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Landry V, Semsar-Kazerooni K, Chen T, Gurberg J, Nguyen LHP, Constantin E. Diagnostic accuracy of portable sleep monitors in pediatric sleep apnea: A systematic review. Sleep Med Rev 2024; 78:101991. [PMID: 39173472 DOI: 10.1016/j.smrv.2024.101991] [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: 12/11/2023] [Revised: 05/01/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
In recent years, a plethora of new type III and IV portable sleep monitors (PSM) have been developed, although evidence regarding their diagnostic accuracy for use in children remains heterogeneous. This study systematically reviews the literature addressing the diagnostic accuracies of type III and IV PSM for pediatric sleep apnea. Publications indexed in Medline, Embase, or Web of Science were reviewed using the PRISMA framework. Of 1054 studies, 62 fulfilled the inclusion criteria. Of the studies evaluating oximetry-based type IV PSM, one (6.25 %) demonstrated a balanced set of high (≥80 %) sensitivities and specificities for the diagnosis of any pediatric sleep apnea, while five studies (27.8 %) showed similar accuracies for moderate-to-severe sleep apnea. For non-oximetry-based type IV PSM, two studies (40 %) reported a balanced set of high diagnostic accuracies for moderate-to-severe sleep apnea. Type III PSM repeatedly demonstrated higher diagnostic accuracies, with six studies (66.7 %) reporting a balanced set of high diagnostic accuracies for moderate-to-severe sleep apnea. This review highlights the potential of type III PSM to detect moderate-to-severe pediatric sleep apnea, although current evidence is limited to support the stand-alone use of type IV PSM for the diagnosis of sleep apnea in most children.
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Affiliation(s)
- Vivianne Landry
- Division of Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, QC, Canada
| | | | - Tanya Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Joshua Gurberg
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Evelyn Constantin
- Department of Pediatrics, Pediatric Sleep Medicine, McGill University, Montreal, QC, Canada.
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Tuohuti A, Lin Z, Cai J, Chen X. Can portable sleep monitors replace polysomnography for diagnosis of pediatric OSA: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:4351-4359. [PMID: 37405453 DOI: 10.1007/s00405-023-08095-6] [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: 03/14/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is an increasing health problem in children. The "gold standard" for OSA diagnosis at the moment is overnight polysomnography (PSG). Some researchers think portable monitors (PMs) are promising methods for diagnosing OSA, which make children more comfortable and lower costs. Compared with PSG, our comprehensively evaluated the diagnostic accuracy of PMs for diagnosing OSA in pediatrics. RESEARCH QUESTION This study aims to determine whether PMs can replace PSG in pediatric OSA diagnosis. STUDY DESIGN AND METHODS The PubMed, Embase, Medline databases Scopus, Web of Science, and Cochrane Library databases were searched systematically for studies published up to December 2022, evaluating the ability of PMs to diagnose OSA in children. For estimating the pooled sensitivity and specificity of the PMs in the included studies, we used a random-effects bivariate model. Studies included in this meta-analysis were evaluated systematically according to QUADAS-2 guidelines for assessing diagnostic accuracy studies. Two independent investigators conducted each stage of the review independently. RESULTS A total of 396 abstracts and 31 full-text articles were screened, and 41 full-text articles were chosen for final review. There were 707 pediatric patients enrolled in these twelve studies, and 9 PMs were evaluated. There was a wide range of diagnostic sensitivity and specificity among PM systems as compared to AHI measured by PSG. The pooled sensitivity and specificity in diagnosing pediatric OSA were, respectively, 0.91 [0.86, 0.94] and 0.76 [0.58, 0.88] for PMs. According to the summary receiver operating characteristic (SROC) curve, the AUC of PMs in diagnosing OSA in pediatric population was 0.93 [0.90, 0.95]. INTERPRETATION PMs were more sensitive but slightly less specific for pediatric OSA. The combination of PMs and questionnaires appeared to be a reliable tool for the diagnosis of pediatric OSA. This test may be used for screening subjects or populations at high risk of OSA when there is a high demand for PSG, but the quantity is limited. No clinical trial was involved in the current study.
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Affiliation(s)
- Aikebaier Tuohuti
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Zehua Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Jie Cai
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Xiong Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
- Sleep Medicine Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
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Cielo CM, Kelly A, Xanthopoulos M, Pipan M, Arputhan A, Walega R, Ward M, Falvo J, Roman Y, Xiao R, Tapia IE. Feasibility and performance of home sleep apnea testing in youth with Down syndrome. J Clin Sleep Med 2023; 19:1605-1613. [PMID: 37185265 PMCID: PMC10476042 DOI: 10.5664/jcsm.10610] [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: 12/01/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
STUDY OBJECTIVES In-laboratory polysomnography is recommended for the evaluation of obstructive sleep apnea (OSA) in youth with Down syndrome. However, insufficient sleep laboratories are available, particularly for youth with neurocognitive disabilities such as Down syndrome. We hypothesized that level II home sleep apnea testing (HSAT) would be feasible, acceptable, and accurate in detecting polysomnography-defined moderate-severe OSA in youth with Down syndrome. METHODS Youth 6 to 25 years old with Down syndrome were recruited to undergo in-home level II HSAT with electroencephalogram and in-lab polysomnography. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored blinded to polysomnography result, were compared to reference polysomnography. RESULTS Forty-three youth (23 female) aged [median (range)] 15.5 (6.1, 25.1) years participated in the study. Forty-one participants were able to complete HSAT and 41 completed polysomnography, with 40 who underwent both tests. HSAT was preferred to polysomnography by 73.7% of parents. Total sleep time for HSAT was 437 ± 123 minutes vs 366 ± 90 minutes for polysomnography (P = .003). Obstructive apnea-hypopnea index by polysomnography was 12.7 events/h (0.2, 113.8), and 32 youth (80%) who completed all testing had OSA. Compared to polysomnography, sensitivity of HSAT was: 0.81, specificity was 0.75, accuracy was 0.8 including 2 youth whose HSAT demonstrated OSA when polysomnography did not. CONCLUSIONS In youth with Down syndrome, level II HSAT was well-tolerated, preferred compared to in-lab polysomnography, and had good accuracy for detecting moderate-severe OSA. Level II HSAT could provide a means for expanding the evaluation of OSA in youth with Down syndrome. CITATION Cielo CM, Kelly A, Xanthopoulos M, et al. Feasibility and performance of home sleep apnea testing in youth with Down syndrome J Clin Sleep Med. 2023;19(9):1605-1613.
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Affiliation(s)
- Christopher M. Cielo
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Kelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa Xanthopoulos
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Pipan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Trisomy 21 Program, Division of Developmental Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ahtish Arputhan
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel Walega
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle Ward
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer Falvo
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yaelis Roman
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rui Xiao
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ignacio E. Tapia
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Fumo-Dos-Santos C, Smith AK, Togeiro SMGP, Tufik S, Moreira GA. Obstructive sleep apnea in asthmatic children: a cross-sectional study about prevalence and risk factors. J Pediatr (Rio J) 2023; 99:443-448. [PMID: 37148908 PMCID: PMC10492151 DOI: 10.1016/j.jped.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVES Primary objectives were to analyze the prevalence of obstructive sleep apnea in (1) boys and girls, and (2) severe asthma versus moderate and mild cases. The authors hypothesized that girls and severe asthma would have a higher prevalence of obstructive sleep apnea. METHODS Cross-sectional evaluation of asthmatic children attending a tertiary Pediatric Pulmonology clinic. The authors performed a history, physical examination, pulmonary function test, and home sleep apnea test. RESULTS The authors studied 80 consecutive patients, 7-18 years old, mean age of 11.6 years (standard deviation 2.7), 51.3% female, and 18.5% obese. Pulmonary function tests were obtained from 80 volunteers, 45% with obstruction pattern. Home sleep apnea tests were available from 76 volunteers, with a mean obstructive respiratory index of 1.8 events/h. Obstructive sleep apnea was found in 49 volunteers (61.2%). The authors did not find associations between obstructive sleep apnea and sex or asthma severity. CONCLUSIONS Obstructive sleep apnea was frequent among these asthmatic children. Sex and asthma severity were not risk factors. Considering the interrelationship of both diseases, it is worth keeping in mind the possibility of obstructive sleep apnea among children and teenagers with asthma.
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Affiliation(s)
| | - Anna K Smith
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Sonia M G P Togeiro
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Departamento de Medicina Interna, São Paulo, SP, Brazil.
| | - Sergio Tufik
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Gustavo A Moreira
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil
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Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Ambulatory transcutaneous carbon dioxide monitoring for children with neuromuscular disease. Sleep Med 2023; 101:221-227. [PMID: 36435158 DOI: 10.1016/j.sleep.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Early screening and diagnosis of nocturnal hypoventilation can slow progression to diurnal hypercapnia and mortality in children with neuromuscular disease (NMD). However, gold standard, laboratory-based polysomnography (PSG) testing is a limited resource. Therefore, we evaluated the diagnostic accuracy of ambulatory transcutaneous carbon dioxide (tcCO2) monitoring used in the home compared to PSG in children with NMD. METHODS Prospective, cross-sectional study in children 0-18 years old with a confirmed diagnosis of NMD and a clinically indicated need for PSG. Ambulatory tcCO2 was assessed by a respiratory therapist in participant's homes. Demographics, and PSG (including tcCO2). RESULTS We enrolled 39 children with NMD; 3 had unusable ambulatory tcCO2 data because of failure of drift correction on the machine (n = 2) or an air bubble (n = 1). The remaining 36 patients aged 11 months to 16 years (median (IQR) 12.5 years (6.0-15.8)) had ambulatory tcCO2 and outpatient level 1 PSG data. Ambulatory tcCO2 monitoring had a sensitivity of 20.0% (95% confidence interval [CI] 0.5-71.6%) and a specificity of 93.5% (95% CI 78.6-99.2%). Almost all children and/or parents (34/36, 94%) preferred ambulatory monitoring over in-hospital PSG. CONCLUSIONS Ambulatory transcutaneous carbon dioxide monitoring was not sufficiently accurate as a clinical tool for the diagnosis of nocturnal hypoventilation our cohort of children with neuromuscular disease despite being preferred over PSG by both children and parents.
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Jacobs S, Mylemans E, Ysebaert M, Vermeiren E, De Guchtenaere A, Heuten H, Bruyndonckx L, De Winter BY, Van Hoorenbeeck K, Verhulst SL, Van Eyck A. The impact of obstructive sleep apnea on endothelial function during weight loss in an obese pediatric population. Sleep Med 2021; 86:48-55. [PMID: 34461597 DOI: 10.1016/j.sleep.2021.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/05/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Childhood obesity is an increasing problem with substantial comorbidities such as obstructive sleep apnea (OSA) and increased cardiovascular morbidity. Endothelial dysfunction is an underlying mechanism related to both obesity and OSA. RESEARCH QUESTION To investigate the effect of weight loss on endothelial function and OSA in obese children and to determine whether a change in endothelial function can be linked to an improvement in OSA. METHODS Obese children between 8 and 18 years of age were recruited while entering a 12-month inpatient weight loss program. Patients were followed at 3 study visits: baseline, after 10 months of weight loss, and 6 months after ending the program (18 months). Anthropometry and endothelial function (EndoPAT) were determined at all study visits. At baseline, sleep screening with a portable device (ApneaLink) was performed. This was repeated after 10 months if OSA was diagnosed at baseline. RESULTS At baseline, 130 children were included, of which 87 had OSA (67%). Seventy-two patients attended the follow-up visit at 10 months, and 28 patients attended the follow-up visit at 18 months. The BMI z-score decreased after 10 months (from 2.7 (1.4-3.4) to 1.7 (0.5-2.7); p < 0.001) and remained stable at 18 months. Endothelial function improved significantly after weight loss, evidenced by a shorter time to peak response (TPR) and higher reactive hyperemia index (p = 0.02 and p < 0.001), and remained improved after 18 months (p < 0.001 and p = 0.007). After 10 months of weight loss, 10 patients had residual OSA. These patients had a higher TPR at 10 months (225 (75-285)s) than those without OSA (135 (45-225)s) and patients with a normalized sleep study (105 (45-285)s; p = 0.02). Linear mixed models showed that more severe OSA was associated with a worse TPR at baseline and less improvement after weight loss. CONCLUSION Weight loss improves endothelial function in an obese pediatric population. However, even after weight loss, endothelial function improved less in the presence of OSA.
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Affiliation(s)
- Sofie Jacobs
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Emilie Mylemans
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Marijke Ysebaert
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Eline Vermeiren
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
| | | | - Hilde Heuten
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
| | - Luc Bruyndonckx
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
| | - Stijn L Verhulst
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.
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Bhattacharjee R, Benjafield A, Blase A, Dever G, Celso J, Nation J, Good R, Malhotra A. The accuracy of a portable sleep monitor to diagnose obstructive sleep apnea in adolescent patients. J Clin Sleep Med 2021; 17:1379-1387. [PMID: 33666166 DOI: 10.5664/jcsm.9202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The efficacy of portable-monitor (PM) sleep testing in children is not well understood. While most studies have evaluated PM in a lab setting, the utility of PM in the home environment is relatively unknown. We sought to determine whether home PM accurately diagnoses obstructive sleep apnea in adolescents and to assess patient satisfaction with home PM sleep testing. METHODS We evaluated adolescents (age 12-18 years) with suspected obstructive sleep apnea using a PM device. In addition to in-laboratory polysomnography (PSG), all participants had PM testing performed twice, once in their home and once concurrent to in-laboratory PSG. PM was compared to PSG using 2 primary outcomes: the apnea-hypopnea index and oxygen desaturation index. All participants were approached for interview to evaluate their experience with PM sleep testing. RESULTS Twenty adolescents participated. Bland-Altman analysis comparing the apnea-hypopnea index and oxygen desaturation index determined by home or in-laboratory PM to in-laboratory PSG revealed mostly agreement; however, some deviations were observed when either parameter was markedly increased. While PM testing tended to underestimate the apnea-hypopnea index, the diagnostic agreement between home PM and PSG was 80% (by the White-Westbrook method). Most preferred PM to PSG and found PM easy to very easy to set up. CONCLUSIONS In a small cohort of adolescents, our study supports the application of home PM in the diagnosis of suspected obstructive sleep apnea. Until studies implementing PM using larger cohorts become readily available, the findings from this preliminary study could contribute to adolescents receiving sleep apnea therapy more promptly. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Identifier: NCT03748771. At the time of issue publication, this registration is not publicly available because the trial includes a device that is not approved or cleared for use in pediatric populations. Once the device is FDA cleared, the registration will become public.
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Affiliation(s)
- Rakesh Bhattacharjee
- University of California San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California
| | | | - Amy Blase
- ResMed Science Center, San Diego, California
| | | | | | - Javan Nation
- University of California San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California
| | - Raquel Good
- Rady Children's Hospital, San Diego, California
| | - Atul Malhotra
- University of California San Diego, La Jolla, California
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Waseem R, Chan MTV, Wang CY, Seet E, Chung F. Predictive performance of oximetry in detecting sleep apnea in surgical patients with cardiovascular risk factors. PLoS One 2021; 16:e0250777. [PMID: 33956830 PMCID: PMC8101727 DOI: 10.1371/journal.pone.0250777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In adults with cardiovascular risk factors undergoing major noncardiac surgery, unrecognized obstructive sleep apnea (OSA) was associated with postoperative cardiovascular complications. There is a need for an easy and accessible home device in predicting sleep apnea. The objective of the study is to determine the predictive performance of the overnight pulse oximetry in predicting OSA in at-risk surgical patients. METHODS This was a planned post-hoc analysis of multicenter prospective cohort study involving 1,218 at-risk surgical patients without prior diagnosis of sleep apnea. All patients underwent home sleep apnea testing (ApneaLink Plus, ResMed) simultaneously with pulse oximetry (PULSOX-300i, Konica Minolta Sensing, Inc). The predictive performance of the 4% oxygen desaturation index (ODI) versus apnea-hypopnea index (AHI) were determined. RESULTS Of 1,218 patients, the mean age was 67.2 ± 9.2 years and body mass index (BMI) was 27.0 ± 5.3 kg/m2. The optimal cut-off for predicting moderate-to-severe and severe OSA was ODI ≥15 events/hour. For predicting moderate-to-severe OSA (AHI ≥15), the sensitivity and specificity of ODI ≥ 15 events per hour were 88.4% (95% confidence interval [CI], 85.7-90.6) and 95.4% (95% CI, 94.2-96.4). For severe OSA (AHI ≥30), the sensitivity and specificity were 97.2% (95% CI, 92.7-99.1) and 78.8% (95% CI, 78.2-79.0). The area under the curve (AUC) for moderate-to-severe and severe OSA was 0.983 (95% CI, 0.977-0.988) and 0.979 (95% CI, 0.97-0.909) respectively. DISCUSSION ODI from oximetry is sensitive and specific in predicting moderate-to-severe or severe OSA in at-risk surgical population. It provides an easy, accurate, and accessible tool for at-risk surgical patients with suspected OSA.
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Affiliation(s)
- Rida Waseem
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Matthew T. V. Chan
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Edwin Seet
- Khoo Teck Puat Hospital, National Healthcare Group, Singapore, Singapore
| | - Frances Chung
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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10
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Childhood Obstructive Sleep Apnea: from Diagnosis to Therapy—an Update. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Diagnosis of Sleep-Disordered Breathing in the Home Environment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1271:107-112. [DOI: 10.1007/5584_2020_497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Krishnasamy S, Sahid SM, Hashim SA, Singh S, Chung F, Mokhtar RAR, Yin WC. Obstructive sleep apnoea and open heart surgery: a review of its incidence and impact to patients. J Thorac Dis 2020; 11:5453-5462. [PMID: 32030264 DOI: 10.21037/jtd.2019.11.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Obstructive sleep apnea (OSA) is a serious health disorder which contributes to cardiovascular complications, decreased work productivity, automobile accidents, and death. This condition is characterized by a temporary cessation of breathing resulting due to upper airway closure during a person's sleep. Strain to the heart caused by this repetitive hypoxic insult can lead to postoperative complications for patients undergoing heart surgery. Recognizing cardiac surgical patients with OSA is important. Early recognition and intervention such as use of BiPAP device can reduce the postoperative complications due to OSA. Methods The aim of this study is to identify the incidence of unrecognized OSA in cardiac surgical patients. This is a retrospective analysis of a prospective data of the study which was done between July 2012 and July 2013 in University Malaya Medical Center. All patients undergoing elective cardiac surgery were recruited and the demographic data, questionnaire and the portable sleep study results were obtained. Patients were followed up till 30 days to record any complications. Data were entered in SPSS version 17 and analysis was done. Results The incidence of OSA was 61.4% and 43.5% were moderate to severe OSA. There was male predominance of OSA (79%) with a mean age of 60 years. OSA subjects had shorter inter-incisor distance (4.18±0.6 cm) and larger waistline (94.1±12.1 cm). The STOP-Bang questionnaire has a sensitivity of 75.8% in predicting apnoa-hypopnea index (AHI) ≥5/hour. Conclusions OSA can be diagnosed with a simple screening questionnaire and a bedside portable sleep study. Cardiac patients diagnosed with OSA can be pre-emptively given extra attention in managing their postoperative care.
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Affiliation(s)
| | - Saidah Mohd Sahid
- Department of General Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Shahrul Amry Hashim
- Cardiothoracic Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sukcharanjit Singh
- Department of Anaesthesiology, Griffith Base Hospital, Griffith, New South Wales, Australia
| | - Frances Chung
- Department of Anaesthesia, University Health Network-Toronto Western Hospital, Toronto, Canada
| | | | - Wang Chew Yin
- Department of Anaesthesiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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13
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Huhtakangas JK, Huhtakangas J, Bloigu R, Saaresranta T. Unattended sleep study in screening for sleep apnea in the acute phase of ischemic stroke. Sleep Med 2020; 65:121-126. [DOI: 10.1016/j.sleep.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
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14
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Bhattacharjee R. Ready for Primetime? Home Sleep Apnea Tests for Children. J Clin Sleep Med 2019; 15:685-686. [PMID: 31053225 DOI: 10.5664/jcsm.7748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 01/09/2023]
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15
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Masoud AI, Patwari PP, Adavadkar PA, Arantes H, Park C, Carley DW. Validation of the MediByte Portable Monitor for the Diagnosis of Sleep Apnea in Pediatric Patients. J Clin Sleep Med 2019; 15:733-742. [PMID: 31053204 DOI: 10.5664/jcsm.7764] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Polysomnography (PSG) is considered the gold standard in the diagnosis of sleep apnea. In pediatric patients, because of limited availability and access to laboratory-based PSG, there can be significant delays in the diagnosis and management of sleep apnea that can result in progressive associated comorbidities. The main objective of the current study was to test the diagnostic value of a portable sleep monitor (PM), the MediByte, in comparison with laboratory PSG in pediatric patients wearing both setups simultaneously. METHODS A consecutive series of pediatric patients referred to the University of Illinois Sleep Science Center wore the MediByte during simultaneous PSG. The apnea-hypopnea index (AHI) was calculated for PSG and both manual and autoscoring functions of the PM. Pearson correlation and Bland-Altman plots were assessed. RESULTS A total of 70 patients successfully completed simultaneous PSG and PM studies (median age 10.8 years). The AHI obtained both manually and automatically scored PM studies strongly correlated with the AHI obtained from the PSG (r ≥ .932, P < .001). The oxygen saturation obtained by the PM showed significant correlation with that obtained by PSG among children aged 12 to 17 years (P < .001), but not among children aged 7 to 11 years (P ≥ .24). The sensitivity and specificity for detection of severe sleep apnea diagnosed by PSG (AHI ≥ 10 events/h) using both PM scoring methods was very high (> 93% for both). CONCLUSIONS Although PSG is still recommended for the diagnosis of sleep apnea, PMs can play a valuable role in diagnosing moderate and severe sleep apnea, especially in older pediatric patients. COMMENTARY A commentary on this article appears in this issue on page 685.
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Affiliation(s)
- Ahmed I Masoud
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Pallavi P Patwari
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, Illinois.,Rush Children's Hospital, Rush University Medical Center, Chicago, Illinois
| | - Pranshu A Adavadkar
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, Illinois
| | - Henry Arantes
- University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, Illinois.,Rush Children's Hospital, Rush University Medical Center, Chicago, Illinois
| | - Chang Park
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, Illinois
| | - David W Carley
- Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, Illinois
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16
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Fishman H, Massicotte C, Li R, Zabih W, McAdam LC, Al-Saleh S, Amin R. The Accuracy of an Ambulatory Level III Sleep Study Compared to a Level I Sleep Study for the Diagnosis of Sleep-Disordered Breathing in Children With Neuromuscular Disease. J Clin Sleep Med 2018; 14:2013-2020. [PMID: 30518444 DOI: 10.5664/jcsm.7526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/10/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Polysomnography (PSG) surveillance recommendations are not being met for children with neuromuscular disease (NMD) because of limited diagnostic facilities. We evaluated the diagnostic accuracy of an ambulatory level III device as compared to a level I PSG. METHODS A cross-sectional study was conducted at a tertiary pediatric institution. Eligibility criteria included: (1) children with NMD; (2) age 6 to 18 years; (3) booked for a clinically indicated overnight level I PSG. Participants were randomized to an overnight level I PSG followed by an ambulatory level III study with end tidal carbon dioxide (etCO2) or vice versa. Sensitivity and specificity of the ambulatory level III device to diagnose sleep-disordered breathing (SDB) at an apnea-hypopnea index (AHI) cutoff of > 1.0 events/h was the primary outcome. RESULTS Moderate to severe SDB was found in 46% of participants (13/28). The device's sensitivity and specificity to detect SDB was 61.5% and 86.7%, respectively. The positive predictive value of the level III study was 80.0% and the negative predictive value was 72.0%. Fifty percent of the cohort were either missing or had incomplete or falsely low ambulatory etCO2 data. CONCLUSIONS A level III device with etCO2 is not yet able to be implemented in clinical practice as a diagnostic tool for SDB in pediatric patients with NMD. COMMENTARY A commentary on this article appears in this issue on page 1973.
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Affiliation(s)
- Haley Fishman
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Colin Massicotte
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rhonda Li
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Weeda Zabih
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Laura C McAdam
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Division of Developmental Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Álvarez D, Crespo A, Vaquerizo-Villar F, Gutierrez-Tobal GC, Cerezo-Hernández A, Barroso-García V, Ansermino JM, Dumont GA, Hornero R, Del Campo F, Garde A. Symbolic dynamics to enhance diagnostic ability of portable oximetry from the phone oximeter in the detection of paediatric sleep apnoea. Physiol Meas 2018; 39:104002. [PMID: 30230476 DOI: 10.1088/1361-6579/aae2a8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study is aimed at assessing symbolic dynamics as a reliable technique to characterise complex fluctuations of portable oximetry in the context of automated detection of childhood obstructive sleep apnoea-hypopnoea syndrome (OSAHS). APPROACH Nocturnal oximetry signals from 142 children with suspected OSAHS were acquired using the Phone Oximeter: a portable device that integrates a pulse oximeter with a smartphone. An apnoea-hypopnoea index (AHI) ≥5 events/h from simultaneous in-lab polysomnography was used to confirm moderate-to-severe childhood OSAHS. Symbolic dynamics was used to parameterise non-linear changes in the overnight oximetry profile. Conventional indices, anthropometric measures, and time-domain linear statistics were also considered. Forward stepwise logistic regression was used to obtain an optimum feature subset. Logistic regression (LR) was used to identify children with moderate-to-severe OSAHS. MAIN RESULTS The histogram of 3-symbol words from symbolic dynamics showed significant differences (p <0.01) between children with AHI <5 events/h and moderate-to-severe patients (AHI ≥5 events/h). Words representing increasing oximetry values after apnoeic events (re-saturations) showed relevant diagnostic information. Regarding the performance of individual characterization approaches, the LR model composed of features from symbolic dynamics alone reached a maximum performance of 78.4% accuracy (65.2% sensitivity; 86.8% specificity) and 0.83 area under the ROC curve (AUC). The classification performance improved combining all features. The optimum model from feature selection achieved 83.3% accuracy (73.5% sensitivity; 89.5% specificity) and 0.89 AUC, significantly (p-value <0.01) outperforming the other models. SIGNIFICANCE Symbolic dynamics provides complementary information to conventional oximetry analysis enabling reliable detection of moderate-to-severe paediatric OSAHS from portable oximetry.
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Affiliation(s)
- Daniel Álvarez
- Pneumology Service, Rio Hortega University Hospital, Valladolid, Valladolid, SPAIN
| | - Andrea Crespo
- Pneumology Service, Rio Hortega University Hospital, Valladolid, Valladolid, SPAIN
| | - Fernado Vaquerizo-Villar
- Biomedical Engineering Group, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Castilla y León, SPAIN
| | - Gonzalo Cesar Gutierrez-Tobal
- Biomedical Engineering Group ETS Ingenieros de Telecommunicacion, Universidad de Valladolid, Camino del Cementerio sn, 47011 Valladoid, Valladolid, SPAIN
| | - Ana Cerezo-Hernández
- Pneumology Service, Rio Hortega University Hospital, Valladolid, Valladolid, SPAIN
| | - Verónica Barroso-García
- Biomedical Engineering Group, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Castilla y León, SPAIN
| | | | - Guy A Dumont
- University of British Columbia, Vancouver, British Columbia, CANADA
| | - Roberto Hornero
- Biomedical Engineering Group, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Castilla y León, SPAIN
| | - Felix Del Campo
- Pneumology Service, Rio Hortega University Hospital, Valladolid, Valladolid, SPAIN
| | - Ainara Garde
- Universiteit Twente, Enschede, 7500 AE, NETHERLANDS
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18
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Hug M, Uehli K, Solbach S, Brighenti-Zogg S, Dürr S, Maier S, Leuppi JD, Miedinger D. Screening for obstructive sleep apnea among hospital outpatients. PLoS One 2018; 13:e0198315. [PMID: 29847582 PMCID: PMC5976202 DOI: 10.1371/journal.pone.0198315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/17/2018] [Indexed: 11/20/2022] Open
Abstract
Background Obstructive sleep apnea syndrome (OSAS) is common in adults. People with OSAS have a higher risk of experiencing traffic accidents and occupational injuries (OIs). We aimed to clarify the diagnostic performance of a three-channel screening device (ApneaLinkTM) compared with the gold standard of full-night attended polysomnography (PSG) among hospital outpatients not referred for sleep-related symptoms. Furthermore, we aimed to determine whether manual revision of the ApneaLinkTM autoscore enhanced diagnostic performance. Methods We investigated 68 patients with OI and 44 without OI recruited from the University Hospital Basel emergency room, using a cross-sectional study design. Participating patients spent one night at home with ApneaLinkTM and within 2 weeks slept for one night at the sleep laboratory. We reanalyzed all ApneaLinkTM data after manual revision. Results We identified significant correlations between the ApneaLinkTM apnea-hypopnea index (AHI) autoscore and the AHI derived by PSG (r = 0.525; p <0.001) and between the ApneaLinkTM oxygen desaturation index (ODI) autoscore and that derived by PSG (r = 0.722; p <0.001). The ApneaLinkTM autoscore showed a sensitivity and specificity of 82% when comparing AHI ≥5 with the cutoff for AHI and/or ODI ≥15 from PSG. In Bland Altman plots the mean difference between ApneaLinkTM AHI autoscore and PSG was 2.75 with SD ± 8.80 (β = 0.034), and between ApneaLinkTM AHI revised score and PSG -1.50 with SD ± 9.28 (β = 0.060). Conclusions The ApneaLinkTM autoscore demonstrated good sensitivity and specificity compared with the gold standard (full-night attended PSG). However, Bland Altman plots revealed substantial fluctuations between PSG and ApneaLinkTM AHI autoscore respectively manually revised score. This spread for the AHI from a clinical perspective is large, and therefore the results have to be interpreted with caution. Furthermore, our findings suggest that there is no clinical benefit in manually revising the ApneaLinkTM autoscore.
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Affiliation(s)
- Michel Hug
- Faculty of Medicine, University of Basel, Basel, Switzerland
- * E-mail:
| | - Katrin Uehli
- Swiss National Accident Insurance Fund (SUVA), Lucerne, Switzerland
| | - Stig Solbach
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Selina Dürr
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Sabrina Maier
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Jörg Daniel Leuppi
- Faculty of Medicine, University of Basel, Basel, Switzerland
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - David Miedinger
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Swiss National Accident Insurance Fund (SUVA), Lucerne, Switzerland
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
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19
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Effect of semi-rapid maxillary expansion in children with obstructive sleep apnea syndrome: 5-month follow-up study. Sleep Breath 2018; 22:1053-1061. [PMID: 29453640 DOI: 10.1007/s11325-018-1636-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/11/2017] [Accepted: 01/28/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the effect of semi-rapid maxillary expansion (SRME) orthodontic treatment on biomarkers and respiratory parameters in children with obstructive sleep apnea syndrome (OSAS) and maxillary transverse deficiency. METHODS Thirty children with OSAS were included in this study. Fifteen children were enrolled as control, and 15 children were subjected to SRME orthodontic treatment method for 5 months. Beside respiratory parameters, pharyngeal area, dental arch, and postero-anterior widths and the levels of OSAS biomarkers in serum and urine were measured. RESULTS Pharyngeal airway space, dental arch, and postero-anterior widths were increased after SRME treatment. Sleep tests showed a decrease in the apnea-hypopnea index (AHI) after 5-month control/treatment duration. Serum kallikrein (KLK)1 levels decreased significantly in the treatment group. There was a significant increase in serum orosomucoid (ORM)2 levels and a decrease in urine perlecan levels in the control group after a 5-month follow-up. A significant negative correlation between serum ORM2, perlecan, gelsolin, and KLK1 levels and intercanin width, as well as between serum ORM2 and KLK1 levels and intermolar width, was observed. CONCLUSIONS SRME treatment can be considered as a useful approach in children with OSAS. A further investigation of OSAS-related biomarkers and their relationship with sleep and orthodontic parameters is needed for providing easier and reliable modulatory strategies in the treatment of OSAS.
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20
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Assessment of oximetry-based statistical classifiers as simplified screening tools in the management of childhood obstructive sleep apnea. Sleep Breath 2018; 22:1063-1073. [PMID: 29453636 DOI: 10.1007/s11325-018-1637-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/12/2018] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE A variety of statistical models based on overnight oximetry has been proposed to simplify the detection of children with suspected obstructive sleep apnea syndrome (OSAS). Despite the usefulness reported, additional thorough comparative analyses are required. This study was aimed at assessing common binary classification models from oximetry for the detection of childhood OSAS. METHODS Overnight oximetry recordings from 176 children referred for clinical suspicion of OSAS were acquired during in-lab polysomnography. Several training and test datasets were randomly composed by means of bootstrapping for model optimization and independent validation. For every child, blood oxygen saturation (SpO2) was parameterized by means of 17 features. Fast correlation-based filter (FCBF) was applied to search for the optimum features. The discriminatory power of three statistical pattern recognition algorithms was assessed: linear discriminant analysis (LDA), quadratic discriminant analysis (QDA), and logistic regression (LR). The performance of each automated model was evaluated for the three common diagnostic polysomnographic cutoffs in pediatric OSAS: 1, 3, and 5 events/h. RESULTS Best screening performances emerged using the 1 event/h cutoff for mild-to-severe childhood OSAS. LR achieved 84.3% accuracy (95% CI 76.8-91.5%) and 0.89 AUC (95% CI 0.83-0.94), while QDA reached 96.5% PPV (95% CI 90.3-100%) and 0.91 AUC (95% CI 0.85-0.96%). Moreover, LR and QDA reached diagnostic accuracies of 82.7% (95% CI 75.0-89.6%) and 82.1% (95% CI 73.8-89.5%) for a cutoff of 5 events/h, respectively. CONCLUSIONS Automated analysis of overnight oximetry may be used to develop reliable as well as accurate screening tools for childhood OSAS.
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21
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Araújo I, Marques F, André S, Araújo M, Marques S, Ferreira R, Moniz P, Proença M, Borrego P, Fonseca C. Diagnosis of sleep apnea in patients with stable chronic heart failure using a portable sleep test diagnostic device. Sleep Breath 2018; 22:749-755. [PMID: 29344749 DOI: 10.1007/s11325-017-1607-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 11/13/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE ApneaLink is a portable device for the screening of sleep apnea, a prevalent and underdiagnosed comorbidity in heart failure patients. A prospective cross-sectional study in patients with chronic heart failure was carried out to assess the sensitivity and specificity of apnea-hypopnea index (AHI) measurements using ApneaLink against the standard polysomnography test. METHODS Adult patients with a prior hospitalization in an acute heart failure hospital unit were recruited for the study. All participants were tested for sleep apnea using ApneaLink and polysomnography simultaneously during an overnight stay at a sleep laboratory. Global sleep apnea was evaluated according to the AHI, which was analyzed and compared. Subpopulation comparison based on ejection fraction was not realized due to population size. RESULTS Thirty-five patients with stable chronic heart failure completed the study (mean age 70.9 ± 10.5 years and body mass index 30.0 ± 4.7 kg/m2). Two patients were excluded due to insufficient study duration. ApneaLink had a sensitivity greater than 80% for all AHI measurements, and a specificity greater than 80% for all AHI measurements, except for AHI ≥ 5 events/h (61.5%). The results showed higher sensitivities and specificities at AHI values of ≥ 10 events/h (sensitivity 81.3% and specificity 84.2%) and ≥ 15 events/h (sensitivity 83.3% and specificity 91.3%). Correlation analysis showed that AHI measurements using ApneaLink and polysomnography had a strong and significant correlation (r = 0.794; P < 0.001). CONCLUSIONS Our results suggest that ApneaLink could be used in clinical practice to identify heart failure patients with high (AHI ≥ 15 events/h) and low (AHI < 5 events/h) probability of having sleep apnea, sparing the need for a diagnostic polysomnography and thus potentially impacting prognosis by providing a more cost-effective and timely diagnosis of this non-cardiac comorbidity.
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Affiliation(s)
- Inês Araújo
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal. .,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
| | - Filipa Marques
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Sandra André
- Polysomnography Laboratory, Pneumology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019, Lisbon, Portugal
| | - Manuel Araújo
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Sara Marques
- Polysomnography Laboratory, Pneumology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019, Lisbon, Portugal
| | - Rita Ferreira
- Polysomnography Laboratory, Pneumology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Rua da Junqueira 126, 1349-019, Lisbon, Portugal
| | - Patrícia Moniz
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Margarida Proença
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Pedro Borrego
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal.,Centre for Public Administration and Public Policies (CAPP), Instituto Superior de Ciências Sociais e Políticas (ISCSP), Universidade de Lisboa, Rua Almerindo Lessa, 1300-663, Lisbon, Portugal
| | - Cândida Fonseca
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
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22
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Van Eyck A, Verhulst SL. Improving the diagnosis of obstructive sleep apnea in children with nocturnal oximetry-based evaluations. Expert Rev Respir Med 2018; 12:165-167. [DOI: 10.1080/17476348.2018.1424546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Stijn L. Verhulst
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
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23
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Prevalence of sleep apnea at the acute phase of ischemic stroke with or without thrombolysis. Sleep Med 2017; 40:40-46. [DOI: 10.1016/j.sleep.2017.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 12/31/2022]
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24
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Meliana V, Chung F, Li CK, Singh M. Interpretation of sleep studies for patients with sleep-disordered breathing: What the anesthesiologist needs to know. Can J Anaesth 2017; 65:60-75. [PMID: 29086358 DOI: 10.1007/s12630-017-0988-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 09/01/2017] [Accepted: 10/10/2017] [Indexed: 11/30/2022] Open
Abstract
There is increased interest in the perioperative management of patients with sleep-disordered breathing (SDB). Anesthesiologists must distill information from clinical reports to make key decisions for optimizing perioperative care. A patient with SDB may present with a sleep study report at the time of surgery. Knowledge of the essential components of such a report can help the anesthesiologist evaluate the patient and optimize the perioperative management. In this narrative review, we describe how level I (i.e., laboratory-based) polysomnography (PSG) data are collected and scored using the recommended scoring guidelines, as well as the basic information and salient features of a typical PSG report relevant to the anesthesiologist. In addition, we briefly review the indications for sleep studies, including the types of laboratory-based studies, as well as the role and limitations of portable monitors (level II-IV studies) and examples of PSG reports in the clinical context.
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Affiliation(s)
- Vina Meliana
- Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, McL 2-405, Toronto, ON, M5T 2S8, Canada
| | - Frances Chung
- Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, McL 2-405, Toronto, ON, M5T 2S8, Canada
| | - Christopher K Li
- Toronto Sleep and Pulmonary Centre, Toronto, ON, Canada.,Department of Medicine, Division of Respirology, University of Toronto, Toronto, ON, Canada
| | - Mandeep Singh
- Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, McL 2-405, Toronto, ON, M5T 2S8, Canada. .,Toronto Sleep and Pulmonary Centre, Toronto, ON, Canada.
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Kamasová M, Václavík J, Václavík T, Hobzová M, Kociánová E, Táborský M. Ambulatory screening for obstructive sleep apnea in patients with resistant arterial hypertension. Sleep Breath 2017; 22:361-367. [PMID: 29080064 DOI: 10.1007/s11325-017-1583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is one of the most common causes of secondary arterial hypertension. It is important to rule out OSA as a cause of resistant hypertension. The ApneaLink device is a simple and cost-efficient outpatient examination, but its usefulness in screening OSA in resistant hypertension has not yet been evaluated. METHODS A total of 69 patients with resistant arterial hypertension were enrolled. Patients underwent a physical examination, including the use of ApneaLink, followed by respiratory polygraphy. The presence of OSA was assessed by the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), mean nocturnal desaturation (SpO2), and percentage of sleep time with SpO2 less than 90%. RESULTS There was no significant difference between the values of AHI found during the use of ApneaLink and respiratory polygraphy (mean 30.4 ± 21.7 vs. 37.2 ± 20.9, P = 0.07). ApneaLink had 77.3% sensitivity and 100% specificity to diagnose OSA with the area under the ROC curve 0.866 (P < 0.001). We also found no significant difference in mean SpO2 (91.3 ± 2.5 vs. 90.9 ± 3.3%, P = 0.22). The ODI evaluated via ApneaLink was significantly lower than by the polygraphy (31.1 ± 18.3 vs. 43.9 ± 24.8, P < 0.001), while the measured percentage of sleep time with SpO2 less than 90% was higher (31.8 ± 23.7 vs. 23.3 ± 24.4, P = 0.001). The severity of OSA was correctly determined by ApneaLink in 50.7% of patients, underestimated in 23.2% and overestimated in 26.1%. CONCLUSIONS The use of ApneaLink is a suitable method for screening the presence of OSA in patients with resistant hypertension, but to accurately assess the severity of OSA, respiratory polygraphy or polysomnography is required.
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Affiliation(s)
- Monika Kamasová
- Department of Internal Medicine I- Cardiology, University Hospital Olomouc and Palacky University Faculty of Medicine and Dentistry, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic.
| | - Jan Václavík
- Department of Internal Medicine I- Cardiology, University Hospital Olomouc and Palacky University Faculty of Medicine and Dentistry, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Tomáš Václavík
- Statistics and Probability Department, Faculty of Informatics and Statistics, University of Economics in Prague, W. Churchill's 1938/4, 130 67, Prague, Czech Republic
| | - Milada Hobzová
- Department of Pulmonary Diseases and Tuberculosis, University Hospital Olomouc and Palacky University Faculty of Medicine and Dentistry, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Eva Kociánová
- Department of Internal Medicine I- Cardiology, University Hospital Olomouc and Palacky University Faculty of Medicine and Dentistry, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Miloš Táborský
- Department of Internal Medicine I- Cardiology, University Hospital Olomouc and Palacky University Faculty of Medicine and Dentistry, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
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Kirk V, Baughn J, D'Andrea L, Friedman N, Galion A, Garetz S, Hassan F, Wrede J, Harrod CG, Malhotra RK. American Academy of Sleep Medicine Position Paper for the Use of a Home Sleep Apnea Test for the Diagnosis of OSA in Children. J Clin Sleep Med 2017; 13:1199-1203. [PMID: 28877820 DOI: 10.5664/jcsm.6772] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The purpose of this position paper is to establish the American Academy of Sleep Medicine's (AASM) position on the use of a home sleep apnea test (HSAT) for the diagnosis of obstructive sleep apnea (OSA) in children (birth to 18 years of age). METHODS The AASM commissioned a task force of 8 experts in sleep medicine to review the available literature on the use of an HSAT to diagnose OSA in children. The task force developed the position statement based on a thorough review of these studies and their clinical expertise. The AASM Board of Directors approved the final position statement. POSITION STATEMENT Use of a home sleep apnea test is not recommended for the diagnosis of obstructive sleep apnea in children. The ultimate judgment regarding propriety of any specific care must be made by the clinician, in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources.
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Affiliation(s)
| | | | - Lynn D'Andrea
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | - Anjalee Galion
- Children's Hospital of Orange County, Orange, California
| | - Susan Garetz
- University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Joanna Wrede
- Seattle Children's Hospital, Seattle, Washington
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Zhu CP, Li TP, Wang X, Zhao YH, Zhou SX, Fu Y, Jiang YW, Xiao XP. The relationship between apnoea hypopnoea index and Gensini score in patients with acute myocardial infarction undergoing emergency primary percutaneous coronary intervention. J Thorac Dis 2017; 9:2476-2483. [PMID: 28932553 DOI: 10.21037/jtd.2017.07.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sleep apnoea hypopnoea syndrome (SAHS) is characterised by repetitive nocturnal hypoxemia and has a high prevalence among patients with acute myocardial infarction (AMI). But there are few studies on patients with AMI undergoing emergency primary percutaneous coronary intervention (pPCI). In this study, we want to find the prevalence of SAHS among patients with AMI undergoing emergency pPCI and determine whether SAHS would worsen the condition among these people, and especially affect the damage degree of the coronary artery. METHODS Over four months, 95 patients admitted for the first time for AMI were observed. All of them had emergency primary PCIs. A total of 86 patients accepted the sleep study and were divided into four groups according to the apnoea hypopnoea index (AHI): SAHS was diagnosed when AHI ≥5/h and was defined as mild for AHI ≥5/h and <15/h, moderate for AHI ≥15/h and <30/h, and severe for AHI ≥30/h. On the contrary, the patients whose AHI <5/h were Non-SAHS. And the characteristics of the patients among these four groups were compared. According to the time of chest pain onset, the number of the patients between SAHS and non-SAHS, and patients' AHI during three intervals of one day were measured and compared; Makers including the sensitivity of serum troponin T (hs-TnT), creatine kinase isoenzyme MB (CK-MB), left ventricular ejection fraction (LVEF), pro-brain-type natriuretic peptide (pro-BNP), Gensini score and collateral vessels between the SAHS and non-SAHS were compared. And the relationships between the AHI of these patients and the markers were analysed. RESULTS Of the 86 patients studied, 65 had SAHS, representing a SAHS prevalence of 75.58% among patients with AMI undergoing emergency pPCI. There were significant differences in average ages, smoking and arrhythmia (P<0.05) between these four groups. There was no significant difference between AMI patients with or without SAHS regarding the day-night pattern. But there showed significant differences between SAHS and non-SAHS in Gensini score (P<0.05) and pro-BNP (P<0.05). Also, there were positive correlations between AHI and Gensini score (r=0.490, P<0.05) and pro-BNP (r=0.338, P<0.05). CONCLUSIONS Among patients with AMI undergoing emergency pPCI, there is a high prevalence of SAHS. There are also positive correlations between AHI and Gensini score, and pro-BNP. Therefore, guided by the results, should we conduct a routine screening to those patients normally and could we relieve the damage to the coronary artery by curing the SAHS?
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Affiliation(s)
- Cai-Ping Zhu
- Department of Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Tao-Ping Li
- Department of Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xiao Wang
- Department of Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Validation of ApneaLink™ Plus for the diagnosis of sleep apnea. Sleep Breath 2017; 21:799-807. [PMID: 28669116 DOI: 10.1007/s11325-017-1532-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study is to evaluate the validation of ApneaLink™ Plus (ALP) based on a large number of subjects in a prospective design. METHOD We recommended enrolling of 200 consecutive patients who had been referred because of habitual snoring or witnessed apnea during sleep. If consent was obtained, patients underwent standard polysomnography (PSG) and ALP evaluation simultaneously at the hospital (ALPlab), and repeated ALP at home (ALPhome) within 1 month. The parameters of ALP were scored based on three different systems, Manual, Auto AASM, and Auto scoring systems. RESULT Among the 200 patients who were recommended for enrollment, 149 completed the study. Sensitivity was good for all three scoring systems, while specificity was poor for the Auto scoring system. The area under curve was highest for the manual scoring system and lowest for the auto scoring system, and increased as the apnea-hypopnea index (AHI) cutoff value increased from 5 to 30. Regarding agreement with PSG, the manual scoring system was most superior, followed by the Auto AASM, and Auto scoring systems. The degree of agreement between PSG and ALP was affected by sleep efficiency and the arousal index. Moderate agreement between PSG and ALP based on central apnea index was observed. CONCLUSION ALP is an accurate and reliable device for the diagnosis of OSA. Manual scoring is recommended; however, Auto AASM is also acceptable. ALP detects central sleep apnea to a certain degree. Both sleep efficiency and the arousal index affect the results of ALP.
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29
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Multiscale Entropy Analysis of Unattended Oximetric Recordings to Assist in the Screening of Paediatric Sleep Apnoea at Home. ENTROPY 2017. [DOI: 10.3390/e19060284] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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30
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Álvarez D, Alonso-Álvarez ML, Gutiérrez-Tobal GC, Crespo A, Kheirandish-Gozal L, Hornero R, Gozal D, Terán-Santos J, Del Campo F. Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings. J Clin Sleep Med 2017; 13:693-702. [PMID: 28356177 DOI: 10.5664/jcsm.6586] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/09/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Nocturnal oximetry has become known as a simple, readily available, and potentially useful diagnostic tool of childhood obstructive sleep apnea (OSA). However, at-home respiratory polygraphy (HRP) remains the preferred alternative to polysomnography (PSG) in unattended settings. The aim of this study was twofold: (1) to design and assess a novel methodology for pediatric OSA screening based on automated analysis of at-home oxyhemoglobin saturation (SpO2), and (2) to compare its diagnostic performance with HRP. METHODS SpO2 recordings were parameterized by means of time, frequency, and conventional oximetric measures. Logistic regression models were optimized using genetic algorithms (GAs) for three cutoffs for OSA: 1, 3, and 5 events/h. The diagnostic performance of logistic regression models, manual obstructive apnea-hypopnea index (OAHI) from HRP, and the conventional oxygen desaturation index ≥ 3% (ODI3) were assessed. RESULTS For a cutoff of 1 event/h, the optimal logistic regression model significantly outperformed both conventional HRP-derived ODI3 and OAHI: 85.5% accuracy (HRP 74.6%; ODI3 65.9%) and 0.97 area under the receiver operating characteristics curve (AUC) (HRP 0.78; ODI3 0.75) were reached. For a cutoff of 3 events/h, the logistic regression model achieved 83.4% accuracy (HRP 85.0%; ODI3 74.5%) and 0.96 AUC (HRP 0.93; ODI3 0.85) whereas using a cutoff of 5 events/h, oximetry reached 82.8% accuracy (HRP 85.1%; ODI3 76.7) and 0.97 AUC (HRP 0.95; ODI3 0.84). CONCLUSIONS Automated analysis of at-home SpO2 recordings provide accurate detection of children with high pretest probability of OSA. Thus, unsupervised nocturnal oximetry may enable a simple and effective alternative to HRP and PSG in unattended settings.
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Affiliation(s)
- Daniel Álvarez
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
| | - María L Alonso-Álvarez
- Unidad Multidisciplinar de Sueño, CIBER Respiratorio, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Andrea Crespo
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
| | - Leila Kheirandish-Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
| | - David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Joaquín Terán-Santos
- Unidad Multidisciplinar de Sueño, CIBER Respiratorio, Hospital Universitario de Burgos, Burgos, Spain
| | - Félix Del Campo
- Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain.,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
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Marrone O, Bonsignore MR. The puzzle of metabolic effects of obstructive sleep apnoea in children. Eur Respir J 2016; 47:1050-3. [PMID: 27037314 DOI: 10.1183/13993003.00115-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Oreste Marrone
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy
| | - Maria R Bonsignore
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy DiBiMIS, University of Palermo, Italy
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de Vries GE, van der Wal HH, Wijkstra P, van der Meer P. Response: A Portable Device as Sleep-Screening Tool in the Identification of Obstructive Sleep Apnea in Chronic Heart Failure: Which Value Should We Consider as Cutoff? J Card Fail 2016; 22:168. [DOI: 10.1016/j.cardfail.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 11/24/2015] [Accepted: 12/01/2015] [Indexed: 11/26/2022]
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Oliveira MG, Treptow EC, Fukuda C, Nery LE, Valadares RM, Tufik S, Bittencourt L, Togeiro SM. Diagnostic accuracy of home-based monitoring system in morbidly obese patients with high risk for sleep apnea. Obes Surg 2015; 25:845-51. [PMID: 25344466 DOI: 10.1007/s11695-014-1469-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND No previous studies have validated the use of portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) in morbidly obese individuals. Our aim was to investigate the accuracy of PM for detecting respiratory events in morbidly obese patients that will be undergoing bariatric surgery. METHODS This was a prospective study involving patients with body mass index (BMI) ≥35 kg/m(2) who were recruited from the Sleep Clinic of Universidade Federal de São Paulo. Sleep-disordered breathing (SDB) was evaluated during full-night polysomnography (PSG). PM use was randomized and used on two consecutive nights: (1) at home (STDHome) and (2) at the sleep laboratory with PSG (PSG_STDLab). RESULTS Although 58 participants initially underwent the recordings, 26 (45%) were excluded because of technical problems. The patients' mean age was 42.9 ± 10.9 (SD) years, and 56% were female. The mean BMI was 40.8 ± 5.2 kg/m(2). All patients had high risk for OSA, as defined by the Stop-Bang questionnaire, and the mean apnea-hypopnea index (AHI) was 46.9 ± 30.4/h. The intraclass coefficient of the correlation between AHI_PSG and AHI_STDLab was r = 0.92 (p = 0.0001); the intraclass coefficient for AHI_PSG and AHI_STDHome was r = 0.84 (p = 0.0001). The Kappa index was 0.87 (p > 0.0001) for severe cases. The sensitivity and the positive predictive value increased with the disease severity. A Bland-Altman analysis showed good agreement between the investigated methods. CONCLUSIONS PM is an efficacious method for diagnosing OSA in obese patients who have a high clinical probability of the disease. The method displays good sensitivity and specificity in severe cases; nevertheless, the high rate of data loss must be taken into account.
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Affiliation(s)
- Márcia G Oliveira
- Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de Sao Paulo - UNIFESP, Rua Pedro de Toledo, 720, Sao Paulo, SP, 04039-034, Brazil,
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Dawson A, Loving RT, Gordon RM, Abel SL, Loewy D, Kripke DF, Kline LE. Type III home sleep testing versus pulse oximetry: is the respiratory disturbance index better than the oxygen desaturation index to predict the apnoea-hypopnoea index measured during laboratory polysomnography? BMJ Open 2015; 5:e007956. [PMID: 26129636 PMCID: PMC4486950 DOI: 10.1136/bmjopen-2015-007956] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In its guidelines on the use of portable monitors to diagnose obstructive sleep apnoea, the American Academy of Sleep Medicine endorses home polygraphy with type III devices recording at a minimum airflow the respiratory effort and pulse oximetry, but advises against simple pulse oximetry. However, oximetry is widely available and simple to use in the home. This study was designed to compare the ability of the oxygen desaturation index (ODI) based on oximetry alone with a stand-alone pulse oximeter (SPO) and from the oximetry channel of the ApneaLink Plus (ALP), with the respiratory disturbance index (RDI) based on four channels from the ALP to predict the apnoea-hypopnoea index (AHI) from laboratory polysomnography. DESIGN Cross-sectional diagnostic accuracy study. SETTING Sleep medicine practice of a multispecialty clinic. PARTICIPANTS Patients referred for laboratory polysomnography with suspected sleep apnoea. We enrolled 135 participants with 123 attempting the home sleep testing and 73 having at least 4 hours of satisfactory data from SPO and ALP. INTERVENTIONS Participants had home testing performed simultaneously with both a SPO and an ALP. The 2 oximeter probes were worn on different fingers of the same hand. The ODI for the SPO was calculated using Profox software (ODI(SOX)). For the ALP, RDI and ODI were calculated using both technician scoring (RDI(MAN) and ODI(MAN)) and the ALP computer scoring (RDI(RAW) and ODI(RAW)). RESULTS The receiver-operator characteristic areas under the curve for AHI ≥ 5 were RDI(MAN) 0.88 (95% confidence limits 0.81-0.96), RDI(RAW) 0.86 (0.76-0.94), ODI(MAN) 0.86 (0.77-0.95), ODI(RAW) 0.84 (0.75-0.93) and ODI(SOX) 0.83 (0.73-0.93). CONCLUSIONS We conclude that the RDI and the ODI, measured at home on the same night, give similar predictions of the laboratory AHI, measured on a different night. The differences between the two methods are small compared with the reported night-to-night variation of the AHI.
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Affiliation(s)
- Arthur Dawson
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Richard T Loving
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Robert M Gordon
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Susan L Abel
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Derek Loewy
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Daniel F Kripke
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
| | - Lawrence E Kline
- Division of Pulmonary and Critical Care Medicine, Scripps Clinic Viterbi Family Sleep Centre, La Jolla, California, USA
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Effects of rapid maxillary expansion and mandibular advancement on upper airways in Marfan’s syndrome children: a home sleep study and cephalometric evaluation. Sleep Breath 2015; 19:1213-20. [DOI: 10.1007/s11325-015-1141-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 12/02/2014] [Accepted: 02/03/2015] [Indexed: 11/26/2022]
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Fredheim JM, Røislien J, Hjelmesæth J. Validation of a portable monitor for the diagnosis of obstructive sleep apnea in morbidly obese patients. J Clin Sleep Med 2014; 10:751-7, 757A. [PMID: 25024652 DOI: 10.5664/jcsm.3864] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVES We aimed to validate the diagnostic accuracy and night-to-night variability of a simple 3-channel (type IV monitor) portable sleep monitor, ApneaLink (AL), in a population of morbidly obese subjects. DESIGN Cross-sectional validation and diagnostic accuracy study. SETTING Public tertiary care obesity center in Norway. PARTICIPANTS A total of 105 (67 females) treatment seeking morbidly obese subjects were included, mean (SD) age 44.3 (11.4) years and BMI 43.6 (5.6) kg/m2. INTERVENTIONS The patients underwent two successive nights of recordings; the first night with the AL only, and the following night with both the reference instrument Embletta (E), a type III portable somnograph, and the AL. MEASUREMENTS AND RESULTS Main outcomes were diagnostic accuracy of AL as assessed by sensitivity, specificity and area under ROC curves, and level of agreement between AL and E. AL had high diagnostic accuracy at all levels of OSA, and the Bland-Altman plots showed good agreement between AL and E. The sensitivity and specificity of the instrument were 93% and 71% at the AHI cutoff 5 events/h, and 94% and 94% at the AHI cutoff 15, respectively. The night-to-night variability was low. CONCLUSION Our results indicate that a simple 3-channel portable sleep monitor (ApneaLink) has a high diagnostic accuracy in diagnosing OSA in morbidly obese treatment seeking patients. Accordingly, this and similar instruments might help non-specialists to diagnose OSA in morbidly obese patients, and, importantly, help non-specialists to refer patients who need specific treatment to specialist without unnecessary delay.
