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Xie J, Fonseca P, van Dijk J, Overeem S, Long X. A multi-task learning model using RR intervals and respiratory effort to assess sleep disordered breathing. Biomed Eng Online 2024; 23:45. [PMID: 38705982 PMCID: PMC11070105 DOI: 10.1186/s12938-024-01240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/23/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) affects a significant portion of the population. As such, there is a need for accessible and affordable assessment methods for diagnosis but also case-finding and long-term follow-up. Research has focused on exploiting cardiac and respiratory signals to extract proxy measures for sleep combined with SDB event detection. We introduce a novel multi-task model combining cardiac activity and respiratory effort to perform sleep-wake classification and SDB event detection in order to automatically estimate the apnea-hypopnea index (AHI) as severity indicator. METHODS The proposed multi-task model utilized both convolutional and recurrent neural networks and was formed by a shared part for common feature extraction, a task-specific part for sleep-wake classification, and a task-specific part for SDB event detection. The model was trained with RR intervals derived from electrocardiogram and respiratory effort signals. To assess performance, overnight polysomnography (PSG) recordings from 198 patients with varying degree of SDB were included, with manually annotated sleep stages and SDB events. RESULTS We achieved a Cohen's kappa of 0.70 in the sleep-wake classification task, corresponding to a Spearman's correlation coefficient (R) of 0.830 between the estimated total sleep time (TST) and the TST obtained from PSG-based sleep scoring. Combining the sleep-wake classification and SDB detection results of the multi-task model, we obtained an R of 0.891 between the estimated and the reference AHI. For severity classification of SBD groups based on AHI, a Cohen's kappa of 0.58 was achieved. The multi-task model performed better than a single-task model proposed in a previous study for AHI estimation, in particular for patients with a lower sleep efficiency (R of 0.861 with the multi-task model and R of 0.746 with single-task model with subjects having sleep efficiency < 60%). CONCLUSION Assisted with automatic sleep-wake classification, our multi-task model demonstrated proficiency in estimating AHI and assessing SDB severity based on AHI in a fully automatic manner using RR intervals and respiratory effort. This shows the potential for improving SDB screening with unobtrusive sensors also for subjects with low sleep efficiency without adding additional sensors for sleep-wake detection.
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Affiliation(s)
- Jiali Xie
- Biomedical Diagnostics Lab, Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ, Eindhoven, The Netherlands.
- Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.
- Eindhoven MedTech Innovaton Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
| | - Pedro Fonseca
- Biomedical Diagnostics Lab, Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ, Eindhoven, The Netherlands
- Philips Research, High Tech Campus, 5656 AE, Eindhoven, The Netherlands
- Eindhoven MedTech Innovaton Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Johannes van Dijk
- Biomedical Diagnostics Lab, Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ, Eindhoven, The Netherlands
- Sleep Medicine Center Kempenhaeghe, 5591 VE, Heeze, The Netherlands
- Department of Orthodontics, Ulm University, 89081, Ulm, Germany
- Eindhoven MedTech Innovaton Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Sebastiaan Overeem
- Biomedical Diagnostics Lab, Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ, Eindhoven, The Netherlands
- Sleep Medicine Center Kempenhaeghe, 5591 VE, Heeze, The Netherlands
- Eindhoven MedTech Innovaton Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Xi Long
- Biomedical Diagnostics Lab, Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ, Eindhoven, The Netherlands
- Eindhoven MedTech Innovaton Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
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Hayano J, Yamamoto H, Tanaka H, Yuda E. Piezoelectric rubber sheet sensor: a promising tool for home sleep apnea testing. Sleep Breath 2024:10.1007/s11325-024-02991-9. [PMID: 38358413 DOI: 10.1007/s11325-024-02991-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE This study aimed to develop an unobtrusive method for home sleep apnea testing (HSAT) utilizing micromotion signals obtained by a piezoelectric rubber sheet sensor. METHODS Algorithms were designated to extract respiratory and ballistocardiogram components from micromotion signals and to detect respiratory events as the characteristic separation of the fast envelope of the respiration component from the slow envelope. In 78 adults with diagnosed or suspected sleep apnea, micromotion signal was recorded with a piezoelectric rubber sheet sensor placed beneath the bedsheet during polysomnography. In a half of the subjects, the algorithms were optimized to calculate respiratory event index (REI), estimating apnea-hypopnea index (AHI). In the other half of subjects, the performance of REI in classifying sleep apnea severity was evaluated. Additionally, the predictive value of the frequency of cyclic variation in heart rate (Fcv) obtained from the ballistocardiogram was assessed. RESULTS In the training group, the optimized REI showed a strong correlation with the AHI (r = 0.93). Using the optimal cutoff of REI ≥ 14/h, subjects with an AHI ≥ 15 were identified with 77.8% sensitivity and 90.5% specificity. When applying this REI to the test group, it correlated closely with the AHI (r = 0.92) and identified subjects with an AHI ≥ 15 with 87.5% sensitivity and 91.3% specificity. While Fcv showed a modest correlation with AHI (r = 0.46 and 0.66 in the training and test groups), it lacked independent predictive power for AHI. CONCLUSION The analysis of respiratory component of micromotion using piezoelectric rubber sheet sensors presents a promising approach for HSAT, providing a practical and effective means of estimating sleep apnea severity.
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Affiliation(s)
| | | | - Haruhito Tanaka
- Gifu Mates Sleep Clinic, Gifu, Japan
- International Institute for Integrative Sleep Medicine (IIIS), University of Tsukuba, Tsukuba, Japan
| | - Emi Yuda
- Heart Beat Science Lab Inc., Sendai, Japan
- Graduate School of Information Sciences, Tohoku University, Sendai, Japan
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Thomas C, Kingshott RN, Allott KM, Tang JCY, Dunn R, Fraser WD, Thorley J, Virgilio N, Prawitt J, Hogervorst E, Škarabot J, Clifford T. Collagen peptide supplementation before bedtime reduces sleep fragmentation and improves cognitive function in physically active males with sleep complaints. Eur J Nutr 2024; 63:323-335. [PMID: 37874350 PMCID: PMC10799148 DOI: 10.1007/s00394-023-03267-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The primary aim of this study was to examine whether a glycine-rich collagen peptides (CP) supplement could enhance sleep quality in physically active men with self-reported sleep complaints. METHODS In a randomized, crossover design, 13 athletic males (age: 24 ± 4 years; training volume; 7 ± 3 h·wk1) with sleep complaints (Athens Insomnia Scale, 9 ± 2) consumed CP (15 g·day1) or a placebo control (CON) 1 h before bedtime for 7 nights. Sleep quality was measured with subjective sleep diaries and actigraphy for 7 nights; polysomnographic sleep and core temperature were recorded on night 7. Cognition, inflammation, and endocrine function were measured on night 7 and the following morning. Subjective sleepiness and fatigue were measured on all 7 nights. The intervention trials were separated by ≥ 7 days and preceded by a 7-night familiarisation trial. RESULTS Polysomnography showed less awakenings with CP than CON (21.3 ± 9.7 vs. 29.3 ± 13.8 counts, respectively; P = 0.028). The 7-day average for subjective awakenings were less with CP vs. CON (1.3 ± 1.5 vs. 1.9 ± 0.6 counts, respectively; P = 0.023). The proportion of correct responses on the baseline Stroop cognitive test were higher with CP than CON (1.00 ± 0.00 vs. 0.97 ± 0.05 AU, respectively; P = 0.009) the morning after night 7. There were no trial differences in core temperature, endocrine function, inflammation, subjective sleepiness, fatigue and sleep quality, or other measures of cognitive function or sleep (P > 0.05). CONCLUSION CP supplementation did not influence sleep quantity, latency, or efficiency, but reduced awakenings and improved cognitive function in physically active males with sleep complaints.
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Affiliation(s)
- Craig Thomas
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Ruth N Kingshott
- Sheffield Children's NHS Foundation Trust, The Sleep House, Sheffield, UK
| | - Kirsty M Allott
- Sheffield Children's NHS Foundation Trust, The Sleep House, Sheffield, UK
| | - Jonathan C Y Tang
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norfolk and Norwich University Hospital Norfolk, Norwich, UK
- Clinical Biochemistry, Departments of Laboratory Medicine and Departments of Diabetes and Endocrinology Norfolk, Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Rachel Dunn
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norfolk and Norwich University Hospital Norfolk, Norwich, UK
- Clinical Biochemistry, Departments of Laboratory Medicine and Departments of Diabetes and Endocrinology Norfolk, Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - William D Fraser
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norfolk and Norwich University Hospital Norfolk, Norwich, UK
- Clinical Biochemistry, Departments of Laboratory Medicine and Departments of Diabetes and Endocrinology Norfolk, Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Josh Thorley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | | | | | - Eef Hogervorst
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Jakob Škarabot
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Tom Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.
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Brunnhuber F, Slater JD, Goyal S, Amin D, Winston JS. The unforeseen future: Impacts of the COVID-19 pandemic on home video-EEG telemetry. Epilepsia 2023; 64 Suppl 4:S12-S22. [PMID: 36453720 PMCID: PMC9877725 DOI: 10.1111/epi.17473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic had widespread impact on health care systems globally-particularly services arranged around elective admission and attendance such as epilepsy monitoring units and home video-EEG telemetry (HVET). Here, we review the ongoing impacts of the pandemic on HVET services among several different providers who used different initial models of HVET. We discuss the features of HVET that led to success in providing continued diagnostic services to patients with epilepsy and related disorders and through retrospective audit of our services demonstrate the high diagnostic yield of HVET. We reflect on this unforeseen future and its implications for other diagnostic techniques and approaches.
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Affiliation(s)
- Franz Brunnhuber
- Department of Clinical NeurophysiologyKing's College HospitalLondonUK
| | | | - Sushma Goyal
- Department of Clinical NeurophysiologyKing's College HospitalLondonUK
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation TrustLondonUK
| | - Devyani Amin
- Department of Clinical NeurophysiologyKing's College HospitalLondonUK
| | - Joel S. Winston
- Department of Clinical NeurophysiologyKing's College HospitalLondonUK
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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Angellotti MF, Grandval S, Palma I, Giovini V, Jaritos V, Diaz-Lapasini G, Carnevale D, Nogueira JF. Nocturnal Polysomnography without Technical Supervision in the Diagnosis of Respiratory Sleep Disorders, Diagnostic Performance of Home and Sleep Laboratory Studies. Sleep Sci 2023; 16:e310-e316. [PMID: 38196765 PMCID: PMC10773501 DOI: 10.1055/s-0043-1772809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2024] Open
Abstract
Introduction Unattended Polysomnography (type 2 PSG) is a procedure for the diagnosis of sleep-disordered breathing (SDB). Published evidence on its performance and efficacy is limited. Available studies reveal a high rate of lost records that could limit its application. Objective To assess the efficacy of type 2 PSG and the rate of studies that must be repeated due to critical loss of signals. Methods prospective, descriptive study. Adult patients with suspected SDB were included. Unattended PSG was performed using portable equipment. 75 patients were connected at home and another 75 in the laboratory, without subsequent monitoring. Records were evaluated to determine the percentage of the night with adequate quality for each of the signals, considered as an evaluable signal for = 70% of the total recording time (TRT). The need to repeat the studies was also estimated. Results: 150 patients were recruited; 44% women; age 57.3 ± 15.4 years; BMI 29.4 ± 6.5. EEG and EOG signals were adequate in 149 records. Flow signal by pressure cannula was adequate in 146 and by thermistor in 67.8%. In only one study the signal of both effort bands were inadequate. Oximetry was lost in 4 cases. Ten tracings (6%) met the criteria for repetition; 8 hospital and 2 home. Conclusions Acceptable records were obtained in most unattended PSG studies, both at home and in the sleep laboratory. The rate of repetition of studies due to loss of signal was 6%, with failure in SaO2 or in flow signals being the main cause of the indication.
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Affiliation(s)
- María Florencia Angellotti
- Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Sofía Grandval
- Instituto Argentino de Investigación Neurológica, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Ileana Palma
- Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Vanina Giovini
- Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Verónica Jaritos
- Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Gastón Diaz-Lapasini
- Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Denise Carnevale
- Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Juan Facundo Nogueira
- Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
- Instituto Argentino de Investigación Neurológica, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
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6
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Portable evaluation of obstructive sleep apnea in adults: A systematic review. Sleep Med Rev 2023; 68:101743. [PMID: 36657366 DOI: 10.1016/j.smrv.2022.101743] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/10/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023]
Abstract
Obstructive sleep apnea (OSA) is a significant healthcare burden affecting approximately one billion people worldwide. The prevalence of OSA is rising with the ongoing obesity epidemic, a key risk factor for its development. While in-laboratory polysomnography (PSG) is the gold standard for diagnosing OSA, it has significant drawbacks that prevent widespread use. Portable devices with different levels of monitoring are available to allow remote assessment for OSA. To better inform clinical practice and research, this comprehensive systematic review evaluated diagnostic performances, study cost and patients' experience of different levels of portable sleep studies (type 2, 3, and 4), as well as wearable devices and non-contact systems, in adults. Despite varying study designs and devices used, portable diagnostic tests are found to be sufficient for initial screening of patients at risk of OSA. Future studies are needed to evaluate cost effectiveness with the incorporation of portable diagnostic tests into the diagnostic pathway for OSA, as well as their application in patients with chronic respiratory diseases and other comorbidities that may affect test performance.
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Jayarathna T, Gargiulo GD, Lui GY, Breen PP. Electrodeless Heart and Respiratory Rate Estimation during Sleep Using a Single Fabric Band and Event-Based Edge Processing. SENSORS (BASEL, SWITZERLAND) 2022; 22:6689. [PMID: 36081149 PMCID: PMC9460329 DOI: 10.3390/s22176689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
Heart rate (HR) and respiratory rate (RR) are two vital parameters of the body medically used for diagnosing short/long-term illness. Out-of-the-body, non-skin-contact HR/RR measurement remains a challenge due to imprecise readings. "Invisible" wearables integrated into day-to-day garments have the potential to produce precise readings with a comfortable user experience. Sleep studies and patient monitoring benefit from "Invisibles" due to longer wearability without significant discomfort. This paper suggests a novel method to reduce the footprint of sleep monitoring devices. We use a single silver-coated nylon fabric band integrated into a substrate of a standard cotton/nylon garment as a resistive elastomer sensor to measure air and blood volume change across the chest. We introduce a novel event-based architecture to process data at the edge device and describe two algorithms to calculate real-time HR/RR on ARM Cortex-M3 and Cortex-M4F microcontrollers. RR estimations show a sensitivity of 99.03% and a precision of 99.03% for identifying individual respiratory peaks. The two algorithms used for HR calculation show a mean absolute error of 0.81 ± 0.97 and 0.86±0.61 beats/min compared with a gold standard ECG-based HR. The event-based algorithm converts the respiratory/pulse waveform into instantaneous events, therefore reducing the data size by 40-140 times and requiring 33% less power to process and transfer data. Furthermore, we show that events hold enough information to reconstruct the original waveform, retaining pulse and respiratory activity. We suggest fabric sensors and event-based algorithms would drastically reduce the device footprint and increase the performance for HR/RR estimations during sleep studies, providing a better user experience.
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Affiliation(s)
- Titus Jayarathna
- The MARCS Institute, Western Sydney University, Westmead, NSW 2145, Australia
| | - Gaetano D. Gargiulo
- The MARCS Institute, Western Sydney University, Westmead, NSW 2145, Australia
- School of Engineering, Design and Built Environment, Western Sydney University, Penrith, NSW 2750, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2052, Australia
- Translational Health Research Institute, Westmead, NSW 2145, Australia
| | - Gough Y. Lui
- The MARCS Institute, Western Sydney University, Westmead, NSW 2145, Australia
| | - Paul P. Breen
- The MARCS Institute, Western Sydney University, Westmead, NSW 2145, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2052, Australia
- Translational Health Research Institute, Westmead, NSW 2145, Australia
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Tan JWC, Leow LC, Wong S, Khoo SM, Kasai T, Kojodjojo P, Sy DQ, Lee CP, Chirakalwasan N, Li HY, Koh N, Tan A, Ong TH, Aung AT, Toh ST, Lee CH. Asian Pacific Society of Cardiology Consensus Statements on the Diagnosis and Management of Obstructive Sleep Apnoea in Patients with Cardiovascular Disease. Eur Cardiol 2022; 17:e16. [PMID: 35795612 PMCID: PMC9247989 DOI: 10.15420/ecr.2021.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is strongly associated with cardiovascular disease (CVD). However, evidence supporting this association in the Asian population is scarce. Given the differences in the epidemiology of CVD and cardiovascular risk factors, as well as differences in the availability of healthcare resources between Asian and Western countries, an Asian Pacific Society of Cardiology (APSC) working group developed consensus recommendations on the management of OSA in patients with CVD in the Asia-Pacific region. The APSC expert panel reviewed and appraised the available evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed and put to an online vote. Consensus was reached when 80% of votes for a given recommendation were in support of ‘agree’ or ‘neutral.’ The resulting statements provide guidance on the assessment and treatment of OSA in patients with CVD in the Asia-Pacific region. The APSC hopes for these recommendations to pave the way for screening, early diagnosis and treatment of OSA in the Asia-Pacific region.
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Affiliation(s)
- Jack Wei Chieh Tan
- Department of Cardiology National Heart Centre Singapore, Singapore; Department of Cardiology, Sengkang General Hospital, Singapore
| | - Leong Chai Leow
- Department of Respiratory and Critical Care Medicine; Singapore General Hospital, Singapore
| | - Serene Wong
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Fast and Chronic Programmes, Alexandra Hospital, Singapore
| | - See Meng Khoo
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Fast and Chronic Programmes, Alexandra Hospital, Singapore
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Duong-Quy Sy
- Clinical Research Center, Lam Dong Medical College, Dalat, Vietnam; Pham Ngoc Thach Medical University, Ho Chi Minh City, Vietnam
| | - Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Hsueh-Yu Li
- Department of Otolaryngology – Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Natalie Koh
- Department of Cardiology National Heart Centre Singapore, Singapore
| | - Adeline Tan
- Division of Respiratory Medicine, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Thun How Ong
- Department of Respiratory and Critical Care Medicine; Singapore General Hospital, Singapore
| | - Aye Thandar Aung
- Department of Cardiovascular Medicine, Mandalay General Hospital, Mandalay, Myanmar
| | - Song Tar Toh
- Department of Otorhinolaryngology – Head and Neck Surgery, Singapore General Hospital, Singapore; Singhealth Duke-NUS Sleep Centre, Singapore
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
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Peripheral Biomarkers to Diagnose Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis. Sleep Med Rev 2022; 64:101659. [DOI: 10.1016/j.smrv.2022.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
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10
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Di Pumpo M, Nurchis MC, Moffa A, Giorgi L, Sabatino L, Baptista P, Sommella L, Casale M, Damiani G. Multiple-access versus telemedicine home-based sleep apnea testing for obstructive sleep apnea (OSA) diagnosis: a cost-minimization study. Sleep Breath 2021; 26:1641-1647. [PMID: 34826058 PMCID: PMC8617356 DOI: 10.1007/s11325-021-02527-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/28/2021] [Accepted: 11/16/2021] [Indexed: 12/02/2022]
Abstract
Purpose The aim of the present study was to compare two clinical pathways: the multiple-access outpatient pathway versus the telemedicine pathway. Methods The multiple-access outpatient pathway and the telemedicine pathway were both performed with WatchPAT and implemented in a real-life healthcare scenario, adopting a cost-minimization approach. A cost-minimization analysis was undertaken to assess the economic impact of the two alternatives. The cost analyses were performed in euros for the year 2021 adopting the patient, the hospital, and the societal perspectives. Given the chosen perspectives, direct medical costs, direct nonmedical costs, and indirect costs were considered. In addition, a univariate sensitivity analysis was conducted. Results From a hospital perspective, the telemedicine approach was estimated to cost €49 more than the multiple-access alternative. Considering the patient perspective, the telemedicine approach was estimated to cost €167 less than the multiple-access pathway. Considering the societal perspective, the telemedicine approach is estimated to cost €119 less than the multiple-access pathway. Conclusion The adoption of telemedicine home sleep apnea testing could improve the efficiency of the healthcare processes if considering the direct and indirect costs incurred by patients and not only by healthcare providers.
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Affiliation(s)
| | - Mario Cesare Nurchis
- Università Cattolica del Sacro Cuore, Rome, Italy.
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Antonio Moffa
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - Lucrezia Giorgi
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - Lorenzo Sabatino
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - Peter Baptista
- Unit of Otolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Manuele Casale
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
| | - Gianfranco Damiani
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Chen YC, Chen CC, Strollo PJ, Li CY, Ko WC, Lin CY, Ko NY. Differences in Sleep Disorders between HIV-Infected Persons and Matched Controls with Sleep Problems: A Matched-Cohort Study Based on Laboratory and Survey Data. J Clin Med 2021; 10:jcm10215206. [PMID: 34768728 PMCID: PMC8585117 DOI: 10.3390/jcm10215206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives: Sleep disturbances are prevalent problems among human immunodeficiency virus (HIV)-infected persons. The recognition of comorbid sleep disorders in patients with HIV is currently hampered by limited knowledge of sleep-related symptoms, sleep architecture, and types of sleep disorders in this population. We aimed to compare the differences in sleep-related symptoms and polysomnography-based sleep disorders between HIV-infected persons and controls. Methods: The study evaluated 170 men with a Pittsburgh sleep quality index scores greater than 5, including 44 HIV-infected men and 126 male controls who were frequency-matched by sex, age (±3.0 years) and BMI (±3.0 kg/m2). For all participants, an overnight sleep study using a Somte V1 monitor was conducted. Differences in sleep-related symptoms and sleep disorders between HIV-infected patients and controls were examined using t-tests or chi-square tests. Results: HIV-infected persons with sleep disturbances more often had psychological disturbances (72.7% vs. 40.5%, p < 0.001) and suspected rapid eye movement behavior disorder (25.0% vs. 4.8%, p < 0.01) than controls. Sleep-disordered breathing was less common in HIV-infected persons than in controls (56.8% vs. 87.3%, p < 0.001). The mean percentage of rapid eye movement sleep was higher among HIV-infected patients than among controls (20.6% vs. 16.6%, p < 0.001). Nocturia was more common in HIV-infected persons than in controls (40.9% vs. 22.2%, p = 0.02). Conclusions: Psychological disturbances and sleep-disordered breathing can be possible explanations of sleep disturbances in HIV-infected persons in whom sleep-disordered breathing is notable. Further studies are warranted to examine the underlying factors of rapid eye movement behavior disorder among HIV-infected persons with sleep disturbances.
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Affiliation(s)
- Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Chang-Chun Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Patrick J. Strollo
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Public Health, College of Public Health, China Medical University, Taichung 404, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Correspondence: (C.-Y.L.); (N.-Y.K.); Tel.: +88-66-2353535 (C.-Y.L.); Fax: +88-66-2377550 (C.-Y.L.)
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Correspondence: (C.-Y.L.); (N.-Y.K.); Tel.: +88-66-2353535 (C.-Y.L.); Fax: +88-66-2377550 (C.-Y.L.)
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Gupta M, Ish P, Chakrabarti S, Sen MK, Mishra P, Suri JC. Diagnostic accuracy and feasibility of portable sleep monitoring in patients with obstructive sleep apnea: Re-exploring the utility in the current COVID-19 pandemic. Monaldi Arch Chest Dis 2021; 92. [PMID: 34523322 DOI: 10.4081/monaldi.2021.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Portable sleep monitoring (PSM) is a promising alternative diagnostic tool for Obstructive Sleep Apnea (OSA) especially in high burden resource limited settings. We aimed to determine the diagnostic accuracy and feasibility of PSM device-based studies in patients presenting for evaluation of OSA at a tertiary care hospital in North-India. PSM studies (using a Type-III PSM device) were compared for technical reliability and diagnostic accuracy with the standard laboratory-based Type-I polysomnography (PSG). Patients were also interviewed about their experience on undergoing an unsupervised PSM studies. Fifty patients (68% males) were enrolled in the study, of which only 30% patients expressed their concerns about undergoing unsupervised PSM studies which included safety issues, ease of use, diagnostic accuracy, etc. Technical acceptability criteria were easily met by the PSM studies with signal loss in 12% studies (complete data loss and inaccessible data in 6% studies), warranting repetition sleep studies in four patients. The overall sensitivity of PSM device (AHI ≥5) was 93.5% (area under curve; AUC: 0.87). The diagnostic accuracy was 68.5%, 80%, and 91.4% for mild, moderate, and severe cases of OSA, respectively. An overall strong correlation was observed between PSM-AHI (apnoea-hypopnoea index) and PSG (r>0.85, p≤0.001), especially in severe OSA. The observed sensitivity was >90% for AHI>20 (clinically significant OSA), with high specificity of 91% for severe OSA (AUC: 0.94, 0.97 for AHI>20, AHI>30 respectively). The overall Bland-Altman concordance analysis also demonstrated only a small dispersion for PSM studies with a Cronbach's coefficient of 0.95. Therefore, there is good diagnostic accuracy as well as feasibility of home-based portable sleep studies in Indian patients. It can be promoted for widespread use in high burden countries like India for diagnosing and managing appropriately selected stable patients with high clinical probability of OSA, especially during the ongoing crises of COVID-19 pandemic.
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Affiliation(s)
- Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Post-graduate Institute of Medical sciences, Lucknow.
| | - Pranav Ish
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Shibdas Chakrabarti
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Manas Kamal Sen
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow.
| | - Jagdish Chander Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi.
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Bouloukaki I, Grote L, McNicholas WT, Hedner J, Verbraecken J, Parati G, Lombardi C, Basoglu OK, Pataka A, Marrone O, Steiropoulos P, Bonsignore MR, Schiza SE. Mild obstructive sleep apnea increases hypertension risk, challenging traditional severity classification. J Clin Sleep Med 2021; 16:889-898. [PMID: 32043960 DOI: 10.5664/jcsm.8354] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The association of mild obstructive sleep apnea (OSA) with important clinical outcomes remains unclear. We aimed to investigate the association between mild OSA and systemic arterial hypertension (SAH) in the European Sleep Apnea Database cohort. METHODS In a multicenter sample of 4,732 participants, we analyzed the risk of mild OSA (subclassified into 2 groups: mildAHI 5-<11/h (apnea-hypopnea index [AHI], 5 to <11 events/h) and mildAHI 11-<15/h (AHI, ≥11 to <15 events/h) compared with nonapneic snorers for prevalent SAH after adjustment for relevant confounding factors including sex, age, smoking, obesity, daytime sleepiness, dyslipidemia, chronic obstructive pulmonary disease, type 2 diabetes, and sleep test methodology (polygraphy or polysomnography). RESULTS SAH prevalence was higher in the mildAHI 11-<15/h OSA group compared with the mildAHI 5-<11/h group and nonapneic snorers (52% vs 45% vs 30%; P < .001). Corresponding adjusted odds ratios for SAH were 1.789 (mildAHI 11-<15/h; 95% confidence interval [CI], 1.49-2.15) and 1.558 (mildAHI 5-<11/h; 95%, CI, 1.34-1.82), respectively (P < .001). In sensitivity analysis, mildAHI 11-<15/h OSA remained a significant predictor for SAH both in the polygraphy (odds ratio, 1.779; 95% CI, 1.403-2.256; P < .001) and polysomnography groups (odds ratio, 1.424; 95% CI, 1.047-1.939; P = .025). CONCLUSIONS Our data suggest a dose-response relationship between mild OSA and SAH risk, starting from 5 events/h in polygraphy recordings and continuing with a further risk increase in the 11- to <150-events/h range. These findings potentially introduce a challenge to traditional thresholds of OSA severity and may help to stratify participants with OSA according to cardiovascular risk.
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Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's University Hospital, School of Medicine, University College, Dublin, Ireland
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Johan Verbraecken
- Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Carolina Lombardi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Athanasia Pataka
- Department of Respiratory Medicine, Respiratory Failure Unit, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Oreste Marrone
- National Research Council (CNR), Istituto per la Ricerca e l'Innovazione Biomedica, Palermo, Italy
| | - Paschalis Steiropoulos
- Sleep Unit, Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Marisa R Bonsignore
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy; *Contributed equally
| | - Sophia E Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
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Lok R, Zeitzer JM. Physiological correlates of the Epworth Sleepiness Scale reveal different dimensions of daytime sleepiness. ACTA ACUST UNITED AC 2021; 2:zpab008. [PMID: 34250482 PMCID: PMC8266524 DOI: 10.1093/sleepadvances/zpab008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/04/2021] [Indexed: 11/12/2022]
Abstract
The Epworth Sleepiness Scale is commonly used to examine self-reported daytime sleepiness in clinical populations; the physiologic correlates of this scale, however, are not well understood. Furthermore, how well this scale correlates with parallel objective and self-reported concepts of daytime sleepiness is not well described. As such, we used machine learning algorithms to examine the association between Epworth Sleepiness Scale scores and 55 sleep and medical variables in the Sleep Heart Health Study (N = 2105). Secondary analyses examined data stratified by age and gender and the relationship between the Epworth and other measures of daytime sleepiness. Analyses of the main data set resulted in low explained variance (7.15%-10.0%), with self-reported frequency of not getting enough sleep as most important predictor (10.3%-13.9% of the model variance). Stratification by neither age nor gender significantly improved explained variance. Cross-correlational analysis revealed low correlation of other daytime sleepiness measures to Epworth scores. We find that Epworth scores are not well explained by habitual or polysomnographic sleep values, or other biomedical characteristics. These analyses indicate that there are different, potentially orthogonal dimensions of the concept of "daytime sleepiness" that may be driven by different aspects of sleep physiology. As the physiologic correlates of the Epworth Sleepiness Scale remain to be elucidated, interpretation of the clinical meaning of these scores should be done with caution.
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Affiliation(s)
- Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Home sleep apnea testing: an accuracy study. Sleep Breath 2021; 26:117-123. [PMID: 33837916 DOI: 10.1007/s11325-021-02372-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/08/2021] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
AIM There are no studies comparing tests performed at home with those carried out in the laboratory, using the same device. The only studies that have been performed have compared the device used at home with the standard polygraph used in the laboratory. The purpose of this study was therefore to verify the accuracy of the home diagnosis of obstructive sleep apnea syndrome (OSAS) via unassisted type 2 portable polysomnography, compared with polysomnography using the same equipment in a sleep laboratory. METHODS To avoid any possible order effect on the apnea-hypopnea index (AHI), we randomly created two groups of 20-total 40 patients, according to the test sequence. One of the groups had the first test at home and the second test in the laboratory (H-L); the other group had the first test in the laboratory and the second at home (L-H). The second test always took place on the night immediately following the first test. All polysomnographic monitoring was undertaken with the same equipment, an Embletta X100 system (Embla, Natus Inc., Middleton, USA). The Embletta X100 is a portable polygraph that records eleven polygraph signs: (1) electroencephalogram C4/A; (2) electroencephalogram O2/M1; (3) submental EMG; (4) electrooculogram of the right side; (5) nasal cannula (air flow); (6) respiratory effort against a plethysmographic chest strap; (7) respiratory effort against an abdominal plethysmographic belt; (8) heart rate; (9) saturation of oxyhemoglobin; (10) snoring; and (11) body position. RESULTS There was no difference in sleep efficiency between the group monitored in the laboratory and the group tested at home (p = 0.30). There was no difference in total sleep time (p = 0.11) or sleep latency (p = 0.52), or in the latency in phases N2 and N3 between the monitoring in the laboratory and at home (N2 p = 0.24; N3 p = 0.09). Some differences occurred regarding the PSG that took place at home, with longer duration of wake after sleep onset (WASO) and longer latency for REM sleep, due to failure of the patient to start the monitoring by pressing the "events" button on the device. In the distribution of sleep phases, there was no difference between the group monitored in the laboratory and the group tested at home. CONCLUSION Results from home sleep monitoring correlate well with the laboratory "gold standard" and may be an option for diagnosing OSAS in selected patients.
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Yoon DW, Shin HW. Sleep Tests in the Non-Contact Era of the COVID-19 Pandemic: Home Sleep Tests Versus In-Laboratory Polysomnography. Clin Exp Otorhinolaryngol 2020; 13:318-319. [PMID: 33176398 PMCID: PMC7669320 DOI: 10.21053/ceo.2020.01599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/10/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dae Wui Yoon
- Department of Biomedical Laboratory Science, Jungwon University, Goesan, Korea
| | - Hyun-Woo Shin
- Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, Korea.,Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
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Hernandez JE, Cretu E. A wireless, real-time respiratory effort and body position monitoring system for sleep. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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The effect of in-lab polysomnography and home sleep polygraphy on sleep position. Sleep Breath 2020; 25:251-255. [PMID: 32418018 PMCID: PMC7987683 DOI: 10.1007/s11325-020-02099-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Little is known regarding the influence of in-laboratory polysomnography (PSG) equipment on sleep position, especially on the prevalence of supine positioning, which in many cases may lead to a more severe sleep apnea diagnosis. The aim of this study was to assess the percentage of supine sleep during an in-laboratory PSG compared to that seen during a home sleep apnea test (HSAT). METHODS This was a retrospective cohort study comparing in-laboratory PSG and HSAT using a peripheral arterial tone (PAT) technology device. RESULTS Of 445 PSG and 416 HSAT studies analyzed, there was no significant difference in the proportion of supine sleep time between PSG (44%) and HSAT (45%, p = 0.53). Analysis of the differences in sleep position (supine versus non-supine), analyzed by sex, BMI (≥ 30 kg/m2 versus < 30 kg/m2), and age (≥ 60 years versus < 60 years), was significant only for women, who had more supine sleep during HSAT at 61 ± 24% than during PSG at 45 ± 26% (p < 0.001). CONCLUSION Overall there was no difference in the percentage of supine sleep when comparing in-laboratory PSG to HSAT. However, women had more supine sleep with HSAT than with PSG.
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Gutiérrez-Carrasquilla L, López-Cano C, Sánchez E, Barbé F, Dalmases M, Hernández M, Campos A, Gaeta AM, Carmona P, Hernández C, Simó R, Lecube A. Effect of Glucose Improvement on Nocturnal Sleep Breathing Parameters in Patients with Type 2 Diabetes: The Candy Dreams Study. J Clin Med 2020; 9:jcm9041022. [PMID: 32260419 PMCID: PMC7230160 DOI: 10.3390/jcm9041022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/24/2020] [Accepted: 04/01/2020] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes exerts a negative impact on sleep breathing. It is unknown whether a long-term improvement in glycemic control ameliorates this effect. We conducted an interventional study with 35 patients with type 2 diabetes and obstructive sleep apnea (OSA) to explore this. At home, sleep breathing parameters were assessed at baseline and after a 4-month period in which antidiabetic therapy was intensified. Patients who decreased their body mass index ≥2kg/m2 were excluded. Those with an HbA1c reduction ≥0.5% were considered good responders (n = 24). After the follow-up, good responders exhibited an improvement in the apnea–hypopnea index (AHI: 26-1 (95% IC: 8.6–95.0) vs. 20.0 (4.0–62.4) events/hour, p = 0.002) and in time with oxygen saturation below 90% (CT90: 13.3 (0.4–69.0) vs. 8.1 (0.4–71.2) %, p = 0.002). No changes were observed in the group of non–responders (p = 0.722 and p = 0.138, respectively). The percentage of moderate and severe OSA decreased among good responders (p = 0.040). In the wider population, the change in HbA1c correlated positively to decreases in AHI (r = 0.358, p = 0.035) and negatively to increases in the minimum arterial oxygen saturation (r = −0.386, p = 0.039). Stepwise multivariate regression analysis showed that baseline AHI and the absolute change in HbA1c independently predicted decreased AHI (R2 = 0.496). The improvement of glycemic control exerts beneficial effects on sleep breathing parameters in type 2 diabetes, which cannot be attributed merely to weight loss.
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Affiliation(s)
- Liliana Gutiérrez-Carrasquilla
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
| | - Enric Sánchez
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
| | - Ferran Barbé
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, 25198 Lleida, Spain; (F.B.); (M.D.); (A.M.G.); (P.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Mireia Dalmases
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, 25198 Lleida, Spain; (F.B.); (M.D.); (A.M.G.); (P.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
| | - Angela Campos
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
| | - Anna Michaela Gaeta
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, 25198 Lleida, Spain; (F.B.); (M.D.); (A.M.G.); (P.C.)
| | - Paola Carmona
- Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, 25198 Lleida, Spain; (F.B.); (M.D.); (A.M.G.); (P.C.)
| | - Cristina Hernández
- Endocrinology and Nutrition Department, University Hospital Vall d’Hebron, Diabetes and Metabolism Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Autonomous University of Barcelona, 08035 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Rafael Simó
- Endocrinology and Nutrition Department, University Hospital Vall d’Hebron, Diabetes and Metabolism Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Autonomous University of Barcelona, 08035 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: (R.S.); (A.L.)
| | - Albert Lecube
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain; (L.G.-C.); (C.L.-C.); (E.S.); (M.H.); (A.C.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: (R.S.); (A.L.)
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Wilson DL, Howard ME, Fung AM, O’Donoghue FJ, Barnes M, Lappas M, Walker SP. The presence of coexisting sleep-disordered breathing among women with hypertensive disorders of pregnancy does not worsen perinatal outcome. PLoS One 2020; 15:e0229568. [PMID: 32101584 PMCID: PMC7043804 DOI: 10.1371/journal.pone.0229568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/09/2020] [Indexed: 01/27/2023] Open
Abstract
Objective To determine whether the presence of co-existing sleep-disordered breathing (SDB) is associated with worse perinatal outcomes among women diagnosed with a hypertensive disorder of pregnancy (HDP), compared with normotensive controls. Study design Women diagnosed with HDP (gestational hypertension or preeclampsia) and BMI- and gestation-matched controls underwent polysomnography in late pregnancy to determine if they had coexisting SDB. Fetal heart rate (FHR) monitoring accompanied the sleep study, and third trimester fetal growth velocity was assessed using ultrasound. Cord blood was taken at delivery to measure key regulators of fetal growth. Results SDB was diagnosed in 52.5% of the HDP group (n = 40) and 38.1% of the control group (n = 42); p = .19. FHR decelerations were commonly observed during sleep, but the presence of SDB did not increase this risk in either the HDP or control group (HDP group—SDB = 35.3% vs. No SDB = 40.0%, p = 1.0; control group—SDB = 41.7% vs. No SDB = 25.0%, p = .44), nor did SDB affect the total number of decelerations overnight (HDP group—SDB = 2.7 ± 1.0 vs. No SDB = 2.8 ± 2.1, p = .94; control group—SDB = 2.0 ± 0.8 vs. No SDB = 2.0 ± 0.7, p = 1.0). Fetal growth restriction was the strongest predictor of fetal heart rate events during sleep (aOR 5.31 (95% CI 1.26–22.26), p = .02). The presence of SDB also did not adversely affect fetal growth; in fact among women with HDP, SDB was associated with significantly larger customised birthweight centiles (43.2% ± 38.3 vs. 16.2% ± 27.0, p = .015) and fewer growth restricted babies at birth (30% vs. 68.4%, p = .026) compared to HDP women without SDB. There was no impact of SDB on measures of fetal growth for the control group. Cord blood measures of fetal growth did not show any adverse effect among women with SDB, either in the HDP or control group. Conclusion We did not find that the presence of mild SDB worsened fetal acute or longitudinal outcomes, either among women with HDP or BMI-matched normotensive controls. Unexpectedly, we found the presence of SDB conferred a better prognosis in HDP in terms of fetal growth. The fetus has considerable adaptive capacity to withstand in utero hypoxia, which may explain our mostly negative findings. In addition, SDB in this cohort was mostly mild. It may be that fetal sequelae will only be unmasked in the setting of more severe degrees of SDB and/or underlying placental disease.
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Affiliation(s)
- Danielle L. Wilson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Alison M. Fung
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Fergal J. O’Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Martha Lappas
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Susan P. Walker
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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Design and Evaluation of a Non-ContactBed-Mounted Sensing Device for AutomatedIn-Home Detection of Obstructive Sleep Apnea:A Pilot Study. BIOSENSORS-BASEL 2019; 9:bios9030090. [PMID: 31336678 PMCID: PMC6784712 DOI: 10.3390/bios9030090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/04/2019] [Accepted: 07/17/2019] [Indexed: 01/02/2023]
Abstract
We conducted a pilot study to evaluate the accuracy of a custom built non-contact pressure-sensitive device in diagnosing obstructive sleep apnea (OSA) severity as an alternative to in-laboratory polysomnography (PSG) and a Type 3 in-home sleep apnea test (HSAT). Fourteen patients completed PSG sleep studies for one night with simultaneous recording from our load-cell-based sensing device in the bed. Subjects subsequently installed pressure sensors in their bed at home and recorded signals for up to four nights. Machine learning models were optimized to classify sleep apnea severity using a standardized American Academy of Sleep Medicine (AASM) scoring of the gold standard studies as reference. On a per-night basis, our model reached a correct OSA detection rate of 82.9% (sensitivity = 88.9%, specificity = 76.5%), and OSA severity classification accuracy of 74.3% (61.5% and 81.8% correctly classified in-clinic and in-home tests, respectively). There was no difference in Apnea Hypopnea Index (AHI) estimation when subjects wore HSAT sensors versus load cells (LCs) only (p-value = 0.62). Our in-home diagnostic system provides an unobtrusive method for detecting OSA with high sensitivity and may potentially be used for long-term monitoring of breathing during sleep. Further research is needed to address the lower specificity resulting from using the highest AHI from repeated samples.
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Evaluation of the feasibility and preference of Nox-A1 type 2 ambulatory device for unattended home sleep test: a randomized crossover study. Sleep Biol Rhythms 2019. [DOI: 10.1007/s41105-019-00213-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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23
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Hernández-Bendezú MDC, Arias-Peña MY, Torres-Fraga MG, Carrillo-Alduenda JL. Quality of an ambulatory monitoring technique for diagnosing obstructive sleep apnea under conditions of limited resources. Sleep Sci 2019; 11:269-273. [PMID: 30746045 PMCID: PMC6361307 DOI: 10.5935/1984-0063.20180042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objectives: To: 1) evaluate the quality of an ambulatory monitoring technique for
diagnosing Obstructive Sleep Apnea Syndrome (OSAS) while patients move
through the city; and 2) identify factors that lead to data loss. Methods: Clinical histories were reviewed and ambulatory portable monitorings of
adults with high pretest probability for OSAS were included, the signals
monitored were pulse oximetry, heart rate, nasal pressure, snoring, chest
band and body position. The equipment was connected from 14:00-20:00 h and
then patients moved through the city turning it off and on at home. Results
were analyzed visually to record all the minutes lost. A good-quality study
was defined as recording time 240 min and signal loss <20%. A
cost/benefit analysis was performed using Golpe et al.'s methodology. Results: A total of 70 recordings were analyzed. Most subjects were obese men with
severe OSAS. Signal quality was determined to be good with a median signal
loss of 4.9 min (0-405) that represented 1% (0-99) of total recording time.
The signal lost most often was pulse oximetry at 1.8 min (0-403,
p=0.0001). Of the 70 studies performed, 57 (81%) met
the definition of good quality, while 13 (19%) had to be repeated. Men lost
the pulse oximetry signal more often than women. This technique could
represent savings of 65-75%. Conclusions: Placing a portable OSAS monitor during the day while patients move around the
city turning it on and off at home does not affect the quality of the study
results obtained and is a cost-effective method.
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Sterr A, Ebajemito JK, Mikkelsen KB, Bonmati-Carrion MA, Santhi N, Della Monica C, Grainger L, Atzori G, Revell V, Debener S, Dijk DJ, DeVos M. Sleep EEG Derived From Behind-the-Ear Electrodes (cEEGrid) Compared to Standard Polysomnography: A Proof of Concept Study. Front Hum Neurosci 2018; 12:452. [PMID: 30534063 PMCID: PMC6276915 DOI: 10.3389/fnhum.2018.00452] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/24/2018] [Indexed: 11/20/2022] Open
Abstract
Electroencephalography (EEG) recordings represent a vital component of the assessment of sleep physiology, but the methodology presently used is costly, intrusive to participants, and laborious in application. There is a recognized need to develop more easily applicable yet reliable EEG systems that allow unobtrusive long-term recording of sleep-wake EEG ideally away from the laboratory setting. cEEGrid is a recently developed flex-printed around-the-ear electrode array, which holds great potential for sleep-wake monitoring research. It is comfortable to wear, simple to apply, and minimally intrusive during sleep. Moreover, it can be combined with a smartphone-controlled miniaturized amplifier and is fully portable. Evaluation of cEEGrid as a motion-tolerant device is ongoing, but initial findings clearly indicate that it is very well suited for cognitive research. The present study aimed to explore the suitability of cEEGrid for sleep research, by testing whether cEEGrid data affords the signal quality and characteristics necessary for sleep stage scoring. In an accredited sleep laboratory, sleep data from cEEGrid and a standard PSG system were acquired simultaneously. Twenty participants were recorded for one extended nocturnal sleep opportunity. Fifteen data sets were scored manually. Sleep parameters relating to sleep maintenance and sleep architecture were then extracted and statistically assessed for signal quality and concordance. The findings suggest that the cEEGrid system is a viable and robust recording tool to capture sleep and wake EEG. Further research is needed to fully determine the suitability of cEEGrid for basic and applied research as well as sleep medicine.
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Affiliation(s)
- Annette Sterr
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guilford, United Kingdom
| | - James K Ebajemito
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guilford, United Kingdom
| | - Kaare B Mikkelsen
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | | | - Nayantara Santhi
- Surrey Sleep Research Centre, University of Surrey, Guildford, United Kingdom
| | - Ciro Della Monica
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Lucinda Grainger
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Giuseppe Atzori
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Victoria Revell
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Stefan Debener
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany.,Cluster of Excellence Hearing, University of Oldenburg, Oldenburg, Germany
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, United Kingdom.,Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Maarten DeVos
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
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Ouayoun MC, Chabolle F, De Vito A, Heiser C, Paramasivan VK, Rabelo FAW, Rotenberg B, Suurna MV. International consensus (ICON) on the ENT role in diagnosis of obstructive sleep apnea syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S3-S6. [PMID: 29402674 DOI: 10.1016/j.anorl.2017.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/19/2022]
Abstract
During the 2017 IFOS ENT World Congress, an international expert panel was asked to clarify the role of ENT in the diagnosis process of the obstructive sleep apnea syndrome (OSA) in adults around the world. OSA is a major public health issue throughout the world. OSA is a highly prevalent disease with heavy clinical, social and economical outcomes. This high prevalence raises serious difficulties of diagnosis accessibility if only somnologists are able to confirm OSA diagnosis. First of all, the panellists reviewed the impact of OSA. Secondly, they defined the ENT role stressing ENT legitimacy, professional expertise and academic and institutional tasks. They also defined when somnologists were necessary. For the international panel, the ENT is a major player in the OSA diagnosis process.
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Affiliation(s)
- M C Ouayoun
- Department of otorhinolaryngology, head and neck surgery at université Sorbonne Paris Cité, faculté de médecine, 74, rue Marcel-Cachin, 93017 Bobigny cedex, France.
| | - F Chabolle
- Department of otorhinolaryngology, head and neck surgery at université Versailles-Saint-Quentin-en-Yvelines, hôpital Foch, 92150 Suresnes, France
| | - A De Vito
- Department of otorhinolaryngology, head and neck surgery at Morgagni-Pierantoni hospital, Forli', Italy
| | - C Heiser
- Department of otorhinolaryngology, head and neck surgery at Technische universität München, Munich, Germany
| | - V K Paramasivan
- Department of otorhinolaryngology, head and neck surgery at Madras ENT research foundation, Chennai, India
| | - F A W Rabelo
- Department of otorhinolaryngology, head and neck surgery at German Hospital Oswaldo Cruz, São Paulo, Brazil
| | - B Rotenberg
- Department of otorhinolaryngology, head and neck surgery at Western University, London, Canada
| | - M V Suurna
- Department of otorhinolaryngology, head and neck surgery at Weill Cornell Medical College, New York, USA
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Patient-predicted sleep position vs. HST data: a tendency to underestimate supine sleep. Sleep Breath 2017; 22:625-630. [PMID: 29149438 DOI: 10.1007/s11325-017-1589-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study is to measure people's accuracy when they estimate what proportion of their nightly sleep at home is supine vs. non-supine. METHODS A series of patients referred for obstructive sleep apnea (OSA) evaluation were asked if they "knew with confidence" how they slept with regard to their body position. "Yes" responders were then asked to estimate what percentage of their sleep was supine vs. non-supine. This value was compared with the actual proportion of supine vs. non-supine sleep that they exhibited in a home sleep test (HST) that followed. RESULTS We obtained data from 49 subjects who expressed that they "knew with confidence" how they sleep in terms of body position. Subjects in aggregate underestimated their proportion of supine sleep by 21.6% (p < .001). Thirty-nine subjects (80%) slept supine more in the HST whereas 8 (16%) slept supine less compared to their pre-test estimates. Using a common classification of OSA severity, 9 subjects (18%) demonstrated a more severe degree of OSA than would have occurred had they slept as they had predicted. CONCLUