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Muñoz Rojo M, Pramono RXA, Devani N, Thomas M, Mandal S, Rodriguez-Villegas E. Validation of Tracheal Sound-Based Respiratory Effort Monitoring for Obstructive Sleep Apnoea Diagnosis. J Clin Med 2024; 13:3628. [PMID: 38930155 PMCID: PMC11204436 DOI: 10.3390/jcm13123628] [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: 04/04/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Respiratory effort is considered important in the context of the diagnosis of obstructive sleep apnoea (OSA), as well as other sleep disorders. However, current monitoring techniques can be obtrusive and interfere with a patient's natural sleep. This study examines the reliability of an unobtrusive tracheal sound-based approach to monitor respiratory effort in the context of OSA, using manually marked respiratory inductance plethysmography (RIP) signals as a gold standard for validation. Methods: In total, 150 patients were trained on the use of type III cardiorespiratory polygraphy, which they took to use at home, alongside a neck-worn AcuPebble system. The respiratory effort channels obtained from the tracheal sound recordings were compared to the effort measured by the RIP bands during automatic and manual marking experiments. A total of 133 central apnoeas, 218 obstructive apnoeas, 263 obstructive hypopneas, and 270 normal breathing randomly selected segments were shuffled and blindly marked by a Registered Polysomnographic Technologist (RPSGT) in both types of channels. The RIP signals had previously also been independently marked by another expert clinician in the context of diagnosing those patients, and without access to the effort channel of AcuPebble. The classification achieved with the acoustically obtained effort was assessed with statistical metrics and the average amplitude distributions per respiratory event type for each of the different channels were also studied to assess the overlap between event types. Results: The performance of the acoustic effort channel was evaluated for the events where both scorers were in agreement in the marking of the gold standard reference channel, showing an average sensitivity of 90.5%, a specificity of 98.6%, and an accuracy of 96.8% against the reference standard with blind expert marking. In addition, a comparison using the Embla Remlogic 4.0 automatic software of the reference standard for classification, as opposed to the expert marking, showed that the acoustic channels outperformed the RIP channels (acoustic sensitivity: 71.9%; acoustic specificity: 97.2%; RIP sensitivity: 70.1%; RIP specificity: 76.1%). The amplitude trends across different event types also showed that the acoustic channels exhibited a better differentiation between the amplitude distributions of different event types, which can help when doing manual interpretation. Conclusions: The results prove that the acoustically obtained effort channel extracted using AcuPebble is an accurate, reliable, and more patient-friendly alternative to RIP in the context of OSA.
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Affiliation(s)
| | - Renard Xaviero Adhi Pramono
- Wearable Technologies Lab, Department of Electrical and Electronic Engineering, Imperial College of Science Technology and Medicine, London SW7 2BX, UK; (R.X.A.P.); (E.R.-V.)
| | - Nikesh Devani
- Thoracic Medicine, Royal Free London NHS Foundation Trust, London NW3 2QG, UK; (N.D.); (S.M.)
| | | | - Swapna Mandal
- Thoracic Medicine, Royal Free London NHS Foundation Trust, London NW3 2QG, UK; (N.D.); (S.M.)
| | - Esther Rodriguez-Villegas
- Wearable Technologies Lab, Department of Electrical and Electronic Engineering, Imperial College of Science Technology and Medicine, London SW7 2BX, UK; (R.X.A.P.); (E.R.-V.)
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2
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Kent DT, Scott WC, Ye C, Fabbri D. Objective Pharyngeal Phenotyping in Obstructive Sleep Apnea With High-Resolution Manometry. Otolaryngol Head Neck Surg 2023; 169:164-175. [PMID: 36939475 DOI: 10.1002/ohn.257] [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: 08/22/2022] [Revised: 12/05/2022] [Accepted: 12/17/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Drug-induced sleep endoscopy (DISE) is a commonly used diagnostic tool for surgical procedural selection in obstructive sleep apnea (OSA), but it is expensive, subjective, and requires sedation. Here we present an initial investigation of high-resolution pharyngeal manometry (HRM) for upper airway phenotyping in OSA, developing a software system that reliably predicts pharyngeal sites of collapse based solely on manometric recordings. STUDY DESIGN Prospective cross-sectional study. SETTING An academic sleep medicine and surgery practice. METHODS Forty participants underwent simultaneous HRM and DISE. A machine learning algorithm was constructed to estimate pharyngeal level-specific severity of collapse, as determined by an expert DISE reviewer. The primary outcome metrics for each level were model accuracy and F1-score, which balances model precision against recall. RESULTS During model training, the average F1-score across all categories was 0.86, with an average weighted accuracy of 0.91. Using a holdout test set of 9 participants, a K-nearest neighbor model trained on 31 participants attained an average F1-score of 0.96 and an average accuracy of 0.97. The F1-score for prediction of complete concentric palatal collapse was 0.86. CONCLUSION Our findings suggest that HRM may enable objective and dynamic mapping of the pharynx, opening new pathways toward reliable and reproducible assessment of this complex anatomy in sleep.
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Affiliation(s)
- David T Kent
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William C Scott
- Department of Otolaryngology-Head and Neck Surgery, Nashville VA Medical Center, Nashville, Tennessee, USA
| | - Cheng Ye
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Frange C, Franco AM, Brasil E, Hirata RP, Lino JA, Mortari DM, Ykeda DS, Leocádio-Miguel MA, D’Aurea CVR, Silva LOE, Telles SCL, Furlan SF, Peruchi BB, Leite CF, Yagihara FT, Campos LD, Ulhôa MA, Cruz MGDR, Beidacki R, Santos RB, de Queiroz SS, Barreto S, Piccin VS, Coelho FMS, Studart L, Assis M, Drager LF. Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines. Sleep Sci 2022; 15:515-573. [PMID: 36419815 PMCID: PMC9670776 DOI: 10.5935/1984-0063.20220083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 08/13/2024] Open
Abstract
This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.
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Affiliation(s)
- Cristina Frange
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de
Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) - São
Paulo - SP - Brazil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
| | - Aline Marques Franco
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Neurociências e Ciências do
Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de
São Paulo (FMRP-USP) - Ribeirão Preto - SP - Brazil
| | - Evelyn Brasil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Terapia Intensiva, Hospital Israelita Albert
Einstein (HIAE) - São Paulo - SP - Brazil
| | - Raquel Pastrello Hirata
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório de Pesquisa em Fisioterapia Pulmonar,
Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL) - Londrina -
PR - Brazil
| | - Juliana Arcanjo Lino
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Ciências Médicas, Universidade Federal do
Ceará (UFC) - Fortaleza - CE - Brazil
| | - Daiana Moreira Mortari
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Universidade Federal do Rio Grande do Sul - Porto Alegre - RS -
Brazil
| | - Daisy Satomi Ykeda
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Curso de Fisioterapia, Universidade Estadual do Piauí
(UESPI) - Teresina - PI - Brazil
| | - Mario André Leocádio-Miguel
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisiologia e Comportamento, Universidade Federal do
Rio Grande do Norte - Natal - RN - Brazil
| | | | - Luciana Oliveira e Silva
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Ciências da Saúde, Universidade
Federal de Uberlândia (UFU) - Uberlândia - MG - Brazil
| | | | - Sofia Fontanello Furlan
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Unidade de Hipertensão, Instituto do Coração
(InCor), Faculdade de Medicina, Universidade de São Paulo (USP) - São
Paulo - SP - Brazil
| | - Bruno Búrigo Peruchi
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório de Neurociência, Universidade do Estado
de Santa Catarina (UNESC) - Criciúma - SC - Brazil
| | - Camila Ferreira Leite
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisioterapia, UFC; Programas de Mestrado em
Fisioterapia e Funcionalidade, e Mestrado em Ciências Cardiovasculares, UFC -
Fortaleza - CE - Brazil
| | - Fabiana Tokie Yagihara
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Setor de Neurofisiologia Clínica, Departamento de
Neurologia e Neurocirurgia, EPM, UNIFESP - São Paulo - SP - Brazil
| | | | - Melissa Araújo Ulhôa
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Instituto Metropolitano de Ensino Superior, Faculdade de Medicina
do Vale do Aço (UNIVAÇO) - Ipatinga - MG - Brazil
| | | | - Ricardo Beidacki
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Faculdade Inspirar, Unidade Porto Alegre - Porto Alegre - RS -
Brazil
| | - Ronaldo Batista Santos
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisioterapia, Hospital Universitário, USP -
São Paulo - Brazil
| | | | - Simone Barreto
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Instituto do Sono, Associação Fundo Incentivo
à Pesquisa - São Paulo - Brazil
| | - Vivien Schmeling Piccin
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório do Sono, Divisão de Pneumologia do
Instituto do Coração (InCor), FMUSP, USP - São Paulo - SP -
Brazil
| | - Fernando Morgadinho Santos Coelho
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de
Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) - São
Paulo - SP - Brazil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Psicobiologia, EPM, UNIFESP - São Paulo -
SP - Brazil
| | - Luciana Studart
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Universidade Federal de Pernambuco - Recife - PE - Brazil
| | - Marcia Assis
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Clínica do Sono de Curitiba, Hospital São Lucas -
Curitiba - PR - Brazil
| | - Luciano F. Drager
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Unidade de Hipertensão, Instituto do Coração
(InCor), Faculdade de Medicina, Universidade de São Paulo (USP) - São
Paulo - SP - Brazil
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Sabil A, Launois S. Tracheal Sound Analysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:265-280. [PMID: 36217090 DOI: 10.1007/978-3-031-06413-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tracheal sound sensors provide multiple respiratory signals that are valuable for studying upper airway characteristics. This chapter reviews the original work and ongoing research on tracheal sound analysis in relation to upper airway obstruction during sleep. Past and current research suggest that being associated with other sleep study recording sensors and advanced signal processing techniques, tracheal sound analysis can extensively contribute to the diagnosis and assessment of sleep-disordered breathing.
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Pepin JL, Le-Dong NN, Cuthbert V, Coumans N, Tamisier R, Malhotra A, Martinot JB. Mandibular Movements are a Reliable Noninvasive Alternative to Esophageal Pressure for Measuring Respiratory Effort in Patients with Sleep Apnea Syndrome. Nat Sci Sleep 2022; 14:635-644. [PMID: 35444480 PMCID: PMC9013709 DOI: 10.2147/nss.s346229] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/07/2022] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Differentiation between obstructive and central apneas and hypopneas requires quantitative measurement of respiratory effort (RE) using esophageal pressure (PES), which is rarely implemented. This study investigated whether the sleep mandibular movements (MM) signal recorded with a tri-axial gyroscopic chin sensor (Sunrise, Namur, Belgium) is a reliable surrogate of PES in patients with suspected obstructive sleep apnea (OSA). PATIENTS AND METHODS In-laboratory polysomnography (PSG) with PES and concurrent MM monitoring was performed. PSGs were scored manually using AASM 2012 rules. Data blocks (n=8042) were randomly sampled during normal breathing (NB), obstructive or central apnea/hypopnea (OA/OH/CA/CH), respiratory effort-related arousal (RERA), and mixed apnea (MxA). Analyses were evaluation of the similarity and linear correlation between PES and MM using the longest common subsequence (LCSS) algorithm and Pearson's coefficient; description of signal amplitudes; estimation of the marginal effect for crossing from NB to a respiratory disturbance for a given change in MM signal using a mixed linear-regression. RESULTS Participants (n=38) had mild to severe OSA (median AH index 28.9/h; median arousal index 23.2/h). MM showed a high level of synchronization with concurrent PES signals. Distribution of MM amplitude differed significantly between event types: median (95% confidence interval) values of 0.60 (0.16-2.43) for CA, 0.83 (0.23-4.71) for CH, 1.93 (0.46-12.43) for MxA, 3.23 (0.72-18.09) for OH, and 6.42 (0.88-26.81) for OA. Mixed regression indicated that crossing from NB to central events would decrease MM signal amplitude by -1.23 (CH) and -2.04 (CA) units, while obstructive events would increase MM amplitude by +3.27 (OH) and +6.79 (OA) units (all p<10-6). CONCLUSION In OSA patients, MM signals facilitated the measurement of specific levels of RE associated with obstructive, central or mixed apneas and/or hypopneas. A high degree of similarity was observed with the PES gold-standard signal.
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Affiliation(s)
- Jean-Louis Pepin
- HP2 Laboratory, Inserm U1300, University Grenoble Alpes, Grenoble, France
| | | | - Valérie Cuthbert
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
| | - Nathalie Coumans
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1300, University Grenoble Alpes, Grenoble, France
| | - Atul Malhotra
- University of California San Diego, La Jolla, CA, USA
| | - Jean-Benoit Martinot
- Sleep Laboratory, CHU Université Catholique de Louvain (UCL) Namur Site Sainte-Elisabeth, Namur, Belgium.,Institute of Experimental and Clinical Research, UCL Bruxelles Woluwe, Brussels, Belgium
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6
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Tolbert TM, Parekh A, Sands SA, Mooney AM, Ayappa I, Rapoport DM. Quantification of airway conductance from noninvasive ventilatory drive in patients with sleep apnea. J Appl Physiol (1985) 2021; 131:1640-1652. [PMID: 34498947 PMCID: PMC8616604 DOI: 10.1152/japplphysiol.00387.2021] [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: 06/02/2021] [Revised: 08/18/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Upper airway conductance, the ratio of inspiratory airflow to inspiratory effort, quantifies the degree of airway obstruction in hypopneas observed in sleep apnea. We evaluated the ratio of ventilation to noninvasive ventilatory drive as a surrogate of conductance. Furthermore, we developed and tested a refinement of noninvasive drive to incorporate the interactions of inspiratory flow, pressure, and drive to better estimate conductance. Hypopneas were compiled from existing polysomnography studies with esophageal catheterization in 18 patients with known or suspected sleep apnea, totaling 1,517 hypopneas during NREM sleep. For each hypopnea, reference standard conductance was calculated as the ratio of peak inspiratory flow to esophageal pressure change during inspiration. Ventilatory drive was calculated using the algorithm developed by Terrill et al. and then mathematically modified according to the presence or absence of flow limitation to noninvasively estimate esophageal pressure. The ratio of ventilation to ventilatory drive and the ratio of peak inspiratory flow to estimated esophageal pressure were each compared with the reference standard for all hypopneas and for median values from individual patients. Hypopnea ventilation to drive ratios were of limited correlation with the reference standard (R2 = 0.17, individual hypopneas; R2 = 0.03, median patient values). Modification of drive to estimated pressure yielded estimated conductance, which strongly correlated with reference standard conductance (R2 = 0.49, individual hypopneas; R2 = 0.77, median patient values). We conclude that the severity of airway obstruction during hypopneas may be estimated from noninvasive drive by accounting for mechanical effects of flow on pressure. NEW & NOTEWORTHY Classification of hypopneas as obstructive (decreased upper airway conductance) or central (decreased inspiratory flow commensurate with decreased effort) is complicated by the requirement of invasive methods, such as esophageal manometry. Here, we demonstrate that using a few esophageal pressure measurements to account for the interactions between inspiratory flow, pressure, and noninvasive ventilatory drive allows estimation of upper airway conductance. Further studies may use these findings to quantify airway obstruction completely noninvasively.
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Affiliation(s)
- Thomas M Tolbert
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ankit Parekh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Anne M Mooney
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Indu Ayappa
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David M Rapoport
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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7
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Parekh A, Tolbert TM, Mooney AM, Ramos-Cejudo J, Osorio RS, Treml M, Herkenrath SD, Randerath WJ, Ayappa I, Rapoport DM. Endotyping Sleep Apnea One Breath at a Time: An Automated Approach for Separating Obstructive from Central Sleep Disordered Breathing. Am J Respir Crit Care Med 2021; 204:1452-1462. [PMID: 34449303 PMCID: PMC8865720 DOI: 10.1164/rccm.202011-4055oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale Determining whether an individual has obstructive or central sleep apnea is fundamental to selecting the appropriate treatment. Objectives Here we derive an automated breath-by-breath probability of obstruction, as a surrogate of gold-standard upper airway resistance, using hallmarks of upper airway obstruction visible on clinical sleep studies. Methods From five nocturnal polysomnography signals (airflow, thoracic and abdominal effort, oxygen saturation, and snore), nine features were extracted and weighted to derive the breath-by-breath probability of obstruction (Pobs). A development and initial test set of 29 subjects (development = 6, test = 23) (New York, NY) and a second test set of 39 subjects (Solingen, Germany), both with esophageal manometry, were used to develop Pobs and validate it against gold-standard upper airway resistance. A separate dataset of 114 subjects with 2 consecutive nocturnal polysomnographies (New York, NY) without esophageal manometry was used to assess the night-to-night variability of Pobs. Measurements and Main Results A total of 1,962,229 breaths were analyzed. On a breath-by-breath level, Pobs was strongly correlated with normalized upper airway resistance in both test sets (set 1: cubic adjusted [adj.] R2 = 0.87, P < 0.001, area under the receiver operating characteristic curve = 0.74; set 2: cubic adj. R2 = 0.83, P < 0.001, area under the receiver operating characteristic curve = 0.7). On a subject level, median Pobs was associated with the median normalized upper airway resistance (set 1: linear adj. R2 = 0.59, P < 0.001; set 2: linear adj. R2 = 0.45, P < 0.001). Median Pobs exhibited low night-to-night variability [intraclass correlation(2, 1) = 0.93]. Conclusions Using nearly 2 million breaths from 182 subjects, we show that breath-by-breath probability of obstruction can reliably predict the overall burden of obstructed breaths in individual subjects and can aid in determining the type of sleep apnea.
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Affiliation(s)
- Ankit Parekh
- Icahn School of Medicine at Mount Sinai, 5925, Pulmonary, Critical Care and Sleep Medicine, New York, New York, United States;
| | - Thomas M Tolbert
- Mount Sinai School of Medicine, 5925, New York, New York, United States
| | - Anne M Mooney
- Icahn School of Medicine at Mount Sinai, 5925, Pulmonary, Critical Care and Sleep Medicine, New York, New York, United States
| | | | | | - Marcel Treml
- Krankenhaus Bethanien gGmbH, Department of Pneumology, Allergology and Sleep Medicine, Solingen, Germany.,Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Simon-Dominik Herkenrath
- Krankenhaus Bethanien gGmbH, Department of Pneumology, Allergology and Sleep Medicine, Solingen, Germany.,Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Winfried J Randerath
- Krankenhaus Bethanien gGmbH, Department of Pneumology, Allergology and Sleep Medicine, Solingen, Germany.,Institute of Pneumology at the University of Witten / Herdecke, Pneumology, Solingen, Germany
| | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, 5925, Pulmonary, Critical Care and Sleep Medicine, New York, New York, United States
| | - David M Rapoport
- Icahn School of Medicine at Mount Sinai, 5925, New York, New York, United States
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8
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Olafsson TA, Steinsvik EA, Bachmann-Harildstad G, Hrubos-Strøm H. A validation study of an esophageal probe-based polygraph against polysomnography in obstructive sleep apnea. Sleep Breath 2021; 26:575-584. [PMID: 34181175 PMCID: PMC9130176 DOI: 10.1007/s11325-021-02374-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to validate the automatically scored results of an esophageal probe-based polygraph system (ApneaGraph® Spiro) against manually scored polysomnography (Nox A1, PSG) results. We compared the apnea-hypopnea index, oxygen saturation index, and respiratory disturbance index of the devices. METHODS Consenting patients, referred for obstructive sleep apnea workup, were tested simultaneously with the ApneaGraph® Spiro and Nox A1® polysomnograph. Each participant made one set of simultaneous registrations for one night. PSG results were scored independently. Apnea-hypopnea index, oxygen desaturation index, and respiratory disturbance index were compared using Pearson's correlation and scatter plots. Sensitivity, specificity, and positive likelihood ratio of all indices at 5, 15, and 30 were calculated. RESULTS A total of 83 participants had successful registrations. The apnea-hypopnea index showed sensitivity of 0.83, specificity of 0.95, and a positive likelihood ratio of 5.11 at an index cutoff of 15. At a cutoff of 30, the positive likelihood ratio rose to 31.43. The respiratory disturbance index showed high sensitivity (> 0.9) at all cutoffs, but specificity was below 0.5 at all cutoffs. Scatterplots revealed overestimation in mild OSA and underestimation in severe OSA for all three indices. CONCLUSIONS The ApneaGraph® Spiro performed acceptably when OSA was defined by an AHI of 15. The equipment overestimated mild OSA and underestimated severe OSA, compared to the PSG.
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Affiliation(s)
- Thorarinn Arnar Olafsson
- Department of Otorhinolaryngology, Akershus University Hospital, PO 1000 1470, Lørenskog, Norway. .,Faculty of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Eivind Andreas Steinsvik
- Department of Otorhinolaryngology, Akershus University Hospital, PO 1000 1470, Lørenskog, Norway
| | - Gregor Bachmann-Harildstad
- Department of Otorhinolaryngology, Akershus University Hospital, PO 1000 1470, Lørenskog, Norway.,Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, PO 1000 1470, Lørenskog, Norway.,Faculty of Basic Medical Sciences, University of Oslo, Oslo, Norway
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9
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Wirth M, Bautz M, von Meyer F, Hofauer B, Strassen U, Heiser C. Obstruction level associated with outcome in hypoglossal nerve stimulation. Sleep Breath 2021; 26:419-427. [PMID: 34091793 PMCID: PMC8857010 DOI: 10.1007/s11325-021-02396-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 03/30/2021] [Accepted: 05/04/2021] [Indexed: 01/14/2023]
Abstract
Purpose Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue protrusion and consecutive alleviation of obstructions at the tongue base level (lower obstructions). Furthermore, obstructions at the soft palate level (upper obstructions) may be prevented through palatoglossal coupling as seen on sleep endoscopy. However, it has not been studied if the distribution of obstruction level during a whole night measurement is a relevant factor for the treatment outcome. Methods Obstruction levels were measured with a manometry system during a whole night of sleep in 26 patients with OSA (f = 1, m = 25; age 59.4 ± 11.3; BMI = 29.6 ± 3.6) either before (n = 9) or after sHNS implantation (n = 12). Five patients received a measurement before and after implantation. Obstructions were categorized into velar (soft palate and above), infravelar (below soft palate), and multilevel obstructions. An association between obstruction level and treatment outcome was calculated. Results The mean distribution of preoperative obstruction level could be divided into the following: 38% velar, 46% multilevel, and 16% infravelar obstructions. Patients with a good treatment response (defined as AHI < 15/h and AHI reduction of 50%) had fewer preoperative velar obstructions compared to non-responder (17% vs. 54%, p-value = 0.006). In patients measured after sHNS implantation, a significantly higher rate of multilevel obstructions per hour was measured in non-responders (p-value = 0.012). Conclusions Selective hypoglossal nerve stimulation was more effective in patients with fewer obstructions at the soft palate level. Manometry may be a complementary diagnostic procedure for the selection of patients for HNS.
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Affiliation(s)
- Markus Wirth
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Maximilian Bautz
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany
| | - Franziska von Meyer
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany
| | - Benedikt Hofauer
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany
| | - Ulrich Strassen
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany
| | - Clemens Heiser
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Munich, Germany
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10
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Amaddeo A, Sabil A, Arroyo JO, De Sanctis L, Griffon L, Baffet G, Khirani S, Fauroux B. Tracheal sounds for the scoring of sleep respiratory events in children. J Clin Sleep Med 2020; 16:361-369. [PMID: 31992398 DOI: 10.5664/jcsm.8206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Oronasal thermistor and nasal cannula are recommended for the scoring of respiratory events (RE) but these sensors are poorly tolerated in children. The aim of the study was to evaluate tracheal sounds (TS) and suprasternal pressure (SSP) for the scoring of RE during sleep in children. METHODS We compared the detection and characterization of RE by AASM-recommended sensors ("AASM" scoring), with the detection and characterization of RE by the combination of TS and SSP with respiratory inductance plethysmography-sum (TS-RIP scoring), and TS and SSP only (TS scoring). RESULTS The recordings of 17 patients were analyzed. The TS, SSP, and RIP flow signals were present during 95%, 95%, and 99% of the validated recording time, respectively, as compared to 79% and 86% for nasal cannula and oronasal thermistor. A total of 1,456 RE were scored with the "AASM" scoring, 1,335 with the TS-RIP scoring, and 1,311 with the TS scoring. Sensitivity for apnea and hypopnea detection was 88% and 84% for the TS-RIP scoring, and 86% and 77% for the TS scoring. For apnea characterization, the TS-RIP scoring sensitivities and specificities were 97% and 100%, 76% and 98%, and 95% and 97%, for obstructive, mixed, and central apnea, respectively. For the TS scoring, they were 95% and 100%, 95% and 97%, and 91% and 97%, respectively. CONCLUSIONS TS and SSP + RIP-sum has a good sensitivity and specificity for the detection and characterization of apnea and hypopnea in children. TS and SSP alone have good sensitivity and specificity for apnea detection and characterization but lower sensitivity for hypopnea detection.
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Affiliation(s)
- Alessandro Amaddeo
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Paris Descartes University, EA 7330, VIFASOM, Paris, France
| | - Abdelkebir Sabil
- Cloud Sleep Lab, Paris, France.,Cidelec, Sainte Gemmes sur Loire, France
| | - Jorge Olmo Arroyo
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France
| | - Livio De Sanctis
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France
| | - Lucie Griffon
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Paris Descartes University, EA 7330, VIFASOM, Paris, France
| | | | - Sonia Khirani
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,ASV Santé, Gennevilliers, France
| | - Brigitte Fauroux
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Paris Descartes University, EA 7330, VIFASOM, Paris, France
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11
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Chuang SY, Teng A, Butler J, Gandevia S, Narang I, Briggs N, Selvadurai H, Jaffe A. Quantitative assessment of nocturnal neural respiratory drive in children with and without obstructive sleep apnoea using surface EMG. Exp Physiol 2019; 104:755-764. [PMID: 30821402 DOI: 10.1113/ep087441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/27/2019] [Indexed: 01/10/2023]
Abstract
NEW FINDINGS What is the central question of this study? Recent studies have suggested potential utility of non-normalized respiratory muscle EMG as an index of neural respiratory drive (NRD). Whether NRD measured using non-normalized surface EMG of the lateral chest wall overlying the diaphragm (sEMGcw) recorded during nocturnal clinical polysomnography can differentiate children with and without obstructive sleep apnoea (OSA) is not known. What is the main finding and its importance? Non-normalized sEMGcw was increased in children with OSA and an additional group of snoring children without OSA but subjectively increased respiratory effort compared with primary snorers. The sEMGcw has potential clinical utility in evaluation of children with sleep-disordered breathing as an objective, non-invasive, non-volitional marker of NRD. ABSTRACT Our aim was to investigate whether neural respiratory drive measured by non-normalized surface EMG recorded from the chest wall overlying the diaphragm (sEMGcw) differentiates children with and without obstructive sleep apnoea (OSA). Polysomnography data of children aged 0-18 years were divided into the following three groups: (i) primary snorers (PS); (ii) snoring children without OSA but with increased work of breathing (incWOB; subjective physician report of increased respiratory effort during sleep); and (iii) children with OSA [obstructive apnoea-hypopnoea index (OAHI) >1 h-1 ]. Excerpts of sEMGcw obtained during tidal unobstructed breathing from light, deep and rapid eye movement sleep were exported for quantitative analysis. Overnight polysomnography data from 45 PS [median age 4.4 years (interquartile range 3.0-7.7 years), OAHI 0 h-1 (0.0-0.2 h-1 )], 19 children with incWOB [age 2.8 years (2.4-5.7 years), OAHI 0.1 h-1 (0.0-0.4 h-1 )] and 27 children with OSA [age 3.6 years (2.6-6.2 years), OAHI 3.7 h-1 (2.3-6.9 h-1 )] were analysed. The sEMGcw was higher in those with OSA [8.47 μV (5.98-13.07 μV); P < 0.0001] and incWOB [8.97 μV (5.94-13.43 μV); P < 0.001] compared with PS [4.633 μV (2.98-6.76 μV)]. There was no significant difference in the sEMGcw between children with incWOB and OSA (P = 0.78). Log sEMGcw remained greater in children with OSA and incWOB compared with PS after age, body mass index centiles, sleep stages and sleep positions were included in the mixed linear models (P < 0.0001). The correlation between sEMGcw and OAHI in children without OSA was small (rs = 0.254, P = 0.04). The sEMGcw is increased in children with OSA and incWOB compared with PS.
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Affiliation(s)
- Sandra Y Chuang
- Respiratory Department, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Arthur Teng
- School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospital, Randwick, NSW, Australia.,Sleep Medicine Department, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Jane Butler
- Neuroscience Research Australia, Randwick, NSW, Australia.,School of Medical Sciences, Wallace Wurth Building, University of New South Wales, Kensington, NSW, Australia
| | - Simon Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia.,School of Medical Sciences, Wallace Wurth Building, University of New South Wales, Kensington, NSW, Australia
| | - Indra Narang
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Nancy Briggs
- School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Hiran Selvadurai
- Respiratory Department, Children's Hospital Westmead, Westmead, NSW, Australia
| | - Adam Jaffe
- Respiratory Department, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospital, Randwick, NSW, Australia
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12
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Hanif U, Schneider LD, Trap L, Leary EB, Moore H, Guilleminault C, Jennum P, Sorensen HBD, Mignot EJM. Non-invasive machine learning estimation of effort differentiates sleep-disordered breathing pathology. Physiol Meas 2019; 40:025008. [DOI: 10.1088/1361-6579/ab0559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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13
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Sabil A, Schöbel C, Glos M, Gunther A, Veauthier C, Arens P, Fietze I, Penzel T. Apnea and hypopnea characterization using esophageal pressure, respiratory inductance plethysmography, and suprasternal pressure: a comparative study. Sleep Breath 2019; 23:1169-1176. [PMID: 30729405 DOI: 10.1007/s11325-019-01793-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/12/2019] [Accepted: 01/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine if recording of suprasternal pressure (SSP) can classify apneas and hypopneas as reliably as respiratory inductance plethysmography (RIP) belts and to compare the two methods to classification with esophageal pressure (Pes), the reference method for assessing respiratory effort. METHODS In addition to polysomnographic recordings that included Pes, SSP was recorded. Recordings from 32 patients (25 males, mean age 66.7 ± 15.3 years, and mean BMI 30.1 ± 4.5 kg/m2) were used to compare the classification of detected apneas and hypopneas by three methods of respiratory effort evaluation (Pes, RIP belts, and SSP). Signals were analyzed randomly and independently from each other. All recordings were analyzed according to AASM guidelines. RESULTS Using Pes as a reference for apnea characterization, the Cohen kappa (κ) was 0.93 for SSP and 0.87 for the RIP. The sensitivity/specificity of SSP was 97.0%/96.9% for obstructive, 93.9%/98.3% for central, and 94.9%/97.9% for mixed apneas. The sensitivity/specificity of the RIP was 97.4%/91.9% for obstructive, 87.5%/97.9% for central, and 85.6%/96.6% for mixed apneas. For hypopnea characterization using the Pes as a reference, κ was 0.92 for SSP and 0.86 for the RIP. The sensitivity/specificity of SSP was 99.7%/97.6% for obstructive and 97.6%/99.7% for central. The sensitivity/specificity of the RIP was 99.8%/81.1% for obstructive and 81.1%/99.8% for central. CONCLUSIONS These results confirm the excellent agreement in the detection of respiratory effort between SSP, RIP belts, and Pes signals. Thus, we conclude that apnea and hypopnea characterization in adults with SSP is a reliable method.
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Affiliation(s)
| | - Christoph Schöbel
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Glos
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexandra Gunther
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Veauthier
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Arens
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- International Clinical Research Center, Saint Anne's University Hospital Brno, Brno, Czech Republic
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14
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Carter SG, Carberry JC, Grunstein RR, Eckert DJ. Polysomnography with an epiglottic pressure catheter does not alter obstructive sleep apnea severity or sleep efficiency. J Sleep Res 2018; 28:e12773. [DOI: 10.1111/jsr.12773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Danny J. Eckert
- Neuroscience Research Australia (NeuRA) Sydney NSW Australia
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15
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Glos M, Sabil A, Jelavic KS, Schöbel C, Fietze I, Penzel T. Characterization of Respiratory Events in Obstructive Sleep Apnea Using Suprasternal Pressure Monitoring. J Clin Sleep Med 2018; 14:359-369. [PMID: 29458696 DOI: 10.5664/jcsm.6978] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/17/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In obstructive sleep apnea (OSA) esophageal pressure (Pes) is the gold standard for measurement of respiratory effort, and respiratory inductance plethysmography (RIP) is considered an accepted measurement technique. However, the use of RIP could lead to limited accuracy in certain cases and therefore suprasternal pressure (SSP) monitoring might improve the reliability of OSA diagnosis. We aimed to use SSP for the visual characterization of respiratory events in adults and compared results to those obtained by RIP from polysomnography (PSG). METHODS In patients with OSA, a 1-night SSP recording using the PneaVoX sensor (Cidelec, Sainte-Gemmes-sur-Loire, France) was done. In parallel, PSG was performed according to American Academy of Sleep Medicine criteria. A subgroup of patients agreed to have Pes measurement in addition. Characterizations of apneas as obstructive, central, and mixed as well as hypopneas as central and obstructive were done by visual evaluation of SSP, RIP, and Pes in random order by two independent scores (S1 and S2). The sensitivity and specificity of characterization by SSP compared to RIP and to Pes were calculated. RESULTS Synchronous recordings of SSP and PSG were analyzed from n = 34 patients with OSA (AHI 34.1 ± 24.2 events/h); 9 of them had synchronized Pes monitoring as well. Interscorer agreement for apnea characterization as obstructive, central, and mixed based on SSP, RIP, and Pes were found, with R2 values from 0.91-0.99. The sensitivity of SSP in apnea characterization with reference to RIP (S1/S2) was 91.5%/92.3% for obstructive, 82.7%/76.2% for central, and 87.4%/79.9% for mixed. The sensitivity of SSP in apnea characterization with reference to Pes was (S1/S2) 93.1%/92.1% for obstructive, 80.8%/81.6% for central, and 91.7%/90.8% for mixed. Hypopnea was only classified for the nine patients with Pes. CONCLUSIONS This study demonstrated a good agreement in the detection of respiratory effort with the SSP signal using the PneaVoX sensor compared to the RIP belts signals as well as to the Pes signal. These findings were consistently found by two independent scorers. In summary, results suggest that SSP is a reliable signal for the classification of respiratory events and could be used as an additional tool for OSA characterization in clinical practice.
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Affiliation(s)
- Martin Glos
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Christoph Schöbel
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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16
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Wirth M, Schramm J, Bautz M, Hofauer B, Edenharter G, Ott A, Heiser C. Reduced upper obstructions in N3 and increased lower obstructions in REM sleep stage detected with manometry. Eur Arch Otorhinolaryngol 2017; 275:239-245. [PMID: 28975391 DOI: 10.1007/s00405-017-4746-x] [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] [Received: 06/16/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022]
Abstract
In obstructive sleep apnea (OSA), airway obstruction occurs at different anatomic levels. The frequency and location of obstructions play a crucial role in the planning of surgical treatment. The aim of this study was to evaluate the pharyngeal obstruction levels in different sleep stages with manometry in OSA patients. In addition, the manometry results were compared with drug-induced sleep endoscopy (DISE). Forty-one patients with OSA received manometry measurements during one night of sleep. All patients were simultaneously evaluated with polysomnography. The frequency of obstructions in different sleep stages was assessed. Twenty patients were additionally studied with DISE. Obstruction levels detected with manometry were compared with DISE. The frequency of upper and to a lesser extent lower obstructions decreased in sleep stage N3. In rapid eye movement (REM) sleep, lower obstructions increased. The overall proportion of upper and lower obstructions detected with manometry corresponded with DISE in 13 of 20 cases. A significant change in the obstruction levels was detected with manometry in N3 and REM sleep. The reduction of both upper and to a lesser extent lower obstructions in N3 suggests more stable airways in slow-wave sleep. Relevant lower obstructions were not detected in DISE compared to manometry in 5 out of 20 examinations. This could be a potential reason for treatment failure of site-specific surgical OSA treatment when only performing DISE preoperatively. Therefore, manometry could be a useful complementary tool in the preoperative evaluation for OSA.
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Affiliation(s)
- Markus Wirth
- Department of Otolaryngology, Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Muenchen, Germany.
| | - Juliane Schramm
- Department of Otolaryngology, Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Muenchen, Germany
| | - Maximilian Bautz
- Department of Otolaryngology, Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Muenchen, Germany
| | - Benedikt Hofauer
- Department of Otolaryngology, Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Muenchen, Germany
| | - Günther Edenharter
- Department of Anesthesiology, Technical University of Munich, Ismaninger Straße 22, 81675, Muenchen, Germany
| | - Armin Ott
- Institute of Medical Statistics and Epidemiology, Technical University of Munich, Ismaninger Straße 22, 81675, Muenchen, Germany
| | - Clemens Heiser
- Department of Otolaryngology, Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Muenchen, Germany
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17
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Martinot JB, Le-Dong NN, Cuthbert V, Denison S, Silkoff PE, Guénard H, Gozal D, Pepin JL, Borel JC. Mandibular Movements As Accurate Reporters of Respiratory Effort during Sleep: Validation against Diaphragmatic Electromyography. Front Neurol 2017; 8:353. [PMID: 28785240 PMCID: PMC5519525 DOI: 10.3389/fneur.2017.00353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/05/2017] [Indexed: 11/29/2022] Open
Abstract
Context Mandibular movements (MM) are considered as reliable reporters of respiratory effort (RE) during sleep and sleep disordered breathing (SDB), but MM accuracy has never been validated against the gold standard diaphragmatic electromyography (EMG-d). Objectives To assess the degree of agreement between MM and EMG-d signals during different sleep stages and abnormal respiratory events. Methods Twenty-five consecutive adult patients with SDB were studied by polysomnography (PSG) that also included multipair esophageal diaphragm electromyography and a magnetometer to record MM. EMG-d activity (microvolt) and MM (millimeter) amplitudes were extracted by envelope processing. Agreement between signals amplitudes was evaluated by mixed linear regression and cross-correlation function and in segments of PSG including event-free and SDB periods. Results The average total sleep time was 370 ± 18 min and the apnea hypopnea index was 24.8 ± 5.2 events/h. MM and EMG-d amplitudes were significantly cross-correlated: median r (95% CI): 0.67 (0.23–0.96). A mixed linear model showed that for each 10 µV of increase in EMG-d activity, MM amplitude increased by 0.28 mm. The variations in MM amplitudes (median range: 0.11–0.84 mm) between normal breathing, respiratory effort-related arousal, obstructive, mixed, and central apnea periods closely corresponded to those observed with EMG-d activity (median range: 2.11–8.23 µV). Conclusion MM amplitudes change proportionally to diaphragmatic EMG activity and accurately identify variations of RE during normal sleep and SDB.
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Affiliation(s)
| | | | | | | | | | | | - David Gozal
- University of Chicago, Chicago, IL, United States
| | - Jean-Louis Pepin
- CHU de Grenoble, Laboratoire EFCR, Pôle Thorax et Vaisseaux, Grenoble, France.,University Grenoble Alps, HP2 INSERM U1042, Grenoble, France
| | - Jean-Christian Borel
- University Grenoble Alps, HP2 INSERM U1042, Grenoble, France.,AGIR à dom. Association, Meylan, France
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18
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Abstract
Tracheal sounds have been the subject of many research studies. In this review, we describe the state of the art, original work relevant to upper airways obstruction during sleep, and ongoing research concerning the methods used when analysing tracheal sounds. Tracheal sound sensors are a simple and noninvasive means of measurement and are more reliable than other breathing sensors. Developments in acoustic processing techniques and enhancements in tracheal sound signals over the past decade have led to improvements in the accuracy and clinical relevance of diagnoses based on this technology. Past and current research suggests that they may have a significant role in the diagnosis of obstructive sleep apnoea. Tracheal sounds analysis may have a significant role in the diagnosis of obstructive sleep apnoeahttp://ow.ly/f7ax30cAcnP
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Affiliation(s)
- Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
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19
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Jung HJ, Wee JH, Rhee CS, Kim JW. Full-night measurement of level of obstruction in sleep apnea utilizing continuous manometry. Laryngoscope 2017; 127:2897-2902. [DOI: 10.1002/lary.26740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 05/03/2017] [Accepted: 05/23/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Hahn Jin Jung
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungbuk National University College of Medicine, Chungbuk National University Hospital; Cheongju South Korea
| | - Jee Hye Wee
- Department of Otorhinolaryngology; Bundang Jesaeng General Hospital, Deajin Medical Center; Seongnam South Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology; Seoul National University College of Medicine, Seoul National University Bundang Hospital; Seongnam South Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology; Seoul National University College of Medicine, Seoul National University Bundang Hospital; Seongnam South Korea
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20
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Chuang SYC, Teng A, Butler JE, Gandevia SC, Selvadurai H, Jaffe A. Validation of a quantitative method to measure neural respiratory drive in children during sleep. Respir Physiol Neurobiol 2017; 239:75-80. [DOI: 10.1016/j.resp.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 12/27/2022]
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21
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Pulse transit time as a tool to characterize obstructive and central apneas in children. Sleep Breath 2017; 22:311-316. [PMID: 28281031 DOI: 10.1007/s11325-017-1488-3] [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: 10/27/2016] [Revised: 01/23/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The characterization of apneas during polysomnography (PSG) as obstructive or central is a key element of a sleep study. Pulse transit time (PTT) has demonstrated its potential as a noninvasive surrogate marker for inspiratory efforts. The aim of the study was to assess the ability of PTT to classify apneas as central or obstructive, as compared to respiratory inductance plethysmography (RIP) in children. METHODS Overnight PSG with simultaneous PTT recording was performed on 11 consecutive children (mean age 8.9 years, range 1-18.2 years). The same observer scored the apneas using two blinded configurations: (1) the RIP scoring used the nasal pressure, thermistors, thoracic and abdominal movements, and pulse oximetry signals: (2) the PTT scoring used PTT in combination with all the other signals without the thoracic and abdominal movements. RESULTS One hundred fourteen apneas out of a total of 520 respiratory events were analyzed. With RIP, 58 (51%) apneas were scored as obstructive and 56 (49%) as central. Using PTT, 77 (68%) of the apneas were scored as obstructive and 37 (32%) as central. When using PTT, 30 apneas scored as central by RIP were scored as obstructive. PTT was highly sensitive (81%) but poorly specific (46%) in scoring 58 apneas as obstructive. PTT was less sensitive (46%) but highly specific (81%) to score 56 apneas as central. CONCLUSION PTT may be used as an additional tool to RIP to improve the scoring of apneas as obstructive or central in children. The high percentage of artifact is a limitation of PTT.
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Amaddeo A, Fernandez-Bolanos M, Olmo Arroyo J, Khirani S, Baffet G, Fauroux B. Validation of a Suprasternal Pressure Sensor for Sleep Apnea Classification in Children. J Clin Sleep Med 2016; 12:1641-1647. [PMID: 27655466 DOI: 10.5664/jcsm.6350] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 08/08/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The recognition and characterization of respiratory events is crucial when interpreting sleep studies. The aim of the study was to validate the PneaVoX sensor, which integrates the recording of respiratory effort by means of suprasternal pressure (SSP), respiratory flow, and snoring for the classification of sleep apneas in children. METHODS Sleep recordings of 20 children with a median age of 7.5 (0.5-16.5) years were analyzed. Scoring of apneas according to the American Academy of Sleep Medicine (AASM) guidelines using nasal pressure, oronasal thermal sensor and respiratory efforts by means of respiratory inductance plethysmography (RIP), was compared to a scoring using the PneaVoX sensor and nasal pressure, without the oronasal thermal sensor nor RIP, during a dual blind study. RESULTS The percentage of sleep time recording without artifacts was 97%, 97%, 87%, 65%, and 98% for the respiratory flow and SSP from the PneaVoX sensor, oronasal thermal sensor, nasal pressure, and RIP, respectively. As compared to the AASM scoring with RIP, sensitivity and specificity of the SSP for the scoring of central apneas were 75% and 99% for the first reader, and 70% and 100% for the second reader, respectively. Sensitivity and specificity for the scoring of obstructive apneas were 98% and 75%, and 100% and 70%, respectively. A significant number of apneas scored as central by RIP were scored as obstructive by the SSP. CONCLUSIONS The PneaVoX sensor has a high degree of scorability in children. The PneaVoX sensor is a useful adjunct for characterizing apneas.
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Affiliation(s)
- Alessandro Amaddeo
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Paris Descartes University, Paris, France.,Research unit INSERM U 955, team 13, Créteil, France
| | - Marta Fernandez-Bolanos
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France
| | - Jorge Olmo Arroyo
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France
| | - Sonia Khirani
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,ASV Santé, Gennevilliers, France
| | | | - Brigitte Fauroux
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Paris Descartes University, Paris, France.,Research unit INSERM U 955, team 13, Créteil, France
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Jerrentrup L, Canisius S, Wilhelm S, Kesper K, Ploch T, Vogelmeier C, Greulich T, Becker HF. Work of Breathing in Fixed and Pressure Relief Continuous Positive Airway Pressure (C-Flex™): A post hoc Analysis. Respiration 2016; 93:23-31. [PMID: 27871083 DOI: 10.1159/000452423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 10/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Expiratory pressure relief continuous positive airway pressure (pressure relief CPAP; C-Flex™) causes increases in inspiratory duty cycle and shortening of expiratory time. It has been suggested that these changes are caused by an increase in work of breathing. OBJECTIVES We studied the effects of C-Flex on work of breathing and intrinsic positive end-expiratory pressure as compared to fixed CPAP. METHODS Work of breathing was analyzed in 24 patients with obstructive sleep apnea during treatment with fixed CPAP and C-Flex with 3 different pressure relief settings in a randomized order during rapid-eye-movement (REM) and non-REM sleep. Work of breathing was assessed on a breath-by-breath basis using a piezoelectric esophageal pressure catheter and a pneumotachograph for measuring airflow. RESULTS We found there was no increase in inspiratory work of breathing observed using C-Flex compared to fixed CPAP. Instead, we found a linear decrease in inspiratory work of breathing with increasing pressure relief, with a mean difference of 1.22 J/min between CPAP and maximum pressure release (C-Flex 3; 90% of the value with nasal CPAP); however, the decrease was not statistically significant. The decrease in inspiratory work of breathing associated with C-Flex has a significant inverse correlation with BMI. CONCLUSIONS The C-Flex technology does not change work of breathing but shows a tendency towards a reduction of inspiratory work of breathing in patients with a lower BMI using higher C-Flex. The effect is probably caused by diminishing airway resistance generated by the positive end-expiratory pressure. Our findings may lead to additional fields of application of the C-Flex technology, such as chronic obstructive pulmonary disease or muscular dystrophy.
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Affiliation(s)
- Lukas Jerrentrup
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Marburg, Germany
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Vandenbussche NL, Overeem S, van Dijk JP, Simons PJ, Pevernagie DA. Assessment of respiratory effort during sleep: Esophageal pressure versus noninvasive monitoring techniques. Sleep Med Rev 2015; 24:28-36. [DOI: 10.1016/j.smrv.2014.12.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
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M'saad S, Yangui I, Feki W, Abid N, Bahloul N, Marouen F, Chakroun A, Kammoun S. [The syndrome of increased upper airways resistance: What are the clinical features and diagnostic procedures?]. Rev Mal Respir 2015; 32:1002-15. [PMID: 26525135 DOI: 10.1016/j.rmr.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 02/15/2015] [Indexed: 11/17/2022]
Abstract
The upper airway resistance syndrome "UARS" is a poorly defined entity, often described as a moderate variant of the obstructive sleep apnea syndrome. It is associated with respiratory effort-related arousal, absence of obstructive sleep apnea, and absence of significant desaturation. It is a relatively common condition that predominantly affects non-obese young adults, with no predominance in either sex. The degree of upper airway collapsibility during sleep of patients with UARS is intermediate between that of normal subjects and that of patients with mild-to-moderate sleep apnea syndrome. Craniofacial and palatal abnormalities are often noted. Patients frequently complain of a functional somatic syndrome, especially daytime sleepiness and chronic fatigue. Polysomnography with esophageal pressure measurements remains the gold standard diagnostic test. The absence of any neurological abnormality gives UARS a good prognosis and it is potentially reversible if treated early. However, some studies suggest that untreated UARS has an increased risk of arterial hypertension. It can also evolve into obstructive sleep apnea.
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Affiliation(s)
- S M'saad
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie.
| | - I Yangui
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - W Feki
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - N Abid
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - N Bahloul
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - F Marouen
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - A Chakroun
- Service d'oto-rhino-laryngologie, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - S Kammoun
- Service de pneumo-allergologie, CHU Hédi Chaker, 3029 Sfax, Tunisie
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Skiba V, Goldstein C, Schotland H. Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea. J Clin Sleep Med 2015; 11:597-602. [PMID: 25700868 DOI: 10.5664/jcsm.4764] [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: 08/15/2014] [Accepted: 12/31/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE Esophageal manometry (Pes) is the gold standard to detect repetitive episodes of increased respiratory effort followed by arousal (RERAs). Because RERAs are not included in the apnea-hypopnea index (AHI), we often refer patients with symptoms of sleep disordered breathing (SDB) and AHI < 5 for a second polysomnogram (PSG) with Pes. Often, the second PSG will demonstrate AHI > 5, confirming a diagnosis of OSA. We speculate that in most cases of suspected SDB, Pes does not add further diagnostic data and that night-to-night variability in OSA severity results in a first false-negative study. METHODS We conducted a retrospective review of PSGs between 2008 and 2012 in adults with initial PSG negative for OSA followed by a second study (with or without Pes) within 6 mo. RESULTS Of 125 studies that met inclusion criteria, a second study was completed with Pes in 105 subjects. SDB was diagnosed in 73 subjects (68.5%) completing a second PSG with Pes: 49 (46.7%) received a diagnosis based on AHI, and 24 (22.8%) received a diagnosis based on Pes (p = 0.003). There were no statistically significant differences in the mean AHI change between the two PSGs in subjects who completed the second study with or without Pes. CONCLUSIONS In patients with symptoms of SDB and initial PSG with AHI < 5, the majority met criteria for OSA on second PSG by AHI without additional information added by Pes. Because Pes is not widely available and is somewhat invasive, a repeat study without Pes may be sufficient to diagnose SDB.
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Affiliation(s)
- Virginia Skiba
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Cathy Goldstein
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Helena Schotland
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
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Maddison KJ, Shepherd KL, Baker VA, Lawther B, Platt P, Hillman DR, Eastwood PR, Walsh JH. Effects on upper airway collapsibility of presence of a pharyngeal catheter. J Sleep Res 2014; 24:92-9. [PMID: 25131139 DOI: 10.1111/jsr.12193] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Kathleen J. Maddison
- Centre for Sleep Science; School of Anatomy, Physiology and Human Biology; The University of Western Australia; Crawley WA Australia
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - Kelly L. Shepherd
- Centre for Sleep Science; School of Anatomy, Physiology and Human Biology; The University of Western Australia; Crawley WA Australia
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - Vanessa A. Baker
- Centre for Sleep Science; School of Anatomy, Physiology and Human Biology; The University of Western Australia; Crawley WA Australia
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - Bradley Lawther
- Department of Anaesthesia; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - Peter Platt
- Department of Anaesthesia; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - David R. Hillman
- Centre for Sleep Science; School of Anatomy, Physiology and Human Biology; The University of Western Australia; Crawley WA Australia
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - Peter R. Eastwood
- Centre for Sleep Science; School of Anatomy, Physiology and Human Biology; The University of Western Australia; Crawley WA Australia
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - Jennifer H. Walsh
- Centre for Sleep Science; School of Anatomy, Physiology and Human Biology; The University of Western Australia; Crawley WA Australia
- West Australian Sleep Disorders Research Institute; Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Nedlands WA Australia
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Chervin RD, Chung S, O'Brien LM, Hoban TF, Garetz SL, Ruzicka DL, Guire KE, Hodges EK, Felt BT, Giordani BJ, Dillon JE. Periodic leg movements during sleep in children scheduled for adenotonsillectomy: frequency, persistence, and impact. Sleep Med 2014; 15:1362-9. [PMID: 25218486 DOI: 10.1016/j.sleep.2014.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/09/2014] [Accepted: 05/11/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to assess the frequency and potential clinical impact of periodic leg movements during sleep (PLMS), with or without arousals, as recorded incidentally from children before and after adenotonsillectomy (AT). METHODS Children scheduled for AT for any clinical indications who participated in the Washtenaw County Adenotonsillectomy Cohort II were studied at enrollment and again 6 months thereafter. Assessments included laboratory-based polysomnography, a Multiple Sleep Latency Test (MSLT), parent-completed behavioral rating scales, neuropsychological testing, and psychiatric evaluation. RESULTS Participants included 144 children (81 boys) aged 3-12 years. Children generally showed mild to moderate obstructive sleep apnea (median respiratory disturbance index 4.5 (Q1 = 2.0, Q3 = 9.5)) at baseline, and 15 subjects (10%) had at least five periodic leg movements per hour of sleep (PLMI ≥ 5). After surgery, 21 (15%) of n = 137 subjects who had follow-up studies showed PLMI ≥ 5 (p = 0.0067). Improvements were noted after surgery in the respiratory disturbance index; insomnia symptoms; sleepiness symptoms; mean sleep latencies; hyperactive behavior; memory, learning, attention, and executive functioning on NEPSY assessments; and frequency of attention-deficit/hyperactivity disorder (DSM-IV criteria). However, PLMI ≥ 5 failed to show associations with worse morbidity in these domains at baseline or follow-up. New appearance of PLMI ≥ 5 after surgery failed to predict worsening of these morbidities (all p > 0.05), with only one exception (NEPSY) where the magnitude of association was nonetheless negligible. Similar findings emerged for periodic leg movements with arousals (PLMAI ≥ 1). CONCLUSION PLMS, with and without arousals, become more common after AT in children. However, results in this setting did not suggest substantial clinical impact.
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Affiliation(s)
- Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
| | - Seockhoon Chung
- Sleep Disorders Center, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Louise M O'Brien
- Sleep Disorders Center and Departments of Neurology, Oral and Maxillofacial Surgery, and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Timothy F Hoban
- Sleep Disorders Center and Division of Pediatric Neurology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Susan L Garetz
- Sleep Disorders Center and Division of Pediatric Otolaryngology, Department of Otolaryngology and Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Deborah L Ruzicka
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth E Guire
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Elise K Hodges
- Division of Neuropsychology, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Barbara T Felt
- Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Bruno J Giordani
- Division of Neuropsychology, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - James E Dillon
- Department of Psychiatry, Central Michigan University, Mount Pleasant, MI, USA
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Jambhekar S, Carroll JL. Diagnosis of pediatric obstructive sleep disordered breathing: beyond the gold standard. Expert Rev Respir Med 2014; 2:791-809. [DOI: 10.1586/17476348.2.6.791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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30
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Strohl KP, Butler JP, Malhotra A. Mechanical properties of the upper airway. Compr Physiol 2013; 2:1853-72. [PMID: 23723026 DOI: 10.1002/cphy.c110053] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The importance of the upper airway (nose, pharynx, and larynx) in health and in the pathogenesis of sleep apnea, asthma, and other airway diseases, discussed elsewhere in the Comprehensive Physiology series, prompts this review of the biomechanical properties and functional aspects of the upper airway. There is a literature based on anatomic or structural descriptions in static circumstances, albeit studied in limited numbers of individuals in both health and disease. As for dynamic features, the literature is limited to studies of pressure and flow through all or parts of the upper airway and to the effects of muscle activation on such features; however, the links between structure and function through airway size, shape, and compliance remain a topic that is completely open for investigation, particularly through analyses using concepts of fluid and structural mechanics. Throughout are included both historically seminal references, as well as those serving as signposts or updated reviews. This article should be considered a resource for concepts needed for the application of biomechanical models of upper airway physiology, applicable to understanding the pathophysiology of disease and anticipated results of treatment interventions.
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Affiliation(s)
- Kingman P Strohl
- Center for Sleep Disorders Research, Division of Pulmonary, Critical Care, and Sleep Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
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Wibmer T, Schildge B, Fischer C, Brunner S, Kropf-Sanchen C, Rüdiger S, Blanta I, Stoiber KM, Rottbauer W, Schumann C. Impact of continuous, non-invasive blood pressure measurement on sleep quality during polysomnography. Sleep Biol Rhythms 2013. [DOI: 10.1111/sbr.12034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Wibmer
- Department of Internal Medicine II; University Hospital of Ulm; Ulm Germany
| | - Benedikt Schildge
- Department of Internal Medicine II; University Hospital of Ulm; Ulm Germany
| | - Christoph Fischer
- Interdisciplinary Center of Sleep Medicine; Charité - Universitätsmedizin Berlin; Berlin Germany
- Institute of Assistance Systems and Qualification; SRH University of Applied Science Heidelberg; Heidelberg Germany
| | - Stefanie Brunner
- Department of Internal Medicine II; University Hospital of Ulm; Ulm Germany
| | | | - Stefan Rüdiger
- Department of Internal Medicine II; University Hospital of Ulm; Ulm Germany
| | - Ioanna Blanta
- Department of Internal Medicine II; University Hospital of Ulm; Ulm Germany
| | - Kathrin M Stoiber
- Department of Internal Medicine II; University Hospital of Ulm; Ulm Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II; University Hospital of Ulm; Ulm Germany
| | - Christian Schumann
- Department of Internal Medicine II; University Hospital of Ulm; Ulm Germany
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Stuckenbrock JK, Freuschle A, Nakajima I, Stuck BA. The influence of pharyngeal and esophageal pressure measurements on the parameters of polysomnography. Eur Arch Otorhinolaryngol 2013; 271:1299-304. [DOI: 10.1007/s00405-013-2771-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/08/2013] [Indexed: 12/01/2022]
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Koo BB, Drummond C, Surovec S, Johnson N, Marvin SA, Redline S. Validation of a polyvinylidene fluoride impedance sensor for respiratory event classification during polysomnography. J Clin Sleep Med 2012; 7:479-85. [PMID: 22003343 DOI: 10.5664/jcsm.1312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The AASM has recommended specific sensors in measuring apnea and hypopnea based on published reliability and validity data. As new technology emerges, these guidelines will need revision. Polyvinylidene fluoride (PVDF) measures impedance and can be incorporated into a belt to approximate airflow and respiratory effort. We compared respiratory event detection using PVDF impedance belts (PVDFb), respiratory inductance plethysmography (RIP), and nasal-oral pneumotachography (PNT). METHODS First, in a clinical setting, 50 subjects (median AHI 26) undergoing polysomnography were fitted with PVDFb and standard sensors. Studies were scored in 4 independent passes using 4 respiratory montages (M); M1: nasal pressure transduction (NPT), thermistry, and RIP; M2: NPT, thermistry, and PVDFb; M3: thermistry and PVDFb; M4: PVDFb alone. Each experimental montage (M2-M4) was compared to the reference standard (M1) for total apneas and hypopneas. In a second experimental study, respiratory event detection was compared across a series of breathing trials for PVDFb, RIP, and PNT in normal subjects. Agreement was evaluated with intraclass correlation coefficient (ICC), κ statistics, and Bland-Altman plots. RESULTS ICCs comparing event numbers by M1 to M 2, 3, and 4 were: 0.99, 0.93, and 0.91, respectively. Almost identical numbers of events were identified for M 1 and M2 (177.5 ± 122.7 vs 177.6 ± 123.2). Event subtypes also were comparable. PVDFb was less sensitive than PNT but no different than RIP in detecting decreased breathing amplitude. CONCLUSIONS PVDFb was comparable to standard RIP in determining respiratory events during polysomnography and in detecting decreased breathing amplitude, suggesting that PVDFb can be used as an alternative to RIP for apnea/hypopnea evaluation.
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Affiliation(s)
- Brian B Koo
- Case Western Reserve University School of Medicine, Department of Neurology, Cleveland, OH 44120, USA.
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Morgenstern C, Schwaibold M, Randerath WJ, Bolz A, Jané R. An invasive and a noninvasive approach for the automatic differentiation of obstructive and central hypopneas. IEEE Trans Biomed Eng 2010; 57:1927-36. [PMID: 20403779 DOI: 10.1109/tbme.2010.2047505] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The automatic differentiation of obstructive and central respiratory events is a major challenge in the diagnosis of sleep-disordered breathing. Esophageal pressure (Pes) measurement is the gold-standard method to identify these events. This study presents a new classifier that automatically differentiates obstructive and central hypopneas with the Pes signal and a new approach for an automatic noninvasive classifier with nasal airflow. An overall of 28 patients underwent night polysomnography with Pes recording, and a total of 769 hypopneas were manually scored by human experts to create a gold-standard annotation set. Features were automatically extracted from the Pes signal to train and test the classifiers (discriminant analysis, support vector machines, and adaboost). After a significantly (p < 0.01) higher incidence of inspiratory flow limitation episodes in obstructive hypopneas was objectively, invasively assessed compared to central hypopneas, the feasibility of an automatic noninvasive classifier with features extracted from the airflow signal was demonstrated. The automatic invasive classifier achieved a mean sensitivity, specificity, and accuracy of 0.90 after a 100-fold cross validation. The automatic noninvasive feasibility study obtained similar hypopnea differentiation results as a manual noninvasive classification algorithm. Hence, both systems seem promising for the automatic differentiation of obstructive and central hypopneas.
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Affiliation(s)
- Christian Morgenstern
- Institut de Bioenginyeria de Catalunya (IBEC), Departament d'Enginyeria de Sistemes, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, and Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, E-08028 Barcelona, Spain.
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Morgenstern C, Schwaibold M, Randerath W, Bolz A, Jane R. Automatic differentiation of obstructive and central hypopneas with esophageal pressure measurement during sleep. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:7102-5. [PMID: 19963945 DOI: 10.1109/iembs.2009.5332900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The differentiation between obstructive and central respiratory events is one of the most recurrent tasks in the diagnosis of sleep disordered breathing. Esophageal pressure measurement is the gold-standard method to assess respiratory effort and identify these events. But as its invasiveness discourages its use in clinical routine, non-invasisve systems have been proposed for differentiation. However, their adoption has been slow due to their limited clinical validation, as the creation of manual, gold-standard validation sets by human experts is a cumbersome procedure. In this study, a new system is proposed for an objective automatic, gold-standard differentiation between obstructive and central hypopneas with the esophageal pressure signal. First, an overall of 356 hypopneas of 16 patients were manually scored by a human expert to create a gold-standard validation set. Then, features were extracted from each hypopnea to train and test classifiers (Discriminant Analysis, Support Vector Machines and adaboost classifiers) to differentiate between central and obstructive hypopneas with the gold-standard esophageal pressure signal. The automatic differentiation system achieved promising results, with a sensitivity of 0.88, a specificity of 0.93 and an accuracy of 0.90. Hence, this system seems promising for an automatic, gold-standard differentiation between obstructive and central hypopneas.
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Affiliation(s)
- C Morgenstern
- Dept. ESAII, Universitat Politècnica de Catalunya (UPC), Institut de Bioenginyeria de Catalunya (IBEC) and CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Pau Gargallo 5, 08028 Barcelona, Spain.
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Ohashi M, Chiba S, Ota F, Moriyama H. [Examination of deglutition during sleep measuring esophageal pressure in sleep apnea syndrome patients]. NIHON JIBIINKOKA GAKKAI KAIHO 2009; 112:609-614. [PMID: 19764543 DOI: 10.3950/jibiinkoka.112.609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Why deglutition occurs during sleep remains unclear and controversial, but subclinical aspiration during sleep is surmised to contribute to much aspiration pneumonia, requiring that deglutition during sleep be evaluated. We studied the relationship between deglutition and sleep using deglutition waves based on nocturnal polysomnography data recorded while measuring esophageal pressure in patients suspected of having sleep-breathing disturbance. Most deglutition was found in stage 1 and then in stage 2 and REM sleep. Little deglutition was seen in stage 3 and 4, however. A relationship was thus found in sleep phase and deglutition, but no clear influence on deglutition during sleep was found for sleep apnea syndrome or age.
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Affiliation(s)
- Masatsugu Ohashi
- Department of Otorhinolaryngology, Ota General Hospital, Kawasaki
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Morgenstern C, Jané R, Schwaibold M, Randerath W. Automatic classification of inspiratory flow limitation assessed non-invasively during sleep. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:1132-5. [PMID: 19162863 DOI: 10.1109/iembs.2008.4649360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Detection of inspiratory flow limitation (IFL) is being recognized of increasing importance in order to diagnose pathologies related to sleep disordered breathing. Currently, IFL is usually identified with the help of invasive esophageal pressure measurement, still considered the gold-standard reference to assess respiratory effort. But the invasiveness of esophageal pressure measurement and its impact on sleep discourages its use in clinical routine. In this study, a new noninvasive automatic system is proposed for objective IFL classification. First, an automatic annotation system for IFL based on pressure/flow relationship was developed. Then, classifiers (Support Vector Machines and adaboost classifiers) were trained with these gold-standard references in order to objectively classify breaths non-invasively, solely based on the breaths' flow contours. The new non-invasive automatic classification system seems to be promising, as it achieved a sensitivity of 0.92 and a specificity of 0.89, outperforming prior classification results obtained by human experts.
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Affiliation(s)
- C Morgenstern
- Dept. ESAII, Universitat Politècnica de Catalunya, Institut de Bioenginyeria de Catalunya and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Pau Gargallo 5, 08028, Barcelona, Spain.
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Popovic D, King C, Guerrero M, Levendowski DJ, Henninger D, Westbrook PR. Validation of forehead venous pressure as a measure of respiratory effort for the diagnosis of sleep apnea. J Clin Monit Comput 2008; 23:1-10. [PMID: 19116764 DOI: 10.1007/s10877-008-9154-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 11/25/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to validate the measurement of Forehead Venous Pressure derived from a single site on the forehead as an alternative to esophageal manometry and respiratory effort bands in the differential diagnosis of sleep apnea. METHODS Fourteen subjects underwent a laboratory polysomnography concurrently with ARES Unicorder at Walter Reed Army Medical Center. Two-hundred respiratory events were selected by a scorer boarded in sleep medicine and classified into six event categories used in the differential diagnosis of sleep disordered breathing. Four sets of events were prepared, each containing airflow and one of four measures of respiratory effort (i.e., esophageal manometer, chest and abdomen bands, and forehead venous pressure). A second board-certified scorer scored each set of events twice while blinded to the type of the effort signal. RESULTS The inter-rater Kappa scores across all event types indicated all four effort signals provided moderate agreement (kappa = 0.43-0.47). When comparing the intra-rater Kappa scores, the chest belt was superior (kappa = 0.88) to the esophageal manometry, FVP and abdomen belt (kappa = 0.78-0.82). The Kappa scores for the intra-rater comparison with the esophageal serving as the gold standard, FVP abdomen and chest all showed near perfect agreement (kappa = 0.81-0.86). The esophageal manometer and FVP provided slightly better inter-rater agreement in the detection of both obstructive hypopneas and apneas as compared to the chest and abdomen belts. There was a 20-30% drop in inter-rater reliability in the detection of flow-limitation and ventilation-change events compared to obstructive events, and all effort signals showed poor inter-rater agreement for central and mixed events. CONCLUSIONS The results of the study suggest that the FVP can serve as an alternative to respiratory bands in the differential diagnosis of sleep disordered breathing, and in the recognition of patients appropriate for bilevel continuous positive airway pressure devices.
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Chervin RD, Malhotra RK, Burns JW. Respiratory cycle-related EEG changes during sleep reflect esophageal pressures. Sleep 2008; 31:1713-20. [PMID: 19090327 PMCID: PMC2603494 DOI: 10.1093/sleep/31.12.1713] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Respiratory cycle-related EEG changes (RCREC) have been demonstrated during sleep by digital analysis and hypothesized to represent subtle inspiratory microarousals that may help to explain daytime sleepiness in patients with sleep-disordered breathing. We therefore examined for the first time associations between RCREC and esophageal pressure swings (deltaPes) that reflect work of breathing. DESIGN Retrospective analysis. SETTING Academic sleep laboratory. PATIENTS Forty adults referred for suspected sleep disordered breathing. INTERVENTIONS Polysomnography with esophageal pressure monitoring and automatic computation of deltaPes using a novel algorithm. RESULTS Computed deltaPes for nearly all respiratory cycles during sleep correlated well with visual scoring of selected respiratory cycle samples (Spearman rho = 0.86, P < 0.0001). The RCREC within the sigma EEG range (12.5-15.5 Hz) rather than that within other frequency ranges most often showed significant within-subject inverse correlations with deltaPes. In contrast, in between-subject comparisons, beta (15.5-30.5 Hz) and to a lesser extent theta (4.5-7.5 Hz) RCREC, rather than sigma RCREC, showed significant inverse associations with mean APes. CONCLUSIONS Variation within subjects of sigma RCREC with APes supports previous evidence that RCREC within this range may reflect microarousals exacerbated by increased work of breathing. Correlation of beta and theta, but not sigma RCREC with deltaPes in between-subject comparisons is more difficult to explain but suggests that ranges other than sigma also deserve further investigation for clinical utility.
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Affiliation(s)
- Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor 48109-0845, USA.
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Hutter DA, Holland BK, Ashtyani H. Occult sleep apnea: the dilemma of negative polysomnography in symptomatic patients. Sleep Med 2008; 5:501-6. [PMID: 15341897 DOI: 10.1016/j.sleep.2004.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2003] [Revised: 04/23/2004] [Accepted: 05/06/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE To determine the benefit of repeat polysomnography with/without esophageal pressure (PES) monitoring to diagnose sleep apnea syndrome (SAS) in patients with symptoms of sleep apnea who have had a 'negative', single-night polysomnogram (PSG). PATIENTS AND METHODS This is a retrospective investigation of 1187 patients seen in our sleep lab from January to December 2001, of which 709 were adults suspected of having sleep apnea. Following a single PSG, 588 patients were diagnosed with sleep apnea and 121 had negative PSGs (an apnea-hypopnea index <5 events per hour). Of the 121 patients, 92 continued to complain of unexplained sleepiness, loud snoring, or apnea, symptoms which were also documented on their initial evaluation (PSG or multiple sleep latency testing). The remaining 29 patients had no further complaints, or another medical cause of their sleepiness was established (i.e. asthma) following the single-night PSG. Of the 92 patients, 28 underwent additional screening with both repeat PSG and PES monitoring within the following 6 months. RESULTS With repeat PSG and PES monitoring, 18 of the 28 patients with previous, negative PSGs were diagnosed with sleep apnea. The sensitivity of a single-night PSG fell to 97%, with a false negative rate of 3%. Only 12 of the 28 would have been positive based on polysomnographic criteria alone, without the additional PES monitoring. On the other hand, 10 of the 28 remained negative and further evaluation revealed other, underlying medical problems (i.e. nocturnal asthma) that explained their symptoms. CONCLUSIONS There is a clear benefit of repeat PSG, with or without PES monitoring, for patients with a prior negative PSG and continued symptoms suspected of having SAS.