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Affiliation(s)
- Jan Magnus Fredheim
- Morbid Obesity Center, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway ; Department of Otolaryngology - Head and Neck Surgery, Vestfold Hospital Trust, Tønsberg, Norway ; Institute of Clinical Medicine, University of Oslo, Norway
| | - J Røislien
- Morbid Obesity Center, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway ; Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - J Hjelmesæth
- Morbid Obesity Center, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway ; Institute of Clinical Medicine, University of Oslo, Norway
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Brown DL, Chervin RD, Hegeman G, Smith MA, Garcia NM, Morgenstern LB, Lisabeth LD. Is technologist review of raw data necessary after home studies for sleep apnea? J Clin Sleep Med 2014; 10:371-5. [PMID: 24733981 DOI: 10.5664/jcsm.3606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVES As the importance of portable monitors for detection of sleep apnea increases, efficient and cost-minimizing methods for data interpretation are needed. We sought to compare in stroke patients, for whom portable studies often have particular advantages, results from a cardiopulmonary monitoring device with and without manual edits by a polysomnographic technologist. METHODS Participants in an ongoing stroke surveillance study in Corpus Christi, Texas, underwent sleep apnea assessments with the ApneaLink Plus device within 45 days of stroke onset. Recordings were analyzed by the device's software unedited, and again after edits were made to the raw data by a registered polysomnographic technologist. Sensitivity and specificity were calculated, with the edited data as the reference standard. Sleep apnea was defined by 3 different apnea-hypopnea index (AHI) thresholds: ≥ 5, ≥ 10, and ≥ 15. RESULTS Among 327 subjects, 54% were male, 59% were Hispanic, and the median age was 65 years (interquartile range: 57, 77). The median AHI for the unedited data was 9 (4, 22), and for the edited data was 13 (6, 27) (p < 0.01). Specificity was above 98% for each AHI cutoff, while sensitivity was 81% to 82%. For each cutoff threshold, the edited data yielded a higher proportion of positive sleep apnea screens (p < 0.01) by approximately 10% in each group. CONCLUSIONS For stroke patients assessed with a cardiopulmonary monitoring device, manual editing by a technologist appears likely to improve sensitivity, whereas specificity of unedited data is already excellent.
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Affiliation(s)
- Devin L Brown
- Stroke Program, University of Michigan, Ann Arbor, MI
| | | | - Garnett Hegeman
- Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | | | | | - Lewis B Morgenstern
- Stroke Program, University of Michigan, Ann Arbor, MI ; Sleep Disorders Center, University of Michigan, Ann Arbor, MI
| | - Lynda D Lisabeth
- Stroke Program, University of Michigan, Ann Arbor, MI ; Sleep Disorders Center, University of Michigan, Ann Arbor, MI
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Certal V, Camacho M, Winck JC, Capasso R, Azevedo I, Costa-Pereira A. Unattended sleep studies in pediatric OSA: A systematic review and meta-analysis. Laryngoscope 2014; 125:255-62. [DOI: 10.1002/lary.24662] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 03/03/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Victor Certal
- Department of Otorhinolaryngology; University of Porto; Porto Portugal
- Sleep Surgery Division, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford California U.S.A
| | - Macario Camacho
- Sleep Surgery Division, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford California U.S.A
| | - João C. Winck
- Department of Pulmonology; Faculty of Medicine, University of Porto; Porto Portugal
| | - Robson Capasso
- Sleep Surgery Division, Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford California U.S.A
| | - Inês Azevedo
- Department of Pediatrics; Faculty of Medicine, University of Porto; Porto Portugal
| | - Altamiro Costa-Pereira
- Hospital Sao Sebastiao, Sta Maria da Feira, and Center for Research in Health Technologies and Information Systems; University of Porto; Porto Portugal
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Oliveira MG, Garbuio S, Treptow EC, Polese JF, Tufik S, Nery LE, Bittencourt L. The use of portable monitoring for sleep apnea diagnosis in adults. Expert Rev Respir Med 2013; 8:123-32. [PMID: 24308652 DOI: 10.1586/17476348.2014.850421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea (OSA). The implementation of alternative approaches to the current management by full polysomnography (PSG) in the sleep laboratory is necessary for diagnosing this syndrome due to the high cost of full-night PSG. A good alternative option for OSA diagnosis is portable monitoring (PM), which is known for its accuracy, ease of management and lower cost when compared with full PSG. PM has not been well validated for OSA diagnosis in patients with medical comorbidities or in elderly individuals and children. PM may be recommended as an alternative method to PSG for patients with high clinical risk for OSA. In the present review, we describe the use of PM for OSA diagnosis and evaluate the current progress, costs, limitations and applications of these devices in various groups of patients, particularly for patients with comorbid diseases.
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Affiliation(s)
- Marcia G Oliveira
- Departamento de Medicina - Universidade Federal de São Paulo, Disciplina de Pneumologia. Rua Pedro de Toledo, 720 - 3° andar - CEP: 04039-002 - São Paulo, Brasil
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The utility of a portable sleep monitor to diagnose sleep-disordered breathing in a pediatric population. Can Respir J 2013; 21:31-5. [PMID: 24083303 DOI: 10.1155/2014/271061] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Central and⁄or obstructive sleep-disordered breathing (SDB) in children represents a spectrum of abnormal breathing during sleep. SDB is diagnosed using the gold standard, overnight polysomnography (PSG). The limited availability and access to PSG prevents its widespread use, resulting in significant delays in diagnosis and treatment of SDB. As such, portable sleep monitors are urgently needed. OBJECTIVE To evaluate the utility of a commercially available portable sleep study monitor (PSS-AL) (ApneaLink, ResMed, USA) to diagnose SDB in children. METHODS Children referred to a pediatric sleep facility were simultaneously monitored using the PSS-AL monitor and overnight PSG. The apnea-hypopnea index (AHI) was calculated using the manual and autoscoring function of the PSS-AL, and PSG. Sensitivity and specificity were compared with the manually scored PSS-AL and PSG. Pearson correlations and Bland-Altman plots were constructed. RESULTS Thirty-five children (13 female) completed the study. The median age was 11.0 years and the median body mass index z-score was 0.67 (range -2.3 to 3.8). SDB was diagnosed in 17 of 35 (49%) subjects using PSG. The AHI obtained by manually scored PSS-AL strongly correlated with the AHI obtained using PSG (r=0.89; P<0.001). Using the manually scored PSS-AL, a cut-off of AHI of >5 events⁄h had a sensitivity of 94% and a specificity of 61% to detect any SDB diagnosed by PSG. CONCLUSIONS Although PSG is still recommended for the diagnosis of SDB, the ApneaLink sleep monitor has a role for triaging children referred for evaluation of SDB, but has limited ability to determine the nature of the SDB.
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Van Hoorenbeeck K, Franckx H, Debode P, Aerts P, Ramet J, Van Gaal LF, Desager KN, De Backer WA, Verhulst SL. Metabolic disregulation in obese adolescents with sleep-disordered breathing before and after weight loss. Obesity (Silver Spring) 2013; 21:1446-50. [PMID: 23408643 DOI: 10.1002/oby.20337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 12/10/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Sleep-disordered breathing (SDB) is prevalent in obesity. Weight loss is one of the most effective treatment options. The aim was to assess the association of SDB and metabolic disruption before and after weight loss. DESIGN AND METHODS Obese adolescents were included when entering an in-patient weight loss program. Fasting blood analysis was performed at baseline and after 4-6 months. Sleep screening was done at baseline and at follow-up in case of baseline SDB. RESULTS 224 obese adolescents were included. Median age was 15.5 years (10.1-18.0) and mean BMI z-score was 2.74 ± 0.42. About 30% had SDB at baseline (N = 68). High-density lipoprotein (HDL)-cholesterol was associated with mean nocturnal oxygen saturation (<SaO2>) (partial r = 0.21; P = 0.002). Aspartate aminotransferase (ASAT) and alanine aminotransferase were related with oxygen desaturation index (partial r = -0.15; P = 0.03 and partial r = -0.15; P = 0.02), but this became insignificant after correction for sex. After weight loss, 24% had residual SDB. Linear regression showed an association between ASAT and <SaO2> (partial r = -0.34; P = 0.002). There were no significant correlations between improvements in laboratory measurements and sleep parameters. HDL-cholesterol improved in relation with the decrease in BMI z-score. CONCLUSION SDB at baseline was associated with higher levels of liver enzymes and lower HDL-cholesterol concentration. Improvements in sleep parameters were not associated with improvements in laboratory measurements.
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Affiliation(s)
- K Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
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