboratory sleep studies. The template included three saturation parameters (mean saturation, oxygen desaturation index [ODI], and cumulative desaturation time) and description of the saturation waveform. A scoring system was proposed combining waveform characteristics and ODI to determine the suspicion for moderate to severe sleep apnea. Waveform description and mean saturation determined the suspicion for cardiopulmonary disease (CPD). Cumulative desaturation time determined need for oxygen prescription. Apnea-hypopnea index was extracted from the sleep study results. RESULTS The overall interrater reliability for final recommendations (sleep apnea suspicion, presence of CPD, and oxygen prescription) was high (kappa = .81, 95% confidence interval [CI] .76-.88). Good agreement was noted in CPD evaluation and suspicion of moderate to severe sleep apnea (kappa = .70, 95% CI .46-.86 and kappa = .65, 95% CI .56-.77 respectively). The interrater reliability for oxygen prescription was in an excellent range (kappa = .98, 95% CI .91-1.00). The accuracy of a high sleep apnea suspicion score in detecting apnea-hypopnea index ≥ 15 events/h ranged from 88.0% to 94.0% (sensitivity 91.3% to 95.7%, specificity 81.5% to 92.6%). Desaturations due to CPD were identified by 75% of the raters as desaturations due to conditions other than sleep apnea. CONCLUSIONS A structured template for OPO interpretation can produce a high interrater agreement and good accuracy, and make it a reliable clinical tool. COMMENTARY A commentary on this article appears in this issue on page 497.
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Affiliation(s)
- Mirna Ayache
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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Jung DW, Hwang SH, Cho JG, Choi BH, Baek HJ, Lee YJ, Jeong DU, Park KS. Real-Time Automatic Apneic Event Detection Using Nocturnal Pulse Oximetry. IEEE Trans Biomed Eng 2018. [DOI: 10.1109/tbme.2017.2715405] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gumb T, Twumasi A, Alimokhtari S, Perez A, Black K, Rapoport DM, Sunderram J, Ayappa I. Comparison of two home sleep testing devices with different strategies for diagnosis of OSA. Sleep Breath 2017; 22:139-147. [PMID: 28823109 DOI: 10.1007/s11325-017-1547-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 07/24/2017] [Accepted: 07/31/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Home sleep testing devices are being widely used in diagnosis/screening for obstructive sleep apnea (OSA). We examined differences in OSA metrics obtained from two devices with divergent home monitoring strategies, the Apnea Risk Evaluation System (ARES™, multiple signals plus forehead reflectance oximetry) and the Nonin WristOx2™ (single channel finger transmission pulse oximeter), compared to differences from night-night variability of OSA. METHODS One hundred fifty-two male/26 female subjects (BMI = 30.3 ± 5.6 kg/m2, age = 52.5 ± 8.9 years) were recruited without regard to OSA symptoms and simultaneously wore both ARES™ and Nonin WristOx2™ for two nights (n = 351 nights). Automated analysis of the WristOx2 yielded oxygen desaturation index (ODIOx2, ≥4% O2 dips/h), and automated analysis with manual editing of ARES™ yielded AHI4ARES (apneas + hypopneas with ≥4% O2 dips/h) and RDIARES (apneas + hypopneas with ≥4% O2 dips/h or arousal surrogates). Baseline awake oxygen saturation, percent time < 90% O2 saturation (%time < 90%O2Sat), and O2 signal loss were compared between the two methods. RESULTS Correlation between AHI4ARES and ODIOx2 was high (ICC = 0.9, 95% CI = 0.87-0.92, p < 0.001, bias ± SD = 0.7 ± 6.1 events/h). Agreement values for OSA diagnosis (77-85%) between devices were similar to those seen from night-to-night variability of OSA using a single device. Awake baseline O2 saturation was significantly higher in the ARES™ (96.2 ± 1.6%) than WristOx2™ (92.2 ± 2.1%, p < 0.01). There was a significantly lower %time < 90%O2Sat reported by the ARES™ compared to WristOx2 (median (IQR) 0.5 (0.0, 2.6) vs. 2.1 (0.3, 9.7), p < 0.001), and the correlation was low (ICC = 0.2). CONCLUSIONS OSA severity metrics predominantly dependent on change in oxygen saturation and metrics used in diagnosis of OSA (AHI4 and ODI) correlated well across devices tested. However, differences in cumulative oxygen desaturation measures (i.e., %time < 90%O2Sat) between the devices suggest that caution is needed when interpreting this metric particularly in populations likely to have significant hypoxia.
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Affiliation(s)
- Tyler Gumb
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University, New York, NY, USA
| | - Akosua Twumasi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY, 10029, USA
| | - Shahnaz Alimokhtari
- Environmental and Occupational Health Sciences Institute, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
| | - Alan Perez
- Environmental and Occupational Health Sciences Institute, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
| | - Kathleen Black
- Environmental and Occupational Health Sciences Institute, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
| | - David M Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University, New York, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY, 10029, USA
| | - Jag Sunderram
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08903, USA
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University, New York, NY, USA. .,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY, 10029, USA.
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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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Isaiah A, Mezrich R, Wolf J. Ultrasonographic Detection of Airway Obstruction in a Model of Obstructive Sleep Apnea. Ultrasound Int Open 2017; 3:E34-E42. [PMID: 28345075 DOI: 10.1055/s-0042-124503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Obstructive sleep apnea (OSA) is a common clinical disorder characterized by repetitive airway obstruction during sleep. The gold standard for diagnosis of OSA, polysomnogram (PSG), cannot anatomically localize obstruction. Precise identification of obstruction has potential to improve outcomes following surgery. Current diagnostic modalities that provide this information require anesthesia, involve ionizing radiation or disrupt sleep. To mitigate these problems, we conceived that ultrasound (US) technology may be adapted (i) to detect, quantify and localize airway obstruction and (ii) for translational application to home-based testing for OSA. Materials and Methods Segmental airway collapse was induced in 4 fresh cadavers by application of negative pressure. Following visualization of airway obstruction, a rotary US probe was used to acquire transcervical images of the airway before and after induction of obstruction. These images (n=800) were analyzed offline using image processing algorithms. Results Our results show that the non-obstructed airway consistently demonstrated the presence of a US air-tissue interface. Importantly, automated detection of the air-tissue interface strongly correlated with manual measurements. The algorithm correctly detected an air-tissue interface in 90% of the US images while incorrectly detecting it in 20% (area under the curve=0.91). Conclusion The non-invasive detection of airway obstruction using US represents a major step in expanding OSA diagnostics beyond PSG. The preliminary data obtained from our model could spur further research in non-invasive localization of obstruction. US offers the benefit of precise localization of the site of obstruction, with potential for improving outcomes in surgical management.
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Affiliation(s)
- Amal Isaiah
- Otorhinolaryngology - Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, United States
| | - Reuben Mezrich
- Radiology, University of Maryland School of Medicine, Baltimore, United States
| | - Jeffrey Wolf
- Otolaryngology - Head and Neck Surgery, University of Maryland School of medicine, Baltimore, United States
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Discriminative methods based on sparse representations of pulse oximetry signals for sleep apnea–hypopnea detection. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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The role of compact polysomnography/polygraphy in sleep breathing disorder patients' management. Eur Arch Otorhinolaryngol 2016; 274:2013-2028. [PMID: 27844222 DOI: 10.1007/s00405-016-4372-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
While managing obstructive sleep apnea (OSA) or suspicious OSA patients, the otorhinolaryngologist frequently has to deal with patients undergoing repeated polysomnography (PSG) or portable monitoring (PM) and, on the other hand, should be confident about the quality and consistency of the polysomnographic diagnosis. The main polysomnographic traces compressed in a unique epoch, defined as compact PSG/PM (CP), which should be reported in all PSG/PM report, could represent an efficient tool to confirm the quality of PSG/PM diagnosis and to recognize the sleep breathing disorders (SBD): OSA, no-OSA SBD and overlap of OSA with no-OSA SBD. In this study, a synthetic and clear guided iconography and an easy decision-making algorithm based on desaturation patterns (phasic, prolonged and overlap desaturation patterns) identifiable on the CP are suggested for a quick check of the quality of PSG/PM diagnosis and to achieve an improvement in the patient's clinical management.