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Affiliation(s)
- Deborah A Hutter
- Division of Pulmonary Critical Care and Sleep Medicine, Hackensack University Medical Center, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Dillon JE, Blunden S, Ruzicka DL, Guire KE, Champine D, Weatherly RA, Hodges EK, Giordani BJ, Chervin RD. DSM-IV diagnoses and obstructive sleep apnea in children before and 1 year after adenotonsillectomy. J Am Acad Child Adolesc Psychiatry 2007; 46:1425-36. [PMID: 18049292 PMCID: PMC2408827 DOI: 10.1097/chi.0b013e31814b8eb2] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Obstructive sleep apnea, a common indication for adenotonsillectomy in children, has been linked to behavioral morbidity. We assessed psychiatric diagnoses in children before and after adenotonsillectomy and examined whether baseline sleep apnea predicted improvement after surgery. METHOD Subjects of this prospective cohort study were children ages 5.0 to 12.9 years old who had been scheduled for adenotonsillectomy (n = 79) or care for unrelated surgical conditions (n = 27, among whom 13 had surgery after baseline assessment). Before intervention and 1 year later, subjects underwent structured diagnostic interviews and polysomnography. The main outcome measure was frequency of DSM-IV attention and disruptive behavior disorder diagnoses at baseline and follow-up. RESULTS At baseline, attention and disruptive behavior disorders were diagnosed in 36.7% of adenotonsillectomy subjects and 11.1% of controls (p < .05); attention-deficit/hyperactivity disorder was found in 27.8% and 7.4%, respectively (p < .05). One year later, group differences were nonsignificant; attention and disruptive behavior disorders were diagnosed in only 23.1% (p < .01), and 50% of subjects with baseline attention-deficit/hyperactivity disorder no longer met diagnostic criteria. Obstructive sleep apnea on polysomnography at baseline did not predict concurrent psychiatric morbidity or later improvement. CONCLUSIONS Attention and disruptive behavior disorders, diagnosed by DSM-IV criteria, were more common before clinically indicated adenotonsillectomy than 1 year later. Surgery may be associated with reduced morbidity, even among subjects lacking polysomnographic evidence of obstructive sleep apnea.
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Affiliation(s)
- James E Dillon
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA.
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Sleep-Related Breathing Disorders of Childhood: Description and Clinical Picture, Diagnosis, and Treatment Approaches. Sleep Med Clin 2007. [DOI: 10.1016/j.jsmc.2007.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Stoohs RA, Blum HC, Knaack L, Guilleminault C. Non-invasive estimation of esophageal pressure based on intercostal EMG monitoring. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2004:3867-9. [PMID: 17271140 DOI: 10.1109/iembs.2004.1404082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recording of esophageal pressure waveform is an important clinical tool to identify patients with sleep-disordered breathing. Commonly, esophageal pressure probes are not tolerated by patients undergoing sleep monitoring. We therefore developed a technique to non-invasively estimate esophageal pressure based on recording of intercostal EMG monitoring. A three step approach to modification of the intercostal EMG signal was created to closely match results obtained from esophageal pressure recording. The algorithm was then tested on 10 subjects with sleep-disordered breathing undergoing full polysomnography with simultaneous monitoring of esophageal pressure and intercostal EMG. Analysis of correlations between esophageal pressure and intercostal EMG were computed by sleep stages. The overall correlation coefficient in all subjects combined was r=0.896, p<0.00001. The results indicate that this method can be used reliably in clinical sleep studies where esophageal pressure recordings cannot be performed.
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Affiliation(s)
- R A Stoohs
- Sleep Disorders Clinic and Research Center, Dortmund, Germany
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Kushida CA. The use of esophageal manometry in the diagnosis of sleep-related breathing disorders. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2004:3860-3. [PMID: 17271138 DOI: 10.1109/iembs.2004.1404080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Esophageal manometry is a technique used to detect abnormal sleep-related respiratory events. One method used to measure and score esophageal pressure during sleep is described. The contraindications for esophageal manometry, the methods for scoring esophageal pressure, the use of esophageal manometry as the "gold standard", and directions for future research are discussed.
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Affiliation(s)
- Clete A Kushida
- Stanford University Center of Excellence for Sleep Disorders, Stanford, CA, USA
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Eastwood PR, Katagiri S, Shepherd KL, Hillman DR. Modulation of upper and lower esophageal sphincter tone during sleep. Sleep Med 2007; 8:135-43. [PMID: 17275400 DOI: 10.1016/j.sleep.2006.08.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 08/08/2006] [Accepted: 08/15/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE The pressures generated within the upper esophageal sphincter (P(UES)) and lower esophageal sphincter (P(LES)) reflect the integrity of these barriers to gastroesophageal and pharyngoesophageal reflux, respectively. This study sought to describe the effects of sleep, respiration and posture on the function of the UES and the LES and the pressure differentials developed across them. METHODS Ten healthy volunteers (7M, 3F: 38+/-10 yr) without a history of sleep-disordered breathing or reflux underwent overnight polysomnography with simultaneous measurement of P(LES) and P(UES) using a purpose-built sleeve device (Dentsleeve). Posture was recorded but not controlled. RESULTS Subjects slept for 4.3+/-1.6h. Compared to waking values, both end-inspiratory and end-expiratory Pues were significantly less during slow wave sleep (SWS) (p<0.05). However, P(LES) was unaffected by sleep stage. During wakefulness and all stages of sleep, both P(UES) and P(LES) were greater at end-inspiration than end-expiration (p<0.05). Similar relationships were observed whether subjects were supine or in the lateral decubitus position. CONCLUSION Sleep decreases the effectiveness of the UES to act as a barrier to pharyngoesophageal reflux, particularly during slow wave sleep (SWS). UES pressure varies with respiration, with minimal values observed during expiration. Hence, barrier function of the UES appears most impaired during SWS, in the expiratory phase of the respiratory cycle. The LES pressure and its barrier pressure also vary with respiration, being least during expiration. However, unlike the UES, the function of the LES was unaffected by sleep.
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Affiliation(s)
- Peter R Eastwood
- Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
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Chervin RD, Ruzicka DL, Giordani BJ, Weatherly RA, Dillon JE, Hodges EK, Marcus CL, Guire KE. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics 2006; 117:e769-78. [PMID: 16585288 PMCID: PMC1434467 DOI: 10.1542/peds.2005-1837] [Citation(s) in RCA: 307] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Most children with sleep-disordered breathing (SDB) have mild-to-moderate forms, for which neurobehavioral complications are believed to be the most important adverse outcomes. To improve understanding of this morbidity, its long-term response to adenotonsillectomy, and its relationship to polysomnographic measures, we studied a series of children before and after clinically indicated adenotonsillectomy or unrelated surgical care. METHODS We recorded sleep and assessed behavioral, cognitive, and psychiatric morbidity in 105 children 5.0 to 12.9 years old: 78 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 27 for unrelated surgical care. One year later, we repeated all assessments in 100 of these children. RESULTS Subjects who had an adenotonsillectomy, in comparison to controls, were more hyperactive on well-validated parent rating scales, inattentive on cognitive testing, sleepy on the Multiple Sleep Latency Test, and likely to have attention-deficit/hyperactivity disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) as judged by a child psychiatrist. In contrast, 1 year later, the 2 groups showed no significant differences in the same measures. Subjects who had an adenotonsillectomy had improved substantially in all measures, and control subjects improved in none. However, polysomnographic assessment of baseline SDB and its subsequent amelioration did not clearly predict either baseline neurobehavioral morbidity or improvement in any area other than sleepiness. CONCLUSIONS Children scheduled for adenotonsillectomy often have mild-to-moderate SDB and significant neurobehavioral morbidity, including hyperactivity, inattention, attention-deficit/hyperactivity disorder, and excessive daytime sleepiness, all of which tend to improve by 1 year after surgery. However, the lack of better correspondence between SDB measures and neurobehavioral outcomes suggests the need for better measures or improved understanding of underlying causal mechanisms.
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Affiliation(s)
- Ronald D Chervin
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
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Armstrong JJ, Leigh MS, Sampson DD, Walsh JH, Hillman DR, Eastwood PR. Quantitative Upper Airway Imaging with Anatomic Optical Coherence Tomography. Am J Respir Crit Care Med 2006; 173:226-33. [PMID: 16239620 DOI: 10.1164/rccm.200507-1148oc] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Measurements of upper airway size and shape are important in investigating the pathophysiology of obstructive sleep apnea (OSA) and in devising, applying, and determining the effectiveness of treatment modalities. We describe an endoscopic optical technique (anatomic optical coherence tomography, aOCT) that provides quantitative real-time imaging of the internal anatomy of the human upper airway. METHODS Validation studies were performed by comparing aOCT- and computed tomography (CT)-derived measurements of cross-sectional area (CSA) in (1) conduits in a wax phantom and (2) the velo-, oro-, and hypopharynx during wakefulness in five volunteers. aOCT scanning was performed during sleep in one subject with OSA. RESULTS aOCT generated images of pharyngeal shape and measurements of CSA and internal dimensions that were comparable to radiographic CT images. The mean difference between aOCT- and CT-derived measurements of CSA in (1) the wax phantom was 2.1 mm(2) with limits of agreement (2 SD) from -13.2 to 17.4 mm(2) and intraclass correlation coefficient of 0.99 (p < 0.001) and (2) the pharyngeal airway was 14.1 mm(2) with limits of agreement from -43.7 to 57.8 mm(2) and intraclass correlation coefficient of 0.89 (p < 0.001). aOCT generated quantitative images of changes in upper airway size and shape before, during, and after an apneic event in an individual with OSA. CONCLUSIONS aOCT generates quantitative, real-time measurements of upper airway size and shape with minimal invasiveness, allowing study over lengthy periods during both sleep and wakefulness. These features should make it useful for study of upper airway behavior to investigate OSA pathophysiology and aid clinical management.
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Affiliation(s)
- Julian J Armstrong
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic, and Computer Engineering, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009.
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