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Teixeira RCP, Cahali MB. In-Laboratory Polysomnography Worsens Obstructive Sleep Apnea by Changing Body Position Compared to Home Testing. Sensors (Basel) 2024; 24:2803. [PMID: 38732909 PMCID: PMC11086251 DOI: 10.3390/s24092803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
(1) Background: Home sleep apnea testing, known as polysomnography type 3 (PSG3), underestimates respiratory events in comparison with in-laboratory polysomnography type 1 (PSG1). Without head electrodes for scoring sleep and arousal, in a home environment, patients feel unfettered and move their bodies more naturally. Adopting a natural position may decrease obstructive sleep apnea (OSA) severity in PSG3, independently of missing hypopneas associated with arousals. (2) Methods: Patients with suspected OSA performed PSG1 and PSG3 in a randomized sequence. We performed an additional analysis, called reduced polysomnography, in which we blindly reassessed all PSG1 tests to remove electroencephalographic electrodes, electrooculogram, and surface electromyography data to estimate the impact of not scoring sleep and arousal-based hypopneas on the test results. A difference of 15 or more in the apnea-hypopnea index (AHI) between tests was deemed clinically relevant. We compared the group of patients with and without clinically relevant differences between lab and home tests (3) Results: As expected, by not scoring sleep, there was a decrease in OSA severity in the lab test, similar to the home test results. The group of patients with clinically relevant differences between lab and home tests presented more severe OSA in the lab compared to the other group (mean AHI, 42.5 vs. 20.2 events/h, p = 0.002), and this difference disappeared in the home test. There was no difference between groups in the shift of OSA severity by abolishing sleep scoring in the lab. However, by comparing lab and home tests, there were greater variations in supine AHI and time spent in the supine position in the group with a clinically relevant difference, either with or without scoring sleep, showing an impact of the site of the test on body position during sleep. These variations presented as a marked increase or decrease in supine outcomes according to the site of the test, with no particular trend. (4) Conclusions: In-lab polysomnography may artificially increase OSA severity in a subset of patients by inducing marked changes in body position compared to home tests. The location of the sleep test seems to interfere with the evaluation of patients with more severe OSA.
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Affiliation(s)
- Raquel Chartuni Pereira Teixeira
- Department of Otolaryngology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, sala 6167, São Paulo 05403-000, SP, Brazil;
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Rusanen M, Korkalainen H, Gretarsdottir H, Siilak T, Olafsdottir KA, Töyräs J, Myllymaa S, Arnardottir ES, Leppänen T, Kainulainen S. Self-applied somnography: technical feasibility of electroencephalography and electro-oculography signal characteristics in sleep staging of suspected sleep-disordered adults. J Sleep Res 2024; 33:e13977. [PMID: 37400248 DOI: 10.1111/jsr.13977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/05/2023]
Abstract
Sleep recordings are increasingly being conducted in patients' homes where patients apply the sensors themselves according to instructions. However, certain sensor types such as cup electrodes used in conventional polysomnography are unfeasible for self-application. To overcome this, self-applied forehead montages with electroencephalography and electro-oculography sensors have been developed. We evaluated the technical feasibility of a self-applied electrode set from Nox Medical (Reykjavik, Iceland) through home sleep recordings of healthy and suspected sleep-disordered adults (n = 174) in the context of sleep staging. Subjects slept with a double setup of conventional type II polysomnography sensors and self-applied forehead sensors. We found that the self-applied electroencephalography and electro-oculography electrodes had acceptable impedance levels but were more prone to losing proper skin-electrode contact than the conventional cup electrodes. Moreover, the forehead electroencephalography signals recorded using the self-applied electrodes expressed lower amplitudes (difference 25.3%-43.9%, p < 0.001) and less absolute power (at 1-40 Hz, p < 0.001) than the polysomnography electroencephalography signals in all sleep stages. However, the signals recorded with the self-applied electroencephalography electrodes expressed more relative power (p < 0.001) at very low frequencies (0.3-1.0 Hz) in all sleep stages. The electro-oculography signals recorded with the self-applied electrodes expressed comparable characteristics with standard electro-oculography. In conclusion, the results support the technical feasibility of the self-applied electroencephalography and electro-oculography for sleep staging in home sleep recordings, after adjustment for amplitude differences, especially for scoring Stage N3 sleep.
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Affiliation(s)
- Matias Rusanen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Henri Korkalainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Heidur Gretarsdottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Tiina Siilak
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Kristin Anna Olafsdottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia
| | - Sami Myllymaa
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland, Australia
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Tschopp S, Borner U, Caversaccio M, Tschopp K. Long-term night-to-night variability of sleep-disordered breathing using a radar-based home sleep apnea test: a prospective cohort study. J Clin Sleep Med 2024. [PMID: 38415722 DOI: 10.5664/jcsm.11070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
STUDY OBJECTIVES Night-to-night variability of sleep-disordered breathing (SDB) limits the diagnostic accuracy of a single measurement. Multiple recordings using a reliable, affordable method could reduce the uncertainty and avoid misdiagnosis, which could be possible with radar-based home sleep apnea testing (HSAT). METHODS We recruited consecutive patients with suspected SDB and performed contactless radar-based HSAT with automated scoring (Sleepiz One) over ten nights. During the first night, patients were simultaneously measured with peripheral-arterial tonometry. RESULTS Twenty-four of the 28 included patients could achieve a minimum of four measurements. The failure rate was 16% (201 of 238 measurements). The apnea-hypopnea index (AHI) and oxygen desaturation index were consistently lower with radar-based HSAT compared to peripheral arterial tonometry. The variability of the AHI was considerable, with a standard error of measurement of 5.2/h (95%CI 4.6-5.7/h) and a minimal detectable difference of 14.4/h (95%CI 12.7-15.9/h). Alcohol consumption partially accounted for the variability, with an AHI increase of 1.7/h (95%CI 0.6-2.8/h) for each standard drink. Based on a single measurement, 17% of patients were misdiagnosed, and 32% were misclassified for SDB severity. After five measurements, the mean AHI of the measured nights stabilized with no evidence of substantial changes with additional measurements. CONCLUSIONS Night-to-night variability is considerable and stable over ten nights. HSAT using radar-based methods over multiple nights is feasible and well tolerated by patients. It could offer lower costs and allow for multiple-night testing to increase accuracy. However, validation and reducing the failure rate are necessary for implementation in the clinical routine. CLINICAL TRIAL REGISTRATION "Recording of Multiple Nights Using a New Contactless Device (Sleepiz One Connect) in Obstructive Sleep Apnea", ClinicalTrials.gov, NCT05134402.
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Affiliation(s)
- Samuel Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerl and
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Liestal, Switzerl and
| | - Urs Borner
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerl and
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerl and
| | - Kurt Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Liestal, Switzerl and
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Wang J, Zhang C, Xu L, Wei J, Yang J, Strohl AE, Yi H, Liu X, Zhang L, Zhao R, Hong S, Zhou B, Zhao L, Zhang X, Dong X, Strohl KP, Wang J, Liu G, Han F. Home monitoring for clinically suspected obstructive sleep apnea in pregnancy. J Clin Sleep Med 2023; 19:1951-1960. [PMID: 37485700 PMCID: PMC10620654 DOI: 10.5664/jcsm.10726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
STUDY OBJECTIVES To determine if a home sleep apnea test (HSAT) using a type III portable monitor (PM), Nox-T3 (Nox Medical, Inc., Reykjavik, Iceland), detects obstructive sleep apnea in pregnant women. METHODS Ninety-two pregnant women (34.5 ± 4.3 years; gestational age 25.4 ± 8.9 weeks; body mass index 29.9 ± 4.7 kg/m2) with suspected obstructive sleep apnea underwent HSAT with the Nox-T3 PM followed by overnight polysomnography (PSG) and PM recording simultaneously in the laboratory within 1 week. PMs were scored automatically and manually using a 3% criteria and compared with PSGs scored by following guidelines. RESULTS Apnea-hypopnea indexes were 8.56 ± 10.42, 8.19 ± 13.79, and 8.71 ± 14.19 events/h on HSAT, in-laboratory PM recording, and PSG (P = .955), respectively. Bland-Altman analysis of the apnea-hypopnea index on PSG vs HSAT showed a mean difference (95% confidence interval) of -0.15 (-1.83, 1.53); limits of agreement (± 2 SD) were -16.26 to 16.56 events/h. Based on a threshold apnea-hypopnea index ≥ 5 events/h, HSAT had 91% sensitivity, 85% specificity, 84% positive-predictive value, and 92% negative-predictive value compared with PSG. When comparing the simultaneous recordings, closer agreement was observed. Automated vs manual analysis of PM showed no significant difference. CONCLUSIONS A type III PM had an acceptable failure rate and high diagnostic performance operating as a reasonable alternative for in-laboratory PSG in pregnant women. CITATION Wang J, Zhang C, Xu L, et al. Home monitoring for clinically suspected obstructive sleep apnea in pregnancy. J Clin Sleep Med. 2023;19(11):1951-1960.
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Affiliation(s)
- Jingyu Wang
- Division of Sleep Medicine, Peking University People’s Hospital, Beijing, China
| | - Chi Zhang
- Division of Sleep Medicine, Peking University People’s Hospital, Beijing, China
| | - Liyue Xu
- Division of Sleep Medicine, Peking University People’s Hospital, Beijing, China
| | - Jun Wei
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China
| | - Jingjing Yang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China
| | - Anna E. Strohl
- Department of OB/GYN-Gynecological Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland Ohio
| | - Huijie Yi
- Peking University School of Nursing, Beijing, China
| | - Xinran Liu
- Peking University School of Nursing, Beijing, China
| | - Linyan Zhang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China
| | - Rui Zhao
- Division of Sleep Medicine, Peking University People’s Hospital, Beijing, China
| | - Shenda Hong
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Bing Zhou
- Division of Sleep Medicine, Peking University People’s Hospital, Beijing, China
| | - Long Zhao
- Division of Sleep Medicine, Peking University People’s Hospital, Beijing, China
| | - Xueli Zhang
- Division of Sleep Medicine, Peking University People’s Hospital, Beijing, China
| | - Xiaosong Dong
- Division of Sleep Medicine, Peking University People’s Hospital, Beijing, China
| | - Kingman P. Strohl
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University, and Cleveland Louis Stokes VA Medical Center, Cleveland, Ohio
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China
| | - Guoli Liu
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China
| | - Fang Han
- Division of Sleep Medicine, Peking University People’s Hospital, Beijing, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lyne CJ, Hamilton GS, Turton AR, Stupar D, Mansfield DR. Validation of a single-use and reusable home sleep apnea test based on peripheral arterial tonometry compared to laboratory polysomnography for the diagnosis of obstructive sleep apnea. J Clin Sleep Med 2023; 19:1429-1435. [PMID: 37078187 PMCID: PMC10394370 DOI: 10.5664/jcsm.10568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/18/2023] [Accepted: 03/18/2023] [Indexed: 04/21/2023]
Abstract
STUDY OBJECTIVES The objective of this study was to independently validate a disposable and a reusable home sleep apnea test (HSAT) recording on peripheral arterial tonometry, compared to laboratory polysomnography (PSG), for the diagnosis of obstructive sleep apnea (OSA). METHODS 115 participants undergoing PSG for suspected OSA were recruited and fitted with the two study devices (NightOwl, Ectosense, Belgium). After exclusions were applied and device failures were removed, data from 100 participants were analyzed. HSAT-derived apnea-hypopnea index (AHI), OSA severity category, total sleep time, and oxygen desaturation index 3% were compared to PSG. RESULTS Both study devices demonstrated satisfactory levels of agreement with minimal mean bias for determination of AHI and oxygen desaturation index 3% (disposable: AHI mean bias 2.04 events/h [95% limits of agreement -20.9 to 25.0], oxygen desaturation index 3% mean bias -0.21/h [-18.1 to 17.7]; reusable: AHI mean bias 2.91 events/h [-16.9 to 22.7], oxygen desaturation index 3% mean bias 0.77/h [-15.7 to 17.3]). Level of agreement diminished at higher AHI levels although misclassification for severe OSA occurred infrequently. Total sleep time level of agreement for the reusable HSAT was also satisfactory with minimal mean bias (4.18 minutes, -125.1 to 112.4), but the disposable HSAT was impacted by studies with high signal rejection (23.7 minutes, -132.7 to 180.1). Categorization of OSA severity demonstrated moderate agreement with laboratory PSG, with a kappa of 0.52 and 0.57 for the disposable and reusable HSATs respectively. CONCLUSIONS The two HSAT devices were comparable and performed well compared to laboratory PSG for the diagnosis of OSA. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; Identifier: ANZCTR12621000444886. CITATION Lyne CJ, Hamilton GS, Turton ARE, et al. Validation of a single-use and reusable home sleep apnea test based on peripheral arterial tonometry compared to laboratory polysomnography for the diagnosis of obstructive sleep apnea. J Clin Sleep Med. 2023;19(8):1429-1435.
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Affiliation(s)
- Christopher J. Lyne
- Monash Lung Sleep Allergy and Immunology, Monash Health, Victoria, Australia
| | - Garun S. Hamilton
- Monash Lung Sleep Allergy and Immunology, Monash Health, Victoria, Australia
- School of Clinical Sciences, Monash University, Victoria, Australia
| | - Anthony R.E. Turton
- Monash Lung Sleep Allergy and Immunology, Monash Health, Victoria, Australia
| | - Durda Stupar
- Monash Lung Sleep Allergy and Immunology, Monash Health, Victoria, Australia
| | - Darren R. Mansfield
- Monash Lung Sleep Allergy and Immunology, Monash Health, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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8
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Walter J, Lee JY, Blake S, Kalluri L, Cziraky M, Stanek E, Miller J, Harty BJ, Yu L, Park J, Zhang M, Coughlin S, Serao A, Lee J, Buban A, Bae M, Edel C, Toloui O, Rangel SM, Power T, Xu S. A new wearable diagnostic home sleep testing platform: comparison with available systems and benefits of multinight assessments. J Clin Sleep Med 2023; 19:865-872. [PMID: 36692166 PMCID: PMC10152349 DOI: 10.5664/jcsm.10432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES We assessed the real-world performance of the ANNE Sleep system against 2 Food and Drug Administration-cleared home sleep testing platforms and the intraindividual night-to-night variability of respiratory event index measured by ANNE Sleep. METHODS We evaluated the home performance of the ANNE Sleep system compared with 2 Food and Drug Administration-cleared home sleep testing platforms (WatchPAT: n = 29 and Alice NightOne: n = 46) during a synchronous night with unsupervised patient application. Additionally, we evaluated night-to-night variability of respiratory event index and total sleep time using the ANNE Sleep system (n = 30). RESULTS For the diagnosis of moderate and severe obstructive sleep apnea, the ANNE Sleep system had a positive percent agreement of 58% (95% confidence interval, 28-85%) and a negative percent agreement of 100% (95% confidence interval, 80-100%) compared to WatchPAT. The positive and negative percent agreement for ANNE Sleep vs Alice NightOne was 85% (95% confidence interval, 66-96%) and 95% (95% confidence interval, 74-100%). There were no differences in mean total sleep time or respiratory event index across multiple nights of monitoring with ANNE. There were no differences consistent with a first-night effect but testing multiple nights reclassified obstructive sleep apnea severity in 5 (17%) individuals and detected 3 additional cases of moderate disease, with only a 12% (standard deviation, 28%) mean fluctuation in respiratory event index from the first night of testing compared to a mean of multiple nights. Overall, 80% of users found ANNE comfortable and easy to use. CONCLUSIONS ANNE Sleep exhibited stronger concordance with Alice NightOne compared to WatchPAT. While we illustrated low night-to-night variability for ANNE Sleep, the results suggest multiple nights increased detection of moderate or severe obstructive sleep apnea. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: ANNE Diagnostic Agreement With Home Sleep Testing; URL: https://clinicaltrials.gov/ct2/show/NCT05421754; Identifier: NCT05421754. CITATION Walter J, Lee JY, Blake S, et al. A new wearable diagnostic home sleep testing platform: comparison with available systems and benefits of multinight assessments. J Clin Sleep Med. 2023;19(5):865-872.
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Affiliation(s)
- Jessica Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | | | | | | | | | | | | | | | - Lian Yu
- Sibel Health, Niles, Illinois
| | | | - Michael Zhang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | | | | | - Claire Edel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Stephanie M. Rangel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
- Sibel Health, Niles, Illinois
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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9
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Massie F, Vits S, Khachatryan A, Van Pee B, Verbraecken J, Bergmann J. Central Sleep Apnea Detection by Means of Finger Photoplethysmography. IEEE J Transl Eng Health Med 2023; 11:126-136. [PMID: 36704242 PMCID: PMC9873144 DOI: 10.1109/jtehm.2023.3236393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/15/2022] [Accepted: 11/18/2022] [Indexed: 01/14/2023]
Abstract
Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA) are two types of Sleep Apnea (SA) with different etiologies and treatment options. Home sleep apnea testing based on photoplethysmography-derived peripheral arterial tonometry (PAT HSAT) has become the most widely deployed outpatient SA diagnostic method. Being able to differentiate between CSA and OSA based solely on photoplethysmography-data would further increase PAT HSAT's clinical utility. The present work proposes a method to detect CSA using finger photoplethysmography (PPG) data and evaluates the proposed method against simultaneous in-lab polysomnography (PSG). METHODS For 266 patients with a suspicion of SA, concurrent in-lab PSG and PPG data were acquired. The respiratory information embedded in the PPG data was extracted and used to train an ensemble of trees classifiers that predicts the central or obstructive nature of each respiratory event. The classifier performance was evaluated using patient-wise leave-one-out cross-validation where an expert analysis of the PSG served as ground truth. A second, independent analysis of the PSG was also evaluated against the ground truth to allow benchmarking of the PPG-based method. RESULTS The method achieved a sensitivity of 81%, a specificity of 99%, a positive predictive value of 90%, and a negative predictive value of 98% at the central apnea-hypopnea index cutoff of 10 events per hour of sleep. CONCLUSION AND SIGNIFICANCE The present study aimed to evaluate a method to detect CSA in SA patients using only PPG data which could be used to flag CSA which in turn may aid in more optimal therapy decision making.
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Affiliation(s)
- Frederik Massie
- Natural Interaction LabDepartment of EngineeringUniversity of Oxford OX1 2JD Oxford U.K
| | - Steven Vits
- Research Group LEMPFaculty of Medicine and Health Sciences, University of Antwerp 2000 Antwerp Belgium
| | | | - Bart Van Pee
- Natural Interaction LabDepartment of EngineeringUniversity of Oxford OX1 2JD Oxford U.K
| | - Johan Verbraecken
- Research Group LEMPFaculty of Medicine and Health Sciences, University of Antwerp 2000 Antwerp Belgium
- Medicine and Multidisciplinary Sleep Disorders CentreDepartment of PulmonaryAntwerp University Hospital 2650 Edegem Belgium
| | - Jeroen Bergmann
- Natural Interaction LabDepartment of EngineeringUniversity of Oxford OX1 2JD Oxford U.K
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10
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Duong-Quy S, Nguyen-Huu H, Hoang-Chau-Bao D, Tran-Duc S, Nguyen-Thi-Hong L, Nguyen-Duy T, Tang-Thi-Thao T, Phan C, Bui-Diem K, Vu-Tran-Thien Q, Nguyen-Ngoc-Phuong T, Nguyen-Nhu V, Le-Thi-Minh H, Craig T. Personalized Medicine and Obstructive Sleep Apnea. J Pers Med 2022; 12. [PMID: 36556255 DOI: 10.3390/jpm12122034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/27/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common disease that is often under-diagnosed and under-treated in all ages. This is due to differences in morphology, diversity in clinical phenotypes, and differences in diagnosis and treatment of OSA in children and adults, even among individuals of the same age. Therefore, a personalized medicine approach to diagnosis and treatment of OSA is necessary for physicians in clinical practice. In children and adults without serious underlying medical conditions, polysomnography at sleep labs may be an inappropriate and inconvenient testing modality compared to home sleep apnea testing. In addition, the apnea-hypopnea index should not be considered as a single parameter for making treatment decisions. Thus, the treatment of OSA should be personalized and based on individual tolerance to sleep-quality-related parameters measured by the microarousal index, harmful effects of OSA on the cardiovascular system related to severe hypoxia, and patients' comorbidities. The current treatment options for OSA include lifestyle modification, continuous positive airway pressure (CPAP) therapy, oral appliance, surgery, and other alternative treatments. CPAP therapy has been recommended as a cornerstone treatment for moderate-to-severe OSA in adults. However, not all patients can afford or tolerate CPAP therapy. This narrative review seeks to describe the current concepts and relevant approaches towards personalized management of patients with OSA, according to pathophysiology, cluster analysis of clinical characteristics, adequate combined therapy, and the consideration of patients' expectations.
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11
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Davies C, Lee JY, Walter J, Kim D, Yu L, Park J, Blake S, Kalluri L, Cziraky M, Stanek E, Miller J, Harty BJ, Schauer J, Rangel SM, Serao A, Edel C, Ran DS, Olagbenro MO, Lim A, Gill K, Cooksey J, Toloui O, Power T, Xu S, Zee P. A single-arm, open-label, multicenter, and comparative study of the ANNE sleep system vs polysomnography to diagnose obstructive sleep apnea. J Clin Sleep Med 2022; 18:2703-2712. [PMID: 35934926 PMCID: PMC9713912 DOI: 10.5664/jcsm.10194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Evaluate per-patient diagnostic performance of a wireless dual-sensor system (ANNE sleep) compared with reference standard polysomnography (PSG) for the diagnosis of moderate and severe obstructive sleep apnea (OSA) with a minimum prespecified threshold of 80% for both sensitivity and specificity. METHODS A multicenter clinical trial was conducted to evaluate ANNE sleep vs PSG to diagnose moderate and severe OSA in individuals 22 years or older. For each testing approach, apnea-hypopnea index (AHI) was manually scored and averaged by 3 registered sleep technologists blinded to the other system. Average variations > 15% were adjudicated by a sleep medicine physician. RESULTS In a total of n = 225 participants (mean age 53 years, range 22-88 years), PSG diagnosed 30% (n = 68) of participants with moderate or severe OSA (AHI ≥ 15 events/h) compared to 29% (n = 65) diagnosed by ANNE sleep (P = .55). The sensitivity and specificity for ANNE sleep were 90% (95% confidence interval: 80-96%) and 98% (95% confidence interval: 94-99%), respectively. Strong correlation was shown in terms of final AHI (r = .93), with an average AHI bias of 0.5 (95% limits of agreement: -12.8 to 11.8). The majority of users noted comfort with using the ANNE sleep in the home setting. No adverse events were noted. CONCLUSIONS Using PSG as the gold standard, ANNE sleep demonstrated high sensitivity and specificity for the diagnosis of moderate or severe OSA. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Comparative Study of the ANNE™ One System to Diagnose Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT04643782; Identifier: NCT04643782. CITATION Davies C, Lee JY, Walter J et al. A single-arm, open-label, multicenter, and comparative study of the ANNE sleep system vs polysomnography to diagnose obstructive sleep apnea. J Clin Sleep Med. 2022;18(12):2703-2712.
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Affiliation(s)
- Charles Davies
- Carle Neuroscience Institute, Division of Sleep Medicine, Carle Foundation Hospital, Urbana, Illinois
| | - Jong Yoon Lee
- Sibel Health, Niles, Illinois
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | - Jessica Walter
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | | | - Lian Yu
- Sibel Health, Niles, Illinois
| | | | | | | | | | | | | | | | - Jacob Schauer
- Department of Preventative Medicine, Northwestern University, Chicago, Illinois
| | - Stephanie M. Rangel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexa Serao
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Claire Edel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Davina S. Ran
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew O. Olagbenro
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew Lim
- Division of Sleep Medicine, Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kuljeet Gill
- Central DuPage Hospital, Northwestern Medicine, Winfield, Illinois
- Division of Sleep Medicine, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Jessica Cooksey
- Division of Sleep Medicine, Department of Neurology, Northwestern University, Chicago, Illinois
- Lake Forest Hospital, Northwestern Medicine, Lake Forest, Illinois
| | - Omid Toloui
- Anthem, Inc. Elevance Health, Indianapolis, Indiana
| | | | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
- Department of Pediatrics (Division of Dermatology), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Phyllis Zee
- Division of Sleep Medicine, Department of Neurology, Northwestern University, Chicago, Illinois
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12
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Muacevic A, Adler JR. Reliability of Home Sleep Apnea Testing for Diagnosing Obstructive Sleep Apnea in Patients With Spontaneous Cerebrospinal Fluid Leaks. Cureus 2022; 14:e29854. [PMID: 36337790 PMCID: PMC9627688 DOI: 10.7759/cureus.29854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To establish the prevalence of obstructive sleep apnea (OSA) in patients with spontaneous cerebrospinal fluid (sCSF) leaks and demonstrate the reliability of home sleep apnea testing (HSAT) to screen for OSA in this population. METHODS A literature review was performed to assess data on OSA prevalence in sCSF leaks. An institutional retrospective review was performed of 20 patients with sCSF leaks who met inclusion criteria. Patients without prior sleep studies were prospectively administered sleep studies, either HSAT or polysomnogram (PSG). RESULTS Twenty patients met the inclusion criteria. Two patients had prior sleep studies while 18 patients obtained prospective sleep studies following diagnosis and prior to management of sCSF leaks. Nineteen patients (95%) had evidence of mild or greater OSA. CONCLUSIONS This study re-demonstrates the high prevalence of OSA in patients with sCSF leaks, consistent with current literature, and investigates the reliability of HSAT for diagnosis of OSA in this population.
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13
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Hinder D, Schams SC, Knaus C, Tschopp K. Home sleep apnea testing with peripheral arterial tonometry to assess outcome in upper airway stimulation. J Clin Sleep Med 2022; 18:2197-2205. [PMID: 35689596 PMCID: PMC9435336 DOI: 10.5664/jcsm.10082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine whether home sleep apnea testing with peripheral arterial tonometry (HSAT-PAT) can be used in upper airway stimulation to evaluate therapy success. METHODS Data analysis from 50 consecutive patients receiving upper airway stimulation was performed. Baseline values were measured by polysomnography and HSAT-PAT. Follow-up was performed during and after titration (3-6 months) by polysomnography and HSAT-PAT and after 1 year by HSAT-PAT only. Primary outcome measures were reduction in the apnea-hypopnea index and oxygen desaturation index. In addition, an analysis of night-to-night variability for HSAT-PAT was performed. RESULTS All 50 patients completed their posttitration visit (3-6 months) and 41 patients completed the 1-year follow-up. In HSAT-PAT after 1 year, the mean apnea-hypopnea index (desaturation 3%) was reduced from 29.5 ± 17.1 events/h to 19.9 ± 13.1 events/h (P < .01) and the oxygen desaturation index (desaturation 4%) was reduced from 17.8 ± 12.6 events/h to 10.2 ± 8.3 events/h (P < .01). Therapy adherence after 1 year was high (6.6 ± 1.9 hours per night) and led to improvement in daytime sleepiness, meaning a reduction in the Epworth Sleepiness Scale score from 12.8 ± 5.4 to 5.9 ± 4.0 (P < .01). Analysis of night-to-night variability showed similar apnea-hypopnea index values between the 2 nights. CONCLUSIONS Upper airway stimulation was able to reduce the apnea-hypopnea index and oxygen desaturation index after 1 year, as assessed by full-night efficacy studies with HSAT-PAT. In addition, improvements in self-reported outcome parameters were observed. The importance of publishing the scoring criteria is highlighted and whether data are based on full-night efficacy studies or a selected period of time from a sleep study. This is a prerequisite for comparing data with other trials in the emerging field of upper airway stimulation. CITATION Hinder D, Schams SC, Knaus C, Tschopp K. Home sleep apnea testing with peripheral arterial tonometry to assess outcome in upper airway stimulation. J Clin Sleep Med. 2022;18(9):2197-2205.
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Affiliation(s)
- Dominik Hinder
- Address correspondence to: Dominik Hinder, MD, Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland;
| | | | - Christoph Knaus
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Kurt Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
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14
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Van Pee B, Massie F, Vits S, Dreesen P, Klerkx S, Bijwadia J, Verbraecken J, Bergmann J. A multicentric validation study of a novel home sleep apnea test based on peripheral arterial tonometry. Sleep 2022; 45:zsac028. [PMID: 35554589 PMCID: PMC9113027 DOI: 10.1093/sleep/zsac028] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/23/2021] [Indexed: 01/03/2023] Open
Abstract
STUDY OBJECTIVES This paper reports on the multicentric validation of a novel FDA-cleared home sleep apnea test based on peripheral arterial tonometry (PAT HSAT). METHODS One hundred sixty-seven participants suspected of having obstructive sleep apnea (OSA) were included in a multicentric cohort. All patients underwent simultaneous polysomnography (PSG) and PAT HSAT, and all PSG data were independently double scored using both the recommended 1A rule for hypopnea, requiring a 3% desaturation or arousal (3% Rule), and the acceptable 1B rule for hypopnea, requiring a 4% desaturation (4% Rule). The double-scoring of PSG enabled a comparison of the agreement between PAT HSAT and PSG to the inter-rater agreement of PSG. Clinical endpoint parameters were selected to evaluate the device's ability to determine the OSA severity category. Finally, a correction for near-boundary apnea-hypopnea index values was proposed to adequately handle the inter-rater variability of the PSG benchmark. RESULTS For both the 3% and the 4% Rules, most endpoint parameters showed a close agreement with PSG. The 4-way OSA severity categorization accuracy of PAT HSAT was strong, but nevertheless lower than the inter-rater agreement of PSG (70% vs 77% for the 3% Rule and 78% vs 81% for the 4% Rule). CONCLUSIONS This paper reported on a multitude of robust endpoint parameters, in particular OSA severity categorization accuracies, while also benchmarking clinical performances against double-scored PSG. This study demonstrated strong agreement of PAT HSAT with PSG. The results of this study also suggest that different brands of PAT HSAT may have distinct clinical performance characteristics.
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Affiliation(s)
- Bart Van Pee
- Department of Engineering, Natural Interaction Lab, Thom Building, University of Oxford, Oxford, UK
| | - Frederik Massie
- Department of Engineering, Natural Interaction Lab, Thom Building, University of Oxford, Oxford, UK
| | - Steven Vits
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Pauline Dreesen
- Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium and Mobile Health Unit, Faculty of Health and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Susie Klerkx
- Department of Pneumology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jagdeep Bijwadia
- Department of Pulmonary Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem,Belgium
- Research Group LEMP, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jeroen Bergmann
- Department of Engineering, Natural Interaction Lab, Thom Building, University of Oxford, Oxford, UK
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15
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Massie F, Van Pee B, Bergmann J. Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests. J Clin Sleep Med 2022; 18:871-876. [PMID: 34710039 PMCID: PMC8883090 DOI: 10.5664/jcsm.9744] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The clinical performance of home sleep apnea tests (HSATs) can be described by their (diagnostic) accuracy, defined as the percentage agreement with the obstructive sleep apnea severity category (normal, mild, moderate, and severe) based on polysomnography. Rather than reporting on accuracy, there has been a strong reliance in the literature to report correlation coefficients between the apnea-hypopnea index of HSATs and polysomnography to support claims of diagnostic performance. This is surprising, as it has been well described that correlation coefficients are inadequate to evaluate equivalence between 2 parameters. The aim of this study was to systematically investigate the magnitude of the discrepancies between correlation coefficients and diagnostic accuracy reported in or retrievable from HSAT validation studies. METHODS We compared the discrepancy between accuracy and apnea-hypopnea index correlation coefficients of all validation papers that met the inclusion criteria. A total of 20 papers were retained, representing a participant pool of 1,652. RESULTS The weighted average apnea-hypopnea index correlation across all 20 papers was 0.82 and the weighted average accuracy was 0.61, highlighting a discrepancy of 0.21 and an overall misdiagnosis rate of 39%. CONCLUSIONS The results of our study confirm the need for increased scientific rigor in selecting primary performance endpoints to support clinical performance claims of HSATs. CITATION Massie F, Van Pee B, Bergmann J. Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests. J Clin Sleep Med. 2022;18(3):871-876.