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Pataka A, Zarogoulidis P, Hohenforst-Schmidt W, Tsiouda T, Tsavlis D, Kioumis I, Papakala E, Karapantzos I, Karapantzou C, Rapti A, Tsakiridis K, Zarogoulidis K, Argyropoulou P. During economic crisis can sleep questionnaires improve the value of oximetry for assessing sleep apnea? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:443. [PMID: 27999777 DOI: 10.21037/atm.2016.11.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The diagnosis of obstructive sleep apnea/hypopnea syndrome (OSAHS) is essential but polysomnography (PSG) is expensive and time consuming. Oximetry has been used as a less expensive indicator of OSAHS. The aim of the study was to evaluate the clinical utility of the combination of oximetry with four different questionnaires: Stop, Stop Bang (S-B), Berlin questionnaire (BQ), Epworth Sleepiness Scale (ESS) in order to identify patients at risk for OSAHS compared with in-laboratory PSG. METHODS Patients visiting a sleep clinic were prospectively studied. They completed Stop, S-B, BQ and ESS. Home oximetry and in laboratory PSG were performed within 3-20 days. RESULTS A total of 204 patients were included in the study (77.5% males, mean age 51.8±13.8 years, BMI 32.8±6.2 kg/m2, SaO2% awake 95.7±2). S-B had the highest sensitivity (Se) (97.5%) and negative predictive value (NPV) (62.5%) but the lowest specificity (Sp) (9%), whereas ESS had the best Sp (75%) and positive predictive values (PPV) (81.4%). The predictive values of questionnaires improved as the severity of OSAHS worsened. The predictive values of oximetry were high for severe but low for mild and moderate OSAHS. For that oximetry was combined with different sleep questionnaires in different OSAHS severity groups, but with no improvement in the predictive values. CONCLUSIONS Oximetry may be used as a tool for identifying severe OSAHS. For mild and moderate disease the combination of questionnaires did not improve the diagnostic accuracy and especially for symptomatic patients with negative results, the need of PSG is essential.
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Affiliation(s)
- Athanasia Pataka
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Theodora Tsiouda
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Drosos Tsavlis
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elene Papakala
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ilias Karapantzos
- Ear, Nose and Throat Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece
| | - Chrysa Karapantzou
- Ear, Nose and Throat Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece
| | - Aggeliki Rapti
- Second Pulmonary Clinic, "Sotiria" Chest Diseases Hospital, Athens 11527, Greece
| | - Kosmas Tsakiridis
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Parakevi Argyropoulou
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Cognitive Event-Related Potentials in Patients With Adenoid Hypertrophy: A Case-Control Pilot Study. J Clin Neurophysiol 2016; 33:443-449. [PMID: 26808619 DOI: 10.1097/wnp.0000000000000258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Children with adenoid hypertrophy commonly have sleep-disordered breathing. Sleep-disordered breathing is associated with various neurocognitive problems. The aim of this study was to assess the cognitive function in those patients using cognitive event-related potentials. METHODS Twenty-three patients with moderate to severe adenoid hypertrophy were compared with 20 healthy controls. The intelligence quotient was performed for all study participants. The latencies of the N200, P300 peaks and the amplitudes of the N200/P300 components of event-related potentials were recorded. The above variables were measured at baseline for both patients and control groups and 2 months after adenoidectomy for the patient group. RESULTS There was no significant difference between patients and controls regarding full intelligence quotient scales. P300 latency was significantly prolonged in patient group compared with the healthy controls. Moreover, postoperative P300 latency was significantly reduced compared with the preoperative P300 latency. Postoperative P300 latency was not statistically different from healthy controls' data. CONCLUSIONS P300 latency delay may reflect some sort of cognitive impairment in patients with adenoid hypertrophy. This delay was reversible after adenoidectomy. Event-related potentials may help for assessment of cognitive functions in patients with adenoid hypertrophy.
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A systematic review of pharmacists performing obstructive sleep apnea screening services. Int J Clin Pharm 2016; 38:752-60. [DOI: 10.1007/s11096-016-0319-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
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Ernst G, Bosio M, Salvado A, Dibur E, Nigro C, Borsini E. Difference between apnea-hypopnea index (AHI) and oxygen desaturation index (ODI): proportional increase associated with degree of obesity. Sleep Breath 2016; 20:1175-1183. [DOI: 10.1007/s11325-016-1330-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/22/2016] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
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Tamai K, Matsuoka H, Suzuki Y, Yoshimatsu H, Masuya D, Nakashima N, Okada N, Oda N, Inoue S, Koma Y, Otsuka A. Nocturnal Oxygen Desaturation Index is Inversely Correlated with Airflow Limitation in Patients with Chronic Obstructive Pulmonary Disease. COPD 2016; 13:235-40. [DOI: 10.3109/15412555.2015.1074995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ebben MR, Krieger AC. Diagnostic accuracy of a mathematical model to predict apnea-hypopnea index using nighttime pulse oximetry. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:35006. [PMID: 27031706 DOI: 10.1117/1.jbo.21.3.035006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/08/2016] [Indexed: 06/05/2023]
Abstract
The intent of this study is to develop a predictive model to convert an oxygen desaturation index (ODI) to an apnea-hypopnea index (AHI). This model will then be compared to actual AHI to determine its precision. One thousand four hundred and sixty-seven subjects given polysomnograms with concurrent pulse oximetry between April 14, 2010, and February 7, 2012, were divided into model development (n = 733) and verification groups (n = 734) in order to develop a predictive model of AHI using ODI. Quadratic regression was used for model development. The coefficient of determination (r(2)) between the actual AHI and the predicted AHI (PredAHI) was 0.80 (r = 0.90), which was significant at a p < 0.001. The areas under the receiver operating characteristic curve ranged from 0.96 for AHI thresholds of ≥ 10 and ≥ 15/h to 0.97 for thresholds of ≥ 5 and ≥ 30/h. The algorithm described in this paper provides a convenient and accurate way to convert ODI to a predicted AHI. This tool makes it easier for clinicians to understand oximetry data in the context of traditional measures of sleep apnea.
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Affiliation(s)
- Matthew R Ebben
- Center for Sleep Medicine, Weill Cornell Medical College, Department of Neurology, 425 East 61st Street, 5th Floor, New York, New York 10065, United States
| | - Ana C Krieger
- Center for Sleep Medicine, Weill Cornell Medical College, Department of Neurology, 425 East 61st Street, 5th Floor, New York, New York 10065, United StatesbCenter for Sleep Medicine, Weill Cornell Medical College, Department of Medicine, 425 East 61st Str
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Bianchi MT, Goparaju B, Moro M. Sleep apnea in patients reporting insomnia or restless legs symptoms. Acta Neurol Scand 2016; 133:61-7. [PMID: 25974333 DOI: 10.1111/ane.12439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Insomnia and restless legs syndrome (RLS) are defined by self-reported symptoms, and polysomnography (PSG) is not routinely indicated. Occult obstructive sleep apnea (OSA), common even in asymptomatic adults, may complicate management of patients presenting with insomnia or restless legs. To this end, we investigated objective sleep apnea metrics in a large retrospective cohort according to self-reported symptom profiles. METHODS We compared sleep apnea findings in patients referred to our center according to self-reported symptoms associated with insomnia, sleep apnea, and restless legs. The cohort included over 1900 adults who underwent diagnostic (n = 1418) or split-night (n = 504) PSGs and completed a symptom and medical history questionnaire. RESULTS More than 30% of patients who did not endorse any OSA symptoms, but did endorse insomnia or restless legs symptoms, were found to have OSA based on apnea-hypopnea index (AHI) >5 during overnight laboratory testing. Regression models of the full cohort showed that the risk of OSA was related, as expected, to older age, male sex, elevated body mass index, and presence of OSA symptoms. The presence of insomnia symptoms did not alter the risk of OSA. The presence of restless legs symptoms showed a small odds ratio for lowered OSA risk. CONCLUSIONS Objective evidence of OSA occurs similarly in those with insomnia or restless legs symptoms, even among those without self-reported OSA symptoms. Providers should be aware of the potential for occult OSA in populations with insomnia and restless legs, which may complicate their management in addition to presenting an independent medical risk itself.
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Affiliation(s)
- M. T. Bianchi
- Neurology Department; Massachusetts General Hospital; Boston MA USA
- Division of Sleep Medicine; Harvard Medical School; Boston MA USA
| | - B. Goparaju
- Neurology Department; Massachusetts General Hospital; Boston MA USA
| | - M. Moro
- Neurology Department; Massachusetts General Hospital; Boston MA USA
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Marcos JV, Hornero R, Nabney IT, Álvarez D, Gutiérrez-Tobal GC, del Campo F. Regularity analysis of nocturnal oximetry recordings to assist in the diagnosis of sleep apnoea syndrome. Med Eng Phys 2015; 38:216-24. [PMID: 26719242 DOI: 10.1016/j.medengphy.2015.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 11/18/2015] [Accepted: 11/29/2015] [Indexed: 10/22/2022]
Abstract
The relationship between sleep apnoea-hypopnoea syndrome (SAHS) severity and the regularity of nocturnal oxygen saturation (SaO2) recordings was analysed. Three different methods were proposed to quantify regularity: approximate entropy (AEn), sample entropy (SEn) and kernel entropy (KEn). A total of 240 subjects suspected of suffering from SAHS took part in the study. They were randomly divided into a training set (96 subjects) and a test set (144 subjects) for the adjustment and assessment of the proposed methods, respectively. According to the measurements provided by AEn, SEn and KEn, higher irregularity of oximetry signals is associated with SAHS-positive patients. Receiver operating characteristic (ROC) and Pearson correlation analyses showed that KEn was the most reliable predictor of SAHS. It provided an area under the ROC curve of 0.91 in two-class classification of subjects as SAHS-negative or SAHS-positive. Moreover, KEn measurements from oximetry data exhibited a linear dependence on the apnoea-hypopnoea index, as shown by a correlation coefficient of 0.87. Therefore, these measurements could be used for the development of simplified diagnostic techniques in order to reduce the demand for polysomnographies. Furthermore, KEn represents a convincing alternative to AEn and SEn for the diagnostic analysis of noisy biomedical signals.
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Affiliation(s)
- J Víctor Marcos
- Grupo de Ingeniería Biomédica, E.T.S. Ingenieros de Telecomunicación, Universidad de Valladolid, Paseo de Belén 15, Valladolid 47011, Spain.
| | - Roberto Hornero
- Grupo de Ingeniería Biomédica, E.T.S. Ingenieros de Telecomunicación, Universidad de Valladolid, Paseo de Belén 15, Valladolid 47011, Spain.
| | - Ian T Nabney
- Non-linearity and Complexity Research Group, Aston University, Aston Triangle, Birmingham B4 7ET, United Kingdom.
| | - Daniel Álvarez
- Grupo de Ingeniería Biomédica, E.T.S. Ingenieros de Telecomunicación, Universidad de Valladolid, Paseo de Belén 15, Valladolid 47011, Spain.
| | - Gonzalo C Gutiérrez-Tobal
- Grupo de Ingeniería Biomédica, E.T.S. Ingenieros de Telecomunicación, Universidad de Valladolid, Paseo de Belén 15, Valladolid 47011, Spain.
| | - Félix del Campo
- Hospital Universitario Pío del Río Hortega de Valladolid, Dulzaina 2, Valladolid 47013, Spain.
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High-resolution wrist-worn overnight oximetry has high positive predictive value for obstructive sleep apnea in a sleep study referral population. Sleep Breath 2015; 20:583-7. [DOI: 10.1007/s11325-015-1251-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/11/2015] [Accepted: 08/25/2015] [Indexed: 11/24/2022]
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36
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Kagawa M, Tojima H, Matsui T. Non-contact diagnostic system for sleep apnea–hypopnea syndrome based on amplitude and phase analysis of thoracic and abdominal Doppler radars. Med Biol Eng Comput 2015; 54:789-98. [DOI: 10.1007/s11517-015-1370-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/07/2015] [Indexed: 12/01/2022]
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Cohen G, de Chazal P. Automated detection of sleep apnea in infants using minimally invasive sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:1652-5. [PMID: 24110021 DOI: 10.1109/embc.2013.6609834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
To address the difficult and necessity of early detection of sleep apnea hypopnea syndrome in infants, we present a study into the effectiveness of pulse oximetry as a minimally invasive means of automated diagnosis of sleep apnea in infants. Overnight polysomnogram data from 328 infants were used to extract time-domain based oximetry features and scored arousal data for each subject. These records were then used to determine apnea events and to train a classifier model based on linear discriminants. Performance of the classifier was evaluated using a leave-one-out cross-validation scheme and an accuracy of 68% was achieved, with a specificity of 68.6% and a sensitivity of 55.9%.
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Cohen G, de Chazal P. Automated detection of sleep apnea in infants: A multi-modal approach. Comput Biol Med 2015; 63:118-23. [PMID: 26073098 DOI: 10.1016/j.compbiomed.2015.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/18/2015] [Accepted: 05/10/2015] [Indexed: 12/15/2022]
Abstract
This study explores the use and applicability of two minimally invasive sensors, electrocardiogram (ECG) and pulse oximetry, in addressing the high costs and difficulty associated with the early detection of sleep apnea hypopnea syndrome in infants. An existing dataset of 396 scored overnight polysomnography recordings were used to train and test a linear discriminants classifier. The dataset contained data from healthy infants, infants diagnosed with sleep apnea, infants with siblings who had died from sudden infant death syndrome (SIDS) and pre-term infants. Features were extracted from the ECG and pulse-oximetry data and used to train the classifier. The performance of the classifier was evaluated using a leave-one-out cross-validation scheme and an accuracy of 66.7% was achieved, with a specificity of 67.0% and a sensitivity of 58.1%. Although the performance of the system is not yet at the level required for clinical use, this work forms an important step in demonstrating the validity and potential for such low-cost and minimally invasive diagnostic systems.
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Affiliation(s)
- Gregory Cohen
- MARCS Institute, University of Western Sydney, Australia.
| | - Philip de Chazal
- MARCS Institute, University of Western Sydney, Australia; School of Electrical and Information Engineering, University of Sydney, Australia.
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LABORATORIO DE FUNCIÓN PULMONAR. REVISTA MÉDICA CLÍNICA LAS CONDES 2015. [DOI: 10.1016/j.rmclc.2015.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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40
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Aimé E, Rovida M, Contardi D, Ricci C, Gaeta M, Innocenti E, Cabral Tantchou-Tchoumi J. Long-term Screening for Sleep Apnoea in Paced Patients: Preliminary Assessment of a Novel Patient Management Flowchart by Using Automatic Pacemaker Indexes and Sleep Lab Polygraphy. Heart Lung Circ 2014; 23:943-50. [PMID: 24851828 DOI: 10.1016/j.hlc.2014.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/09/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
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41
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A clinical prediction formula for apnea-hypopnea index. Int J Otolaryngol 2014; 2014:438376. [PMID: 25349613 PMCID: PMC4199210 DOI: 10.1155/2014/438376] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 11/29/2022] Open
Abstract
Objectives. There are many studies regarding unnecessary polysomnography (PSG) when obstructive sleep apnea syndrome (OSAS) is suspected. In order to reduce unnecessary PSG, this study aims to predict the apnea-hypopnea index (AHI) via simple clinical data for patients who complain of OSAS symptoms. Method. Demographic, anthropometric, physical examination and laboratory data of a total of 390 patients (290 men, average age 50 ± 11) who were subject to diagnostic PSG were obtained and evaluated retrospectively. The relationship between these data and the PSG results was analyzed. A multivariate linear regression analysis was performed step by step to identify independent AHI predictors. Results. Useful parameters were found in this analysis in terms of body mass index (BMI), waist circumference (WC), neck circumference (NC), oxygen saturation measured by pulse oximetry (SpO2), and tonsil size (TS) to predict the AHI. The formula derived from these parameters was the predicted AHI = (0.797 × BMI) + (2.286 × NC) − (1.272 × SpO2) + (5.114 × TS) + (0.314 × WC). Conclusion. This study showed a strong correlation between AHI score and indicators of obesity. This formula, in terms of predicting the AHI for patients who complain about snoring, witnessed apneas, and excessive daytime sleepiness, may be used to predict OSAS prior to PSG and prevent unnecessary PSG.
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Pengo MF, Kosky C, Williams AJ, Rossi GP, Steier J. Response from the authors to the letter "Pulse rate trends in obstructive sleep apnoea: a reliable tool to predict long term response to CPAP?". J Thorac Dis 2014; 6:E200-1. [PMID: 25276400 PMCID: PMC4178085 DOI: 10.3978/j.issn.2072-1439.2014.09.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 08/29/2014] [Indexed: 01/22/2023]
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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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Kum RO, Ozcan M, Yılmaz YF, Gungor V, Yurtsever Kum N, Unal A. The Relation of the Obstruction Site on Muller's Maneuver with BMI, Neck Circumference and PSG Findings in OSAS. Indian J Otolaryngol Head Neck Surg 2014; 66:167-72. [PMID: 24822156 DOI: 10.1007/s12070-014-0699-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 01/18/2014] [Indexed: 12/12/2022] Open
Abstract
We investigated relation of the site of obstruction detected on Muller maneuver (MM) with polysomnography (PSG) and physical examination findings. Data of 703 patients admitted to Ankara Numune Education and Research Hospital Sleep Laboratory between 2008 and 2013 were analyzed retrospectively; 394 patients with apnea-hypopnea indexes (AHI) ≥5/h were included. Site of collapse on MM was determined at retrolingual level at anteroposterior (M1) and lateral-lateral (M2) directions; at retropalatal level at anteroposterior (M3) and lateral-lateral (M4) directions. There were 125 (31.7 %) females and 269 (68.3 %) males. BMI had significant positive correlations with M2 (p < 0.001) and M4 (p = 0.002) scores, ESS (p = 0.013) and AHI (p = 0.001). AHI had significant positive correlations with ESS (p = 0.003), M2 (p < 0.001), M3 (p = 0.037) and M4 (p < 0.001) scores and NC (p = 0.001). Minimum oxygen saturation had significant reverse correlations with M1 (p = 0.046), M2 (p < 0.001), M3 (p = 0.003), M4 (p < 0.001), AHI (p < 0.001), ESS (p = 0.003) and BMI (p = 0.001). In OSAS patients, increased BMI, NC and AHI are correlated with lateral pharyngeal wall (LPW) collapse in retropalatal and retrolingual levels on MM. LPW collapse is more valuable to predict OSAS compared to anteroposterior collapse. LPW collapse on MM may be used as a selection criterion for ordering PSG. Further studies are needed to better clarify importance of LPW in OSAS surgery.
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Affiliation(s)
- Rauf Oguzhan Kum
- Ankara Numune Education and Research Hospital 1.ENT Clinic, Ankara, Turkey
| | - Muge Ozcan
- Ankara Numune Education and Research Hospital 1.ENT Clinic, Ankara, Turkey
| | - Yavuz Fuat Yılmaz
- Ankara Numune Education and Research Hospital 1.ENT Clinic, Ankara, Turkey
| | - Volkan Gungor
- Ankara Numune Education and Research Hospital 1.ENT Clinic, Ankara, Turkey
| | | | - Adnan Unal
- Ankara Numune Education and Research Hospital 1.ENT Clinic, Ankara, Turkey ; Department of Otolaryngology, Hitit University, Çorum, Turkey
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45
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Chiner E, Andreu AL, Sancho-Chust JN, Sánchez-de-la-Torre A, Barbé F. The use of ambulatory strategies for the diagnosis and treatment of obstructive sleep apnea in adults. Expert Rev Respir Med 2014; 7:259-73. [DOI: 10.1586/ers.13.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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46
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Weingarten TN, Kor DJ, Gali B, Sprung J. Predicting postoperative pulmonary complications in high-risk populations. Curr Opin Anaesthesiol 2013; 26:116-125. [PMID: 23407151 DOI: 10.1097/aco.0b013e32835e21d2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Our objective is to describe prediction models for surgical patients who have suspected obstructive sleep apnea (OSA) at risk for postoperative respiratory complications and for surgical patients at risk for postoperative acute respiratory distress syndrome (ARDS). RECENT FINDINGS Because of the increased rate of severe perioperative respiratory complications in patients with OSA, the American Society of Anesthesiologists issued practice guidelines for perioperative management. When OSA is diagnosed preoperatively, the rate of postoperative pulmonary complications is low and not associated with OSA severity. However, OSA continues to be an important risk because a substantial proportion of patients in the contemporary surgical population have undiagnosed OSA. Strategies based on preoperative and immediate postoperative clinical signs and symptoms can help identify patients with a high likelihood of OSA, postoperative desaturations, and pulmonary complications. ARDS is another serious postoperative complication associated with high mortality rate and limited treatment options, and its prevention is critical. Practice changes have led to a dramatic reduction in ARDS incidence. A recently developed prediction model can help identify high-risk patients. SUMMARY Evidence is emerging that early identification of modifiable risk factors and implementation of 'protective' management strategies may lead to reduction of severe postoperative pulmonary complications.
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Affiliation(s)
- Toby N Weingarten
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daryl J Kor
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bhargavi Gali
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
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Venema B, Schiefer J, Blazek V, Blanik N, Leonhardt S. Evaluating Innovative In-Ear Pulse Oximetry for Unobtrusive Cardiovascular and Pulmonary Monitoring During Sleep. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2013; 1:2700208. [PMID: 27170855 PMCID: PMC4819232 DOI: 10.1109/jtehm.2013.2277870] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/24/2013] [Accepted: 07/14/2013] [Indexed: 11/06/2022]
Abstract
Homecare is healthcare based on the principle "outpatient before inpatient," with the aim of moving at least some care-delivery to the home. But reliable determination of vital signs at home requires new, smart sensors, which can be used by the patients themselves. We present a novel pulse oximetry sensor worn in the ear channel. It was previously shown that measurement of heart rate, arterial oxygen saturation and related respiratory information can be performed with reliable accuracy under laboratory conditions. The present study explores the clinical feasibility of the sensor system for cardiovascular monitoring during sleep, with the aim to diagnose sleep apnea. For this, human trials were performed in a sleep laboratory including patients with a clinical suspicion of sleep apnea. Besides a general analysis of the sensor's signal quality during sleep, the evaluation focuses on heart rate dynamics and time-variant oxygen saturation. In addition, several methods to derive respiration rate from photoplethysmographic signals are examined and discussed. Results from the in-ear sensor are compared with standard polysomnography monitoring and demonstrate that this novel system allows long-term nocturnal measurement of heart rate, oxygen saturation and respiratory rate with sufficient accuracy.
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Affiliation(s)
- Boudewijn Venema
- RWTH Aachen University Philips Chair for Medical Information Technology (MedIT) Aachen Germany 52074
| | - Johannes Schiefer
- RWTH Aachen University Hospital Department of Neurology Aachen Germany 52074
| | - Vladimir Blazek
- RWTH Aachen University Philips Chair for Medical Information Technology (MedIT) Aachen Germany 52074
| | - Nikolai Blanik
- RWTH Aachen University Philips Chair for Medical Information Technology (MedIT) Aachen Germany 52074
| | - Steffen Leonhardt
- RWTH Aachen University Philips Chair for Medical Information Technology (MedIT) Aachen Germany 52074
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Kim H, Kim MS, Lee JE, Kim JW, Lee CH, Yoon IY, Rhee CS. Treatment outcomes and compliance according to obesity in patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol 2013; 270:2885-90. [PMID: 23455579 DOI: 10.1007/s00405-013-2397-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/05/2013] [Indexed: 11/25/2022]
Abstract
The objective of this study was to assess treatment outcomes and compliance according to obesity among groups of patients with obstructive sleep apnea (OSA) receiving different treatments. A total of 297 patients with OSA treated between 2006 and 2009 underwent pre- and post-treatment polysomnography. One hundred and fifty-one patients were treated with continuous airway positive pressure (CPAP), 76 with mandible advancement device (MAD), and 70 with oropharyngeal surgery. All patients were classified according to obesity. Treatment success rate and compliance of CPAP were analyzed according to obesity. For each treatment modality, the overall treatment success rate was not significantly different between obese and non-obese patients. However, the oxygen desaturation index was different in patients who were treated with MAD and surgery. Additionally, obese patients with severe OSA showed an unfavorable response to CPAP treatment. For CPAP compliance, obese patients showed a tendency to be highly compliant with CPAP treatment at 12 months than non-obese patients. This study showed that obesity might be a factor in determining the success or failure of treatment. Additionally, obesity may be a predictive factor to determine CPAP compliance.
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Affiliation(s)
- Heejin Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
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Chouchou F, Poupard L, Philippe C, Court-Fortune I, Barthélémy JC, Roche F. Thoracic impedance, in association with oximetry, in a multi-modal ECG Holter system is useful for screening sleep disordered breathing. Int J Cardiol 2013; 163:100-2. [DOI: 10.1016/j.ijcard.2012.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 06/23/2012] [Indexed: 10/28/2022]
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50
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Probabilistic neural network approach for the detection of SAHS from overnight pulse oximetry. Med Biol Eng Comput 2012; 51:305-15. [PMID: 23160897 DOI: 10.1007/s11517-012-0995-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/03/2012] [Indexed: 10/27/2022]
Abstract
Diagnosis of sleep apnea hypopnoea syndrome (SAHS) depends on the apnea-hypopnea index determined by the standard in-laboratory overnight polysomnography (PSG). PSG is a costly, labor intensive and, at times, inaccessible approach. Because of the high demand, the need for timely diagnosis and the associated costs, novel methods for SAHS detection are required. In this study, a novel multivariate system is proposed for SAHS detection from the analysis of overnight blood oxygen saturation (SpO2). 115 subjects with SAHS suspicion were studied. A starting set of 17 time domain, stochastic, frequency-domain and nonlinear features were initially computed from SpO2 recordings. Sequential forward feature selection and a probabilistic neural network with leave-one-out cross-validation were applied. Oxygen desaturations below a 4 % threshold within 30 s (ODI430), restorations of 4 % within 10 s (RES4), median value (Sat50), SD1 Poincaré descriptor and the relative power in the 0.013-0.067 Hz frequency band (PSD15/75) formed the optimum features subset. 92.4 % sensitivity and 95.9 % specificity were achieved. Results significantly outperformed the univariate and multivariate approaches reported in literature. The outcome is a simple cost-effective tool that could be used as an alternative or supplementary method in a domiciliary approach to early diagnosis of SAHS.
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