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Affiliation(s)
- Frederik Massie
- Address correspondence to: Frederik Massie, MSc, Natural Interaction Lab, Department of Engineering, Thom Building, University of Oxford, Parks Road, Oxford OX1 3PJ, United Kingdom;
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16
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Withers A, Maul J, Rosenheim E, O’Donnell A, Wilson A, Stick S. Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children. J Clin Sleep Med 2022; 18:393-402. [PMID: 34323688 PMCID: PMC8804994 DOI: 10.5664/jcsm.9576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES To compare type 2 polysomnography (T2PSG) to the gold standard type 1 in-laboratory polysomnography (T1PSG) for diagnosing obstructive sleep apnea (OSA) in children; validate home T2PSG in children with suspected OSA. METHODS Eighty-one participants (ages 6-18) with suspected OSA had simultaneous T1PSG and T2PSG in the sleep laboratory, 47 participants (ages 5-16) had T1PSG in the sleep laboratory and T2PSG performed at home. Sleep scientists staged and scored polysomnography data, and pediatric sleep physicians assigned a diagnosis of normal or OSA. Participant demographics, polysomnography variables, and diagnoses were compared using chi-square and Fisher's exact tests for nominal variables, t test for continuous variables and Cohen's kappa to assess concordance. RESULTS Acceptable recordings were obtained for every home T2PSG. When T1PSG and T2PSG were simultaneous, correlation between the number of arousals, respiratory disturbance index, and sleep stages was excellent. T2PSG at home demonstrated less stage 2 sleep, more rapid eye movement sleep, and higher sleep efficiency. Comparison of home T2PSG to T1PSG for diagnosing OSA showed a false-positive rate of 6.6% and false-negative rate of 3% for those performed at home. CONCLUSIONS T2PSG in the home is feasible with excellent concordance with T1PSG for the purposes of diagnosing OSA in children aged 5-18 years. Home T2PSG may be more representative of a "normal" night for children and could benefit those suspected of having OSA by reducing waiting times for laboratory PSG, improving access to PSG and possibly reducing costs of investigating and treating OSA. CITATION Withers A, Maul J, Rosenheim E, O'Donnell A, Wilson A, Stick S. Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children. J Clin Sleep Med. 2022;18(2):393-402.
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Affiliation(s)
- Adelaide Withers
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia,Telethon Kids Institute, Perth, Western Australia, Australia,Wal-yan Respiratory Research Centre, Perth, Western Australia, Australia,Curtin University, Perth, Western Australia, Australia,Address correspondence to: Adelaide Withers, MBBS, Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Hospital Ave, Nedlands WA 6009, Australia;
| | - Jennifer Maul
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
| | | | - Anne O’Donnell
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Andrew Wilson
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia,Telethon Kids Institute, Perth, Western Australia, Australia,Curtin University, Perth, Western Australia, Australia,Division of Paediatrics and Child Health, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Stephen Stick
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia,Telethon Kids Institute, Perth, Western Australia, Australia,Wal-yan Respiratory Research Centre, Perth, Western Australia, Australia,Division of Paediatrics and Child Health, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia,University of Western Australia, Perth, Western Australia, Australia
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17
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Blekic N, Bold I, Mettay T, Bruyneel M. Impact of Desaturation Patterns versus Apnea-Hypopnea Index in the Development of Cardiovascular Comorbidities in Obstructive Sleep Apnea Patients. Nat Sci Sleep 2022; 14:1457-1468. [PMID: 36045914 PMCID: PMC9423119 DOI: 10.2147/nss.s374572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Various phenotypes of obstructive sleep apnea (OSA) have been recently described and are poorly assessed by the commonly used polysomnographic indices, such as the apnea-hypopnea index and oxygen desaturation index. Nocturnal hypoxemia is the hallmark of OSA and new quantitative markers, as hypoxic burden or desaturation severity, have been shown to be associated with cardiovascular (CV) mortality. The purpose of this overview is to review the endophenotypical and clinical characteristics of OSA, the current metrics, and to analyze different measurements of hypoxemia in OSA to predict the cardiovascular impact (eg hypoxic burden). Potential interest of multidimensional models to classify OSA, such as BAVENO classification, is also discussed, with the goal of focusing on specific endophenotypes that are likely to develop CV comorbidities, in order to guide clinicians to more aggressive management of OSA in these individuals.
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Affiliation(s)
- Nathan Blekic
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
| | - Ionela Bold
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Mettay
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Bruyneel
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium.,Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium and Université Libre de Bruxelles, Brussels, Belgium
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18
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Donskoy I, Loghmanee D, Fields BG, Troester M, Martin W. Telemedicine-based sleep services for a complex child: optimizing care during a pandemic and beyond. J Clin Sleep Med 2022; 18:325-327. [PMID: 34402782 PMCID: PMC8807920 DOI: 10.5664/jcsm.9616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 12-year-old male with nonverbal autism and morbid obesity was referred to a pediatric sleep center during the SARS-CoV-2 pandemic for complaints of snoring with tonsillar hypertrophy and difficulty falling asleep. Due to social challenges, the family had not sought in-person care in the past. Through telemedicine consultation and home sleep apnea testing, the patient was diagnosed with obstructive sleep apnea as well as an irregular sleep-wake disorder. This unique utilization of the health care system in the care of a complex patient with multiple sleep disorders demonstrates the utility of remote care and testing. There is a great benefit to continuing to provide pediatric sleep care in this way beyond the pandemic.
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Affiliation(s)
- Innessa Donskoy
- Advocate Children’s Hospital, Park Ridge, Illinois;,Address correspondence to: Innessa Donskoy, MD, FAAP, FAASM, 1675 Dempster Street, Park Ridge, IL 60068;
| | | | - Barry G. Fields
- Emory University School of Medicine, Atlanta, Georgia;,Atlanta VA Medical Center, North Druid Hills, Georgia
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19
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Li S, Xu L, Dong X, Zhang X, Keenan BT, Han F, Bi T, Chang Y, Yu Y, Zhou B, Pack AI, Kuna ST. Home sleep apnea testing of adults with chronic heart failure. J Clin Sleep Med 2021; 17:1453-1463. [PMID: 33688828 DOI: 10.5664/jcsm.9224] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES To evaluate home sleep apnea testing (HSAT) using a type 3 portable monitor to help diagnose sleep-disordered breathing (SDB) and identify respiratory events including obstructive sleep apnea, central sleep apnea, and Cheyne-Stokes respiration in adults with stable chronic heart failure. METHODS Eighty-four adults with chronic heart failure (86.9% males, age [mean ± standard deviation] 58.7 ± 16.3 years, body mass index 29.4 ± 13.0 kg/m², left ventricular ejection fraction 40.3% ± 11.5%) performed unattended HSAT followed by an in-laboratory polysomnography (PSG) with simultaneous portable monitor recording. RESULTS The apnea-hypopnea index was 22.0 ± 17.0 events/h according to HSAT, 26.8 ± 20.5 events/h on an in-laboratory portable monitor, and 23.8 ± 21.3 events/h using PSG (P = .373). A Bland-Altman analysis of the apnea-hypopnea index using HSAT vs PSG showed a mean difference (95% confidence interval) of -2.4 (-4.9 to 0.1) events/h and limits of agreement (±2 standard deviations) of -24.1 to 19.2 events/h. HSAT underestimated the apnea-hypopnea index to a greater extent at a higher apnea-hypopnea index (rho = -.358; P < .001). Similar levels of agreement from HSAT vs PSG were observed when comparing the obstructive apnea index, central apnea index, and percentage of time in a Cheyne-Stokes respiration pattern. When we used an apnea-hypopnea index ≥ 5 events/h to diagnose SDB, HSAT had 86.7% sensitivity, 76.5% specificity, 92.9% positive predictive value, and 61.9% negative predictive value compared to PSG. Detection of Cheyne-Stokes respiration using HSAT showed 94.6% sensitivity, 91.1% specificity, 88.6% positive predictive value, and 97.6% negative predictive value compared to PSG. CONCLUSIONS HSAT with a type 3 portable monitor can help diagnose SDB and identify obstructive sleep apnea, central sleep apnea, and Cheyne-Stokes respiration events in adults with chronic heart failure.
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Affiliation(s)
- Shengnan Li
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China.,Contributed equally
| | - Liyue Xu
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China.,Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Contributed equally
| | - Xiaosong Dong
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Xueli Zhang
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Brendan T Keenan
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fang Han
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Taoran Bi
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Yuan Chang
- Department of Respiratory Medicine, Peking University International Hospital, Beijing, China
| | - Yongbo Yu
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Bing Zhou
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Allan I Pack
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel T Kuna
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Westenberg JN, Petrof BJ, Noel F, Zielinski D, Constantin E, Oskoui M, Kaminska M. Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders. J Clin Sleep Med 2021; 17:1579-1590. [PMID: 33739260 PMCID: PMC8656910 DOI: 10.5664/jcsm.9254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is common in patients with neuromuscular disorders (NMD), developing before chronic hypercapnia appears. Polysomnography (PSG) is the diagnostic gold standard but is often impractical and poorly accessible for individuals with NMD. We sought to determine the diagnostic accuracy, feasibility, and patient preference of home sleep apnea testing (HSAT) compared with PSG for the detection of SDB in NMD. METHODS Participants with NMD at risk for SDB aged ≥ 13 years underwent HSAT followed by overnight PSG with concomitant laboratory sleep apnea testing (same device as HSAT). Sensitivity and specificity were calculated for standard apnea-hypopnea index cutoffs for mild (≥ 5 events/h), moderate (≥ 15 events/h), and severe SDB (≥ 30 events/h) and for an oxygen desaturation index ≥ 5 events/h. Receiver operating characteristic curves were built. A questionnaire assessed patient preference. RESULTS Of 38 participants, 73% had moderate to severe SDB and 79% had technically acceptable HSAT. For an apnea-hypopnea index ≥ 15 events/h, HSAT sensitivity and specificity were 50% and 88%, respectively. For an oxygen desaturation index ≥ 5 events/h, HSAT sensitivity and specificity were 95% and 78%, respectively. The area under the receiver operating characteristic curve for an apnea-hypopnea index ≥ 15 events/h was 0.88 (95% confidence interval, 0.69-1.00) for HSAT. The HSAT underestimated the apnea-hypopnea index from PSG (bias, -10.7 ± 15.9 events/h). HSAT was preferred to PSG by 61% of participants. CONCLUSIONS HSAT is feasible, preferred by patients, and reliable for detecting SDB in most patients, although it cannot definitively rule out SDB. Therefore, HSAT is a viable diagnostic approach for SDB in NMD when PSG is not feasible, recognizing that it does not accurately distinguish between upper-airway obstruction and hypoventilation. Additional work is needed to further optimize home sleep testing in NMD. CITATION Westenberg JN, Petrof BJ, Noel F, et al. Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders. J Clin Sleep Med. 2021;17(8):1579-1590.
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Affiliation(s)
- Jean N. Westenberg
- Respiratory and Epidemiology and Clinical Research Unit, Translational Research in Respiratory Diseases Program, McGill University Health Centre, Montreal, Quebec, Canada
| | - Basil J. Petrof
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
- Meakins Christie Laboratories, Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Francine Noel
- Respiratory and Epidemiology and Clinical Research Unit, Translational Research in Respiratory Diseases Program, McGill University Health Centre, Montreal, Quebec, Canada
| | - David Zielinski
- Department of Pediatrics and Pediatric Sleep Laboratory, McGill University, Montreal, Quebec, Canada
| | - Evelyn Constantin
- Department of Pediatrics and Pediatric Sleep Laboratory, McGill University, Montreal, Quebec, Canada
| | - Maryam Oskoui
- Department of Pediatrics and Pediatric Sleep Laboratory, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Marta Kaminska
- Respiratory and Epidemiology and Clinical Research Unit, Translational Research in Respiratory Diseases Program, McGill University Health Centre, Montreal, Quebec, Canada
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
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22
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Valério MP, Pereira S, Moita J, Teixeira F, Travassos C, Coutinho AS, Rodrigues DM. Is the Nox-T3 device scoring algorithm accurate enough for the diagnosis of obstructive sleep apnea? Adv Respir Med 2021; 89:262-267. [PMID: 34196378 DOI: 10.5603/arm.a2021.0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/02/2021] [Accepted: 01/06/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is highly prevalent. Home sleep apnea testing (HSAT) for OSA is rapidly expanding because of its cost effectiveness in the diagnosis of OSA. Type 3 portable monitors are used for this purpose. In most cases, these devices contain an algorithm for automatic scoring of events. We propose to study the accuracy of the automatic scoring algorithm in our population in order to compare it with the manually edited scoring of Nox-T3®. MATERIAL AND METHODS For five months, a prospective study was performed. Patients were randomly distributed to the available HSAT devices. We collected the data of patients who performed HSAT with Nox-T3®. We used normality plots, the Spearman correlation, the Wilcoxon signed-rank test, and Bland-Altman plots. RESULTS The sample consisted of 283 participants. The average manual apnea and hypopnea index (AHI) was 23.7 ± 22.1 events/h. All manual scores (AHI, apnea index, hypopnea index, and oxygen desaturation index) had strong correlations with their respective automated scores. When AHI > 15 and AHI > 30 the difference between the values of this index (automatic and manual) was not statistically significant. Also, for AHI values > 15 the mean difference between the two scoring methods was 0.17 events/h. For AHI values > 30, this difference was - 1.23 events/h. CONCLUSIONS When AHI is < 15, there may be a need for confirmation of automatic scores, especially in symptomatic patients with a high pretest probability of OSA. But, for patients with AHI > 15, automatic scores obtained from this device seem accurate enough to diagnose OSA in the correct clinical setting.
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Affiliation(s)
| | - Samuel Pereira
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joaquim Moita
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fátima Teixeira
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Conceição Travassos
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Sofia Coutinho
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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23
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Ioachimescu OC, Allam JS, Samarghandi A, Anand N, Fields BG, Dholakia SA, Venkateshiah SB, Eisenstein R, Ciavatta MM, Collop NA. Performance of peripheral arterial tonometry-based testing for the diagnosis of obstructive sleep apnea in a large sleep clinic cohort. J Clin Sleep Med 2021; 16:1663-1674. [PMID: 32515348 DOI: 10.5664/jcsm.8620] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES Peripheral arterial tonometry (PAT)-based technology represents a validated portable monitoring modality for the diagnosis of OSA. We assessed the diagnostic accuracy of PAT-based technology in a large point-of-care cohort of patients studied with concurrent polysomnography (PSG). METHODS During study enrollment, all participants suspected to have OSA and tested by in-laboratory PSG underwent concurrent PAT device recordings. RESULTS Five hundred concomitant PSG and WatchPat tests were analyzed. Median (interquartile range) PSG AHI was 18 (8-37) events/h and PAT AHI3% was 25 (12-46) events/h. Average bias was + 4 events/h. Diagnostic concordance was found in 42%, 41%, and 83% of mild, moderate, and severe OSA, respectively (accuracy = 53%). Among patients with PAT diagnoses of moderate or severe OSA, 5% did not have OSA and 19% had mild OSA; in those with mild OSA, PSG showed moderate or severe disease in 20% and no OSA in 30% of patients (accuracy = 69%). On average, using a 3% desaturation threshold, WatchPat overestimated disease prevalence and severity (mean + 4 events/h) and the 4% threshold underestimated disease prevalence and severity by -6 events/h. CONCLUSIONS Although there was an overall tendency to overestimate the severity of OSA, a significant percentage of patients had clinically relevant misclassifications. As such, we recommend that patients without OSA or with mild disease assessed by PAT undergo repeat in-laboratory PSG. Optimized clinical pathways are urgently needed to minimize therapeutic decisions instituted in the presence of diagnostic uncertainty.
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Affiliation(s)
- Octavian C Ioachimescu
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - J Shirine Allam
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Arash Samarghandi
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Neesha Anand
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Barry G Fields
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Swapan A Dholakia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Saiprakash B Venkateshiah
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Rina Eisenstein
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Mary-Margaret Ciavatta
- Department of Medicine, Sleep Medicine Center, Atlanta VA Medical Center, Atlanta, Georgia
| | - Nancy A Collop
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia
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24
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Gu W, Leung L, Kwok KC, Wu IC, Folz RJ, Chiang AA. Belun Ring Platform: a novel home sleep apnea testing system for assessment of obstructive sleep apnea. J Clin Sleep Med 2021; 16:1611-1617. [PMID: 32464087 DOI: 10.5664/jcsm.8592] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVES The objective of the study is to validate the performance of Belun Ring Platform, a novel home sleep apnea testing system using a patented pulse oximeter sensor and a proprietary cloud-based neural networks algorithm. METHODS The Belun Ring captures oxygen saturation, photoplethysmography, and accelerometer signals. The Belun Ring total sleep time is derived from features extracted from accelerometer, oxygen saturation, and photoplethysmography signals. The Belun Ring respiratory event index is derived from Belun Ring total sleep time and features extracted from heart rate variability and oxygen saturation changes. A total of 50 adults without significant cardiopulmonary or neuromuscular comorbidities and heart rate affecting medications were evaluated. In-lab sleep studies were performed simultaneously with the Ring and the studies were manually scored using the American Academy of Sleep Medicine Scoring Manual 4% desaturation criteria. RESULTS The Belun Ring respiratory event index correlated well with the polysomnography-apnea-hypopnea index (AHI; r = .894, P < .001). The sensitivity and specificity in categorizing AHI ≥ 15 events/h were 0.85 and 0.87, respectively, and the positive predictive value and negative predictive value were 0.88 and 0.83, respectively. The Belun Ring total sleep time also correlated well with the polysomnography-total sleep time (r = .945, P < .001). Although the Belun Ring Platform has a good overall performance, it tends to overestimate AHI in individuals with AHI under 15 events/h and underestimate AHI in those with AHI over 15 events/h. Conclusions: In this proof-of-concept study, the Belun Ring Platform demonstrated a reasonable accuracy in predicting AHI and total sleep time in patients without significant comorbidities and heart rate-affecting medications. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Validation of a Novel Device for Screening Patients With Symptoms of Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT04121923; Identifier: NCT04121923.
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Affiliation(s)
- Wenbo Gu
- Belun Technology Company Limited, Hong Kong, People's Republic of China.,Department of Computer Science, National Chiao Tung University, Hsinchu, Taiwan
| | - Lydia Leung
- Belun Technology Company Limited, Hong Kong, People's Republic of China
| | - Ka Cheung Kwok
- Belun Technology Company Limited, Hong Kong, People's Republic of China
| | - I-Chen Wu
- Department of Computer Science, National Chiao Tung University, Hsinchu, Taiwan
| | - Rodney J Folz
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ambrose A Chiang
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University, Cleveland, Ohio.,Division of Sleep Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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25
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Tschopp S, Wimmer W, Caversaccio M, Borner U, Tschopp K. Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry: a case for multiple night testing. J Clin Sleep Med 2021; 17:1751-1758. [PMID: 33783347 DOI: 10.5664/jcsm.9300] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Night-to-night variability of obstructive sleep apnea severity (OSA) is considerable and may depend on the diagnostic modality used. We investigated the night-to-night variability using peripheral arterial tonometry (PAT). METHODS Home sleep apnea testing was performed in 51 patients during three consecutive nights using PAT. Patients referred to our sleep clinic were screened and prospectively recruited for this study. All recordings were automatically and manually scored according to the PAT scoring guidelines. RESULTS No systematic differences in pAHI were found between the nights. The night-to-night variability was comparable between manually and automatically scored data. PAT-derived apnea-hypopnea index (pAHI) varied in 35% of patients more than 10/h between the nights. The OSA severity of 24% of patients was misclassified when using one night compared to the average of all nights. On average, pAHI varied by 57% from night-to-night. The variability of pAHI could partially be explained by the variability of time spent in the supine position with more time supine leading to a higher pAHI. On measuring a subsequent night, 12-14% of patients spontaneously fulfilled the commonly accepted criteria for treatment success without any intervention. CONCLUSIONS With repeated recordings of PAT, we found no first night effect. However, there is considerable night-to-night variability similar to values found for polysomnography, which can partially be explained by the variability of time spent in the supine position. OSA severity was frequently misclassified due to the night-to-night variability. Our findings make a strong case for multiple testing in the diagnostic work-up of OSA patients.
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Affiliation(s)
- Samuel Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.,Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Urs Borner
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Kurt Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Liestal, Switzerland
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26
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Braganza MV, Hanly PJ, Fraser KL, Tsai WH, Pendharkar SR. Predicting CPAP failure in patients with suspected sleep hypoventilation identified on ambulatory testing. J Clin Sleep Med 2020; 16:1555-1565. [PMID: 32501210 DOI: 10.5664/jcsm.8616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Home sleep apnea testing (HSAT) is commonly used to diagnose obstructive sleep apnea, but its role in identifying patients with suspected hypoventilation or predicting their response to continuous positive airway pressure (CPAP) therapy has not been assessed. The primary objective was to determine if HSAT, combined with clinical variables, could predict the failure of CPAP to correct nocturnal hypoxemia during polysomnography in a population with suspected hypoventilation. Secondary objectives were to determine if HSAT and clinical parameters could predict awake or sleep hypoventilation. METHODS A retrospective review was performed of 142 consecutive patients who underwent split-night polysomnography for suspected hypoventilation after clinical assessment by a sleep physician and review of HSAT. We collected quantitative indices of nocturnal hypoxemia, patient demographics, medications, pulmonary function tests, as well as arterial blood gas data from the night of the polysomnography . CPAP failure was defined as persistent obstructive sleep apnea, hypoxemia (oxygen saturation measured by pulse oximetry < 85%), or hypercapnia despite maximal CPAP. RESULTS Failure of CPAP was predicted by awake oxygen saturation and arterial blood gas results but not by HSAT indices of nocturnal hypoxemia. Awake oxygen saturation ≥ 94% ruled out CPAP failure, and partial pressure of oxygen measured by arterial blood gas ≥ 68 mmHg decreased the likelihood of CPAP failure significantly. CONCLUSIONS In patients with suspected hypoventilation based on clinical review and HSAT interpretation by a sleep physician, awake oxygen saturation measured by pulse oximetry and partial pressure of oxygen measured by arterial blood gas can reliably identify patients in whom CPAP is likely to fail. Additional research is required to determine the role of HSAT in the identification and treatment of patients with hypoventilation.
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Affiliation(s)
- Michael V Braganza
- Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick J Hanly
- Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kristin L Fraser
- Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Willis H Tsai
- Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sachin R Pendharkar
- Sleep Centre, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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27
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Ito K, Uetsu M, Kadotani H. Validation of Oximetry for Diagnosing Obstructive Sleep Apnea in a Clinical Setting. Clocks Sleep 2020; 2:364-374. [PMID: 33089210 PMCID: PMC7573809 DOI: 10.3390/clockssleep2030027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/27/2020] [Indexed: 12/22/2022] Open
Abstract
A large epidemiological study using oximetry to analyze obstructive sleep apnea (OSA) and metabolic comorbidities was performed in Japan; however, reliability and validity of oximetry in the Japanese population remains poorly understood. In this study, oximetry data from the epidemiological study were compared with data from clinically performed polysomnography (PSG) and out-of-center sleep testing (OCST) in epidemiological study participants who later attended our outpatient units. The oxygen desaturation index (ODI) from oximetry showed a moderate positive relationship (correlation coefficient r = 0.561, p < 0.001) with apnea/hypopnea data from PSG/OCST. The area under the receiver operating characteristic curve showed moderate accuracy of this method in the detection of moderate-to-severe or severe OSA. However, the optimal ODI thresholds to detect moderate-to-severe OSA and severe OSA were the same (ODI > 20.1). Oximetry may be a useful tool for screening moderate-to-severe or severe sleep apnea. However, it may be difficult to set an appropriate threshold to distinguish between moderate and severe sleep apnea by oximetry alone.
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Affiliation(s)
- Kazuki Ito
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan;
- Department of Anesthesiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Masahiro Uetsu
- Sleep Outpatient Unit for Sleep Apnea Syndrome, Nagahama City Hospital, 313 Ohinui-cho, Nagahama, Shiga 526-0043, Japan;
| | - Hiroshi Kadotani
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan;
- Sleep Outpatient Unit for Sleep Apnea Syndrome, Nagahama City Hospital, 313 Ohinui-cho, Nagahama, Shiga 526-0043, Japan;
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28
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Epstein M, Musa T, Chiu S, Costanzo J, Dunne C, Cerrone F, Capone R. Use of the WatchPAT to detect occult residual sleep-disordered breathing in patients on CPAP for obstructive sleep apnea. J Clin Sleep Med 2020; 16:1073-1080. [PMID: 32118574 DOI: 10.5664/jcsm.8406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES To determine the accuracy of the apnea-hypopnea index (AHI) as measured by continuous positive airway pressure (CPAP) machines by simultaneously employing a home sleep apnea testing device (WatchPAT 200, Itamar Medical, Israel [WPAT]) in patients suspected of having residual sleep-disordered breathing (SDB). METHODS Patients with new, recurrent, or worsening signs, symptoms, or comorbidities associated with obstructive sleep apnea underwent home sleep apnea testing using WPAT while simultaneously using CPAP at their usual prescribed settings. CPAP AHI and WPAT AHI, respiratory disturbance index, and oximetry readings were then compared. RESULTS We identified an elevated AHI with WPAT testing in nearly half of patients with clinically suspected residual SDB and a normal CPAP AHI. WPAT detected additional respiratory events as well, including rapid eye movement-related apneas, respiratory effort-related arousals, and hypoxemia. CONCLUSIONS WPAT AHI was significantly higher than simultaneous CPAP AHI in nearly half of those patients with clinically suspected residual SDB being treated with CPAP. Additional respiratory disturbances, including rapid eye movement-related respiratory events, respiratory effort-related arousals, and hypoxemia, were elucidated only with the use of the WPAT. Residual SDB may have potential clinical consequences, including reduced CPAP adherence, ongoing hypersomnolence, and other health-related sequelae. Simultaneous WPAT testing of patients with a normal CPAP AHI may represent a valuable tool to detect clinically suspected residual SDB or to ensure adequate treatment in high-risk patients with obstructive sleep apnea in general.
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Affiliation(s)
- Matthew Epstein
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey.,New Jersey Medical School, Newark, New Jersey
| | - Tariq Musa
- Atlantic Health System, Morristown, New Jersey
| | | | | | - Christine Dunne
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey
| | - Federico Cerrone
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey
| | - Robert Capone
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey
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29
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Dzierzewski JM, Dautovich ND, Rybarczyk B, Taylor SA. Night-to-night fluctuations in sleep apnea severity: diagnostic and treatment implications. J Clin Sleep Med 2020; 16:539-544. [PMID: 32022669 DOI: 10.5664/jcsm.8272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVES Sleep apnea is a common disorder with serious consequences; however, effective treatments are available. Successful implementation of treatment strategies relies on accurate diagnosis, which may be hampered by the presence of substantial nightly fluctuation in sleep apnea severity. We examined the amount of nightly fluctuation in the severity of sleep apnea around commonly used diagnostic and treatment cut points in individuals who underwent two nights of home sleep apnea testing (HSAT). METHODS A nationwide retrospective cohort study of adults thought to have sleep apnea underwent two nights of HSAT between 2005 and 2017. RESULTS The study included 47,423 adults (mean age, 55.2 [14.6] years; 53.7% male). The average apnea-hypopnea index (AHI) for the sample was 26.9. The average amount of nightly fluctuation in AHI was 5.5. More than a third of the sample, 16,115 individuals, had fluctuations between diagnostic cut points across the two nights of HSAT. The negative predictive value of the HSAT in the first night was 47.42%, 73.57%, and 88.65% for detecting an AHI ≥ 5, AHI ≥ 15, and AHI ≥ 30, respectively. CONCLUSIONS The addition of a second night of HSAT has the potential to reduce the likelihood of missed diagnoses that could result from nightly fluctuation in the severity of sleep apnea.
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Affiliation(s)
| | - Natalie D Dautovich
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Bruce Rybarczyk
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Samuel A Taylor
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia
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30
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Stretch R, Ryden A, Fung CH, Martires J, Liu S, Balasubramanian V, Saedi B, Hwang D, Martin JL, Della Penna N, Zeidler MR. Predicting Nondiagnostic Home Sleep Apnea Tests Using Machine Learning. J Clin Sleep Med 2019; 15:1599-1608. [PMID: 31739849 PMCID: PMC6853403 DOI: 10.5664/jcsm.8020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Home sleep apnea testing (HSAT) is an efficient and cost-effective method of diagnosing obstructive sleep apnea (OSA). However, nondiagnostic HSAT necessitates additional tests that erode these benefits, delaying diagnoses and increasing costs. Our objective was to optimize this diagnostic pathway by using predictive modeling to identify patients who should be referred directly to polysomnography (PSG) due to their high probability of nondiagnostic HSAT. METHODS HSAT performed as the initial test for suspected OSA within the Veterans Administration Greater Los Angeles Healthcare System was analyzed retrospectively. Data were extracted from pre-HSAT questionnaires and the medical record. Tests were diagnostic if there was a respiratory event index (REI) ≥ 5 events/h. Tests with REI < 5 events/h or technical inadequacy-two outcomes requiring additional testing with PSG-were considered nondiagnostic. Standard logistic regression models were compared with models trained using machine learning techniques. RESULTS Models were trained using 80% of available data and validated on the remaining 20%. Performance was evaluated using partial area under the precision-recall curve (pAUPRC). Machine learning techniques consistently yielded higher pAUPRC than standard logistic regression, which had pAUPRC of 0.574. The random forest model outperformed all other models (pAUPRC 0.862). Preferred calibration of this model yielded the following: sensitivity 0.46, specificity 0.95, positive predictive value 0.81, negative predictive value 0.80. CONCLUSIONS Compared with standard logistic regression models, machine learning models improve prediction of patients requiring in-laboratory PSG. These models could be implemented into a clinical decision support tool to help clinicians select the optimal test to diagnose OSA.
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Affiliation(s)
- Robert Stretch
- David Geffen School of Medicine at University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Armand Ryden
- David Geffen School of Medicine at University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Constance H. Fung
- David Geffen School of Medicine at University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Joanne Martires
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Stephen Liu
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | - Babak Saedi
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Dennis Hwang
- Southern California Permanente Medical Group, Los Angeles, California
| | - Jennifer L. Martin
- David Geffen School of Medicine at University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Nicolás Della Penna
- Laboratory of Computational Physiology at Massachusetts Institute of Technology, Boston, Massachusetts
| | - Michelle R. Zeidler
- David Geffen School of Medicine at University of California, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
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31
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Donovan LM, Shah A, Chai-Coetzer CL, Barbé F, Ayas NT, Kapur VK. Redesigning Care for OSA. Chest 2019; 157:966-976. [PMID: 31639334 DOI: 10.1016/j.chest.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/09/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Constrained by a limited supply of specialized personnel, health systems face a challenge in caring for the large number of patients with OSA. The complexity of this challenge is heightened by the varied clinical presentations of OSA and the diversity of treatment approaches. Innovations such as simplified home-based care models and the incorporation of nonspecialist providers have shown promise in the management of uncomplicated patients, producing comparable outcomes to the resource-intensive traditional approach. However, it is unclear if these innovations can meet the needs of all patients with OSA, including those with mild disease, atypical presentations, and certain comorbid medical and mental health conditions. This review discusses the diversity of needs in OSA care, the evidence base behind recent care innovations, and the potential limitations of each innovation in meeting the diversity of care needs. We propose how these innovations can fit within the stepped care and hub and spoke models in a way that addresses the full spectrum of OSA, and we discuss future research directions to assess the deployment of these innovations.
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Affiliation(s)
- Lucas M Donovan
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA; University of Washington School of Medicine, Seattle, WA
| | - Aditi Shah
- Leon Judah Blackmore Sleep Disorders Program, University of British Columbia, Vancouver, BC, Canada
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia; Respiratory and Sleep Service, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Ferran Barbé
- Institut de Recerca Biomèdica of Lleida and CIBERES, Lleida, Catalonia, Spain
| | - Najib T Ayas
- Leon Judah Blackmore Sleep Disorders Program, University of British Columbia, Vancouver, BC, Canada
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32
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Gupta MA. Rapid Eye Movement Sleep Percentage and Duration in Posttraumatic Stress Disorder Vary Dynamically and Inversely With Indices of Sympathetic Activation During Sleep and Sleep Fragmentation. J Clin Sleep Med 2019; 15:785-789. [PMID: 31053211 DOI: 10.5664/jcsm.7778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/21/2019] [Indexed: 11/13/2022]
Abstract
ABSTRACT Posttraumatic stress disorder (PTSD) is associated with activation of the brain fear circuitry. Studies of sleep in PTSD provide a unique window into the relation or connection of sleep physiology and autonomic activation. Serial level 3 home sleep apnea tests (HSATs) (10 HSATs over 1 month) in a patient who was medication free, had PTSD, and had refused positive airway pressure therapy, revealed both percentage of rapid eye movement (REM) sleep (mean ± standard deviation [SD]: 19.88% ± 10.11%; range 1.94% to 35.01%) and REM sleep duration (minutes) (mean ± SD: 73.08 ± 48.24; range 3.49- 151.59) varied markedly over the 10 HSATs. Both percentage of REM sleep and REM sleep duration correlated negatively with sleep onset latency (r = -.661, P = .037 and r = -.748, P = .013, respectively) and the mean pulse rate during sleep (r = -.667, P = .035 and r = -.771, P = .009, respectively), and positively with sleep efficiency (r = .824, P = .003 and r = .922, P < .001, respectively) and percentage of stage N3 sleep (r = .784, P = .007 and r = .734, P = .016, respectively), an index of parasympathetic tone during sleep. These empirical findings suggest a previously unreported inverse relation of REM sleep with sleep fragmentation and sympathetic activation.
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Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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33
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Lin SH, Branson C, Leung J, Park L, Doshi N, Auerbach SH. Oximetry as an Accurate Tool for Identifying Moderate to Severe Sleep Apnea in Patients With Acute Stroke. J Clin Sleep Med 2018; 14:2065-2073. [PMID: 30518446 DOI: 10.5664/jcsm.7538] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/16/2018] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is highly prevalent in patients with acute stroke. SDB is often underdiagnosed and associated with neurological deterioration and stroke recurrence. Polysomnography or home sleep apnea testing (HSAT) is typically used as the diagnostic modality; however, it may not be feasible to use regularly in patients with acute stroke. We investigated the predictive performance of pulse oximetry, a simpler alternative, to identify SDB. METHODS The records of 254 patients, who were admitted to Boston Medical Center for acute stroke and underwent HSAT, were retrospectively reviewed. Oxygen desaturation index (ODI) from pulse oximetry channel were compared to respiratory event index (REI) obtained from HSAT devices. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ODI were calculated, and different ODI cutoff values to predict SDB were proposed. RESULTS ODI had a strong correlation (r = .902) and agreement with REI. ODI was accurate in predicting SDB at different REI thresholds (REI ≥ 5, REI ≥ 15, and REI ≥ 30 events/h) with the area under the curve (AUC) of .965, .974, and .951, respectively. An ODI ≥ 5 events/h rules in the presence of SDB (specificity 91.7%, PPV 96.3%). An ODI ≥ 15 events/h rules in moderate to severe SDB (specificity 96.4%, PPV 95%) and an ODI < 5 events/h rules out moderate to severe SDB (sensitivity 100%, NPV 100%). CONCLUSIONS Nocturnal pulse oximetry has a high diagnostic accuracy in predicting moderate to severe SDB in patients with acute stroke. Oximetry can be a simple modality to rapidly recognize patients with more severe SDB and facilitate the referral to the confirmation sleep study.
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Affiliation(s)
- Shih Hao Lin
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Chantale Branson
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Jamie Leung
- Boston University School of Medicine, Boston, Massachusetts
| | - Lisa Park
- Boston University School of Medicine, Boston, Massachusetts
| | - Nirmita Doshi
- Boston University School of Medicine, Boston, Massachusetts
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Massie F, Mendes de Almeida D, Dreesen P, Thijs I, Vranken J, Klerkx S. An Evaluation of the NightOwl Home Sleep Apnea Testing System. J Clin Sleep Med 2018; 14:1791-1796. [PMID: 30353811 DOI: 10.5664/jcsm.7398] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/07/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The objective of this study was to evaluate the performance of a miniaturized home sleep apnea test, called NightOwl. The system consists of a sensor placed on the fingertip and a cloud-based analytics software. The sensor acquires accelerometer and photoplethysmographic data. The software derives actigraphy from the former, and blood oxygen saturation and peripheral arterial tone, among other features, from the latter. METHODS Data of 101 participants who underwent an in-laboratory polysomnography (PSG), while wearing the NightOwl sensor, were collected. In order to establish an external benchmark, all PSG tests were edited by a somnologist of Younes Medical Technologies Ltd. (YMT) after analysis by the Michele Sleep Scoring System (MSSS). The respiratory event index (REI) derived by NightOwl (NightOwl-REI), the apnea-hypopnea index (AHI) derived by Ziekenhuis Oost-Limburg (ZOL-AHI), and the AHI derived by YMT (MSSS-AHI) were compared. RESULTS The NightOwl-REI had a high correlation with the MSSS-AHI (ρ = .87, P < .001), which was close to the correlation between the ZOL-AHI and MSSS-AHI (ρ = .84, P < .001). The NightOwl-REI and ZOL-AHI had a correlation of .77 (P < .001). After categorization of the AHI, the agreement between the NightOwl-REI and the MSSS-AHI was .812 and the agreement between the ZOL-AHI and MSSS-AHI was .743, after double-labeling near-boundary participants. CONCLUSIONS The NightOwl-REI achieved a close correlation and REI-categorization with the MSSS-AHI, especially in light of the significant inter-scorer variability of the analysis of the PSG.
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Affiliation(s)
| | | | - Pauline Dreesen
- Future Health Department, Ziekenhuis Oost-Limburg (Hospital East-Limburg), Genk, Belgium and Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge Thijs
- Future Health Department, Ziekenhuis Oost-Limburg (Hospital East-Limburg), Genk, Belgium and Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Julie Vranken
- Future Health Department, Ziekenhuis Oost-Limburg (Hospital East-Limburg), Genk, Belgium and Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Susie Klerkx
- Department of Pneumology, Ziekenhuis Oost-Limburg (Hospital East-Limburg), Genk, Belgium
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35
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Johnson DA, Guo N, Rueschman M, Wang R, Wilson JG, Redline S. Prevalence and correlates of obstructive sleep apnea among African Americans: the Jackson Heart Sleep Study. Sleep 2018; 41:5090670. [PMID: 30192958 PMCID: PMC6187109 DOI: 10.1093/sleep/zsy154] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/19/2018] [Indexed: 12/24/2022] Open
Abstract
Study Objectives African Americans have been under-represented in obstructive sleep apnea (OSA) research. This study determined the prevalence and correlates of OSA overall and by sex among African Americans in the Jackson Heart Sleep Study. Methods Participants (N = 852) underwent a type 3 in-home sleep apnea study, 7 day wrist actigraphy and completed standardized measurements and questionnaires. OSA was defined as an apnea-hypopnea index (AHI) of ≥15, where hypopneas were defined as ≥ 4% associated desaturation. Physician diagnosis of OSA was self-reported. Logistic regression models were fit to determine the associations of demographics, socioeconomic status, sleep symptoms, actigraphy-based sleep, body mass index (BMI), and comorbidities with OSA. Results Average age was 63.1 (standard deviation = 10.7), 66% were female, and mean BMI was 32.0 (6.9) kg/m2. Approximately 24% had an AHI ≥ 15; of those, 5% had a physician diagnosis of OSA. Prevalence of OSA increased across BMI categories, but not age groups. Men had a 12% higher prevalence of OSA compared with women, p < 0.01. Older age, male sex, higher BMI, larger neck circumference, and report of habitual snoring were independently associated with higher odds of OSA, all p < 0.05. Associations between sleep symptoms and OSA were similar for men and women. Sleepiness and waist circumference were not associated with OSA. Conclusions There was a high prevalence of objectively measured but undiagnosed OSA in this sample of African Americans. Snoring, BMI, and neck circumference were important markers of OSA for men and women. Our results suggest that screening tools that incorporate information on sleepiness and waist circumference may be suboptimal in this population.
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Affiliation(s)
- Dayna A Johnson
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Na Guo
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - Michael Rueschman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - Rui Wang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - James G Wilson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
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36
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Saletu MT, Kotzian ST, Schwarzinger A, Haider S, Spatt J, Saletu B. Home Sleep Apnea Testing is a Feasible and Accurate Method to Diagnose Obstructive Sleep Apnea in Stroke Patients During In-Hospital Rehabilitation. J Clin Sleep Med 2018; 14:1495-1501. [PMID: 30176970 DOI: 10.5664/jcsm.7322] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/14/2018] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVES To study the feasibility and accuracy of home sleep apnea testing (HSAT) in the diagnosis of obstructive sleep apnea (OSA) in a stroke rehabilitation unit. METHODS Stroke patients referred to a neurorehabilitation center underwent OSA screening by means of HSAT within the Home Polygraphic Recording with Telemedicine Monitoring for Diagnosis and Treatment of Sleep Apnea in Stroke, or HOPES study (ClinicalTrials.gov identifier: NCT02748681). Feasibility was determined by evaluating the acceptability of recording quality. Patients in whom moderate OSA was diagnosed subsequently underwent unattended polysomnography (PSG) confirmation. Accuracy was studied by comparing the respiratory event index (REI)/monitoring time (MT) of screening HSAT with the apnea-hypopnea index (AHI)/total sleep time (TST) obtained during subsequent PSG with Bland-Altman plots. The influence of PSG-evaluated wake time and arousals on OSA classification was studied by comparing the AHI and REI of the same night. RESULTS A total of 265 patients (58 ± 9 years, 70% male) were screened. A total of 92% of HSAT studies were performed with acceptable recording quality. In total, 33 patients (63 ± 5 years, 58% male) with moderate OSA (REI ≥ 15 to < 30 events/h) were included in the HSAT/PSG comparison. The Bland-Altman plot shows acceptable limits of agreement from -19.5 to +16.4, with a mean difference of -1.33. The REI detected in the PSG night demonstrated no significant differences to the AHI and a high correlation (r = .97; P < .001). The 95% confidence interval of the Bland-Altman plots varied from -7.61 to +4.80. CONCLUSIONS These findings confirm a good feasibility and sufficient accuracy of HSAT attached in a stroke rehabilitation unit. Therefore, the authors suggest that American Academy of Sleep Medicine recommendations for HSAT should include stroke patients.
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Affiliation(s)
- Michael T Saletu
- Neurologisches Rehabilitationszentrum Rosenhügel (NRZ), Vienna, Austria.,Department of Sleep Medicine, LKH Graz Südwest, Austria
| | - Stefan T Kotzian
- Neurologisches Rehabilitationszentrum Rosenhügel (NRZ), Vienna, Austria
| | | | - Sandra Haider
- Neurologisches Rehabilitationszentrum Rosenhügel (NRZ), Vienna, Austria
| | - Josef Spatt
- Neurologisches Rehabilitationszentrum Rosenhügel (NRZ), Vienna, Austria
| | - Bernd Saletu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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37
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Freedman N. Doing It Better for Less: Incorporating OSA Management Into Alternative Payment Models. Chest 2018; 155:227-233. [PMID: 29981717 DOI: 10.1016/j.chest.2018.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/10/2018] [Accepted: 06/28/2018] [Indexed: 12/19/2022] Open
Abstract
As the cost of health care continues to escalate, payers are adapting by moving away from models based on traditional fee-for-service reimbursement to models focused on rewarding care delivery that reduces costs and improves quality. These alternative payment models (APMs) are being introduced by government and commercial payers and will likely become the norm over time. Recent changes in sleep medicine related to advances in technology and approaches by payers for the management of OSA make this an appropriate time to incorporate the delivery of sleep medicine services into APMs. For OSA, the approaches that should lead to success include the appropriate use of home sleep apnea testing and automatic positive airway pressure; lower cost providers to manage less complex patients; evolving technologies including cloud-based positive airway pressure adherence monitoring, telemedicine, and Internet-based coaching to improve adherence with treatments; data analytics to better identify high-risk populations and to more appropriately allocate resources; and appropriate referrals of more complex cases to sleep specialists for management. All of these approaches should improve the value of care for payers, providers, and patients while allowing sleep specialists to more appropriately allocate their efforts to overseeing APM program development and administration and allowing them to focus on the management of more complicated patients.
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Affiliation(s)
- Neil Freedman
- Division of Pulmonary, Critical Care, Allergy and Immunology, Department of Medicine, Northshore University Health System, Evanston, IL.
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38
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Hughes BH, Brinton JT, Ingram DG, Halbower AC. The Impact of Altitude on Sleep-Disordered Breathing in Children Dwelling at High Altitude: A Crossover Study. Sleep 2018; 40:3932553. [PMID: 28934528 DOI: 10.1093/sleep/zsx120] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Study Objectives Sleep-disordered breathing (SDB) is prevalent among children and is associated with adverse health outcomes. Worldwide, approximately 250 million individuals reside at altitudes higher than 2000 meters above sea level (masl). The effect of chronic high-altitude exposure on children with SDB is unknown. This study aims to determine the impact of altitude on sleep study outcomes in children with SDB dwelling at high altitude. Methods A single-center crossover study was performed to compare results of high-altitude home polysomnography (H-PSG) with lower altitude laboratory polysomnography (L-PSG) in school-age children dwelling at high altitude with symptoms consistent with SDB. The primary outcome was apnea-hypopnea index (AHI), with secondary outcomes including obstructive AHI; central AHI; and measures of oxygenation, sleep quality, and pulse rate. Results Twelve participants were enrolled, with 10 included in the final analysis. Median altitude was 1644 masl on L-PSG and 2531 masl on H-PSG. Median AHI was 2.40 on L-PSG and 10.95 on H-PSG. Both obstructive and central respiratory events accounted for the difference in AHI. Oxygenation and sleep fragmentation were worse and pulse rate higher on H-PSG compared to L-PSG. Conclusions These findings reveal a clinically substantial impact of altitude on respiratory, sleep, and cardiovascular outcomes in children with SDB who dwell at high altitude. Within this population, L-PSG underestimates obstructive sleep apnea and central sleep apnea compared to H-PSG. Given the shortage of high-altitude pediatric sleep laboratories, these results suggest a role for home sleep apnea testing for children residing at high altitude.
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Affiliation(s)
- Benjamin H Hughes
- School of Medicine, Department of Pediatrics, The University of Colorado Anschutz Medical Campus, Aurora, CO.,The Breathing Institute, Section of Pediatric Pulmonary Medicine, Children's Hospital Colorado, Aurora, CO
| | - John T Brinton
- School of Medicine, Department of Pediatrics, The University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - David G Ingram
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO.,Department of Pulmonology and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO
| | - Ann C Halbower
- School of Medicine, Department of Pediatrics, The University of Colorado Anschutz Medical Campus, Aurora, CO.,The Breathing Institute, Section of Pediatric Pulmonary Medicine, Children's Hospital Colorado, Aurora, CO
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39
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Prasad B, Steffen AD, Van Dongen HPA, Pack FM, Strakovsky I, Staley B, Dinges DF, Maislin G, Pack AI, Weaver TE. Determinants of sleepiness in obstructive sleep apnea. Sleep 2018; 41:4850639. [PMID: 29444292 DOI: 10.1093/sleep/zsx199] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/18/2017] [Indexed: 01/15/2023] Open
Abstract
STUDY OBJECTIVES Significant interindividual variability in sleepiness is observed in clinical populations with obstructive sleep apnea (OSA). This phenomenon is only partially explained by the apnea-hypopnea index (AHI). Understanding factors that lead to sleepiness is critical to effective management of patients with OSA. We examined demographic and other factors associated with sleepiness in OSA. METHODS Prospective study of 283 patients with newly diagnosed OSA by polysomnography (AHI ≥ 5 per hour). Subjective sleepiness (Epworth Sleep Scale [ESS] ≥ 11) and objective sleepiness (psychomotor vigilance task [PVT] mean lapse ≥ 2) were assessed. RESULTS Participants were classified into four groups (1: sleepy by ESS and PVT, 2: sleepy by PVT only, 3: sleepy by ESS only, and 4: nonsleepy reference group) and compared by generalized logit model. Shorter daily sleep duration by actigraphy and less morningness were associated with higher risk of sleepiness (Odds ratio [OR] = 0.52, 95% confidence interval [CI] 0.33-0.82 and OR = 0.89, CI 0.80-0.98, respectively). African-American race was associated with sleepiness (group 1, OR = 8.8, CI 2.8-27.3; group 2, OR = 16.6, CI 3.3-83.6; and group 3, OR = 3.3, CI 1.0-10.1). IL-6 level was higher in groups 1 and 3 (OR = 1.9, CI 1.0-3.4 and OR 2.0, CI 1.1-3.7, respectively). CONCLUSIONS African-American race, short sleep duration, chronotype, and increased proinflammatory cytokine IL-6 level were associated with sleepiness in OSA. These findings will inform future investigations determining mechanisms of sleepiness in OSA.
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Affiliation(s)
- Bharati Prasad
- Department of Medicine, Pulmonary, Critical Care, Sleep and Allergy, College of Medicine, University of Illinois at Chicago, Chicago, IL.,Jesse Brown VA Medical Center, Chicago, IL.,Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Alana D Steffen
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL.,Department of Health System Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA
| | - Francis M Pack
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Inna Strakovsky
- Office of Clinical Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bethany Staley
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David F Dinges
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Greg Maislin
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Terri E Weaver
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL.,Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
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40
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Xu L, Han F, Keenan BT, Kneeland-Szanto E, Yan H, Dong X, Chang Y, Zhao L, Zhang X, Li J, Pack AI, Kuna ST. Validation of the Nox-T3 Portable Monitor for Diagnosis of Obstructive Sleep Apnea in Chinese Adults. J Clin Sleep Med 2017; 13:675-683. [PMID: 28356181 DOI: 10.5664/jcsm.6582] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/20/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the performance of a portable monitor (Nox-T3, Nox Medical Inc. Reykjavik, Iceland) used to diagnose obstructive sleep apnea in Chinese adults. METHODS Eighty Chinese adults (mean ± standard deviation age 47.6 ± 14.0 years, 77.5% males, body mass index 27.5 ± 5.4 kg/m2) underwent overnight, unattended home sleep apnea testing (HSAT) with the Nox-T3 portable monitor followed by an overnight in-laboratory polysomnogram (PSG) with simultaneous portable monitor recording. The portable monitor recordings were scored using automated analysis and then manually edited using different criteria for scoring hypopneas. Polysomnography was scored based on recommended guidelines. RESULTS When scoring of hypopneas required a ≥ 4% oxygen desaturation event, the mean ± standard deviation apnea-hypopnea index (AHI) was 24.4 ± 20.8 events/h on HSAT, 28.0 ± 22.9 events/h on in-laboratory portable monitor recording, and 28.6 ± 23.9 events/h on PSG (P < .0001). Bland-Altman analysis of AHI on PSG versus HSAT showed a mean difference (95% confidence interval) of -4.64 (-7.15, -2.13); limits of agreement (equal to ± 2 standard deviations) was -26.62 to 17.35 events/h. Based on a threshold of AHI ≥ 5 events/h, HSAT had 95% sensitivity, 69% specificity, 94% positive predictive value, and 75% negative predictive value compared to PSG. Using an AHI ≥ 15 events/h, HSAT had 93% sensitivity, 85% specificity, 89% positive predictive value, and 91% negative predictive value. Closer agreements were present when comparing the simultaneous recordings. Similar results were obtained using different scoring criteria for hypopneas. CONCLUSIONS Despite known differences between HSAT and PSG, the results show close agreement between the two diagnostic tests in Chinese adults, especially when controlling for night-to-night variability and changes in sleeping environment.
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Affiliation(s)
- Liyue Xu
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Fang Han
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Brendan T Keenan
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Kneeland-Szanto
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Han Yan
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Xiaosong Dong
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Yuan Chang
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Long Zhao
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Xueli Zhang
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Jing Li
- Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China
| | - Allan I Pack
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel T Kuna
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Shetty S, Fernandes A, Patel S, Combs D, Grandner MA, Parthasarathy S. Unanticipated Nocturnal Oxygen Requirement during Positive Pressure Therapy for Sleep Apnea and Medical Comorbidities. J Clin Sleep Med 2017; 13:73-79. [PMID: 27655454 DOI: 10.5664/jcsm.6392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/31/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Home-based management of sleep-disordered breathing (SDB) generally excludes patients with significant medical comorbidities, but such an approach lacks scientific evidence. The current study examined whether significant medical comorbidities are associated with persistent hypoxia that requires unanticipated nocturnal O2 supplementation to positive airway pressure (PAP) therapy. Conceivably, in such patients, home-based management of SDB may not detect or therefore adequately treat persistent hypoxia. METHODS In this retrospective study of 200 patients undergoing laboratory-based polysomnography, we ascertained significant medical comorbidities (chronic obstructive pulmonary disease, congestive heart failure, and morbid obesity) and their association with the need for unanticipated O2 supplementation to PAP therapy. Postural oxygen (SpO2) desaturations between upright and reclining positions were determined during calm wakefulness. RESULTS Postural change in SpO2 during calm wakefulness was greater in patients who eventually needed nocturnal O2 supplementation to PAP therapy than those needing PAP therapy alone (p < 0.0001). The presence of chronic obstructive pulmonary disease (odds ratio [OR] 6.0; 95% confidence interval [CI]; 2.1, 17.5; p = 0.001), morbid obesity (OR 3.6; 95% CI 1.9, 7.0; p < 0.0001), and age older than 50 y (OR 2.8; 95% CI 1.3, 5.9; p = 0.007) but not heart failure were associated with unanticipated need for nocturnal O2 supplementation. A clinical prediction rule of less than two determinants (age older than 50 y, morbid obesity, chronic obstructive pulmonary disease, and postural SpO2 desaturation greater than 5%) had excellent negative predictive value (0.92; 95% CI 0.85, 0.96) and likelihood ratio of negative test (0.08; 95% CI 0.04, 0.16). CONCLUSIONS Medical comorbidities can predict persistent hypoxia that requires unanticipated O2 supplementation to PAP therapy. Such findings justify the use of medical comorbidities to exclude home management of SDB. COMMENTARY A commentary on this article appears in this issue on page 7.
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Affiliation(s)
- Safal Shetty
- Center for Sleep Disorders and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ.,Department of Medicine, University of Arizona
| | - Aaron Fernandes
- Center for Sleep Disorders and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ.,Department of Medicine, University of Arizona
| | - Sarah Patel
- Center for Sleep Disorders and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ.,Department of Medicine, University of Arizona
| | - Daniel Combs
- Arizona Respiratory Center and Department of Pediatrics, University of Arizona
| | | | - Sairam Parthasarathy
- Center for Sleep Disorders and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ.,Department of Medicine, University of Arizona.,UAHS Center for Sleep and Circadian Sciences, University of Arizona
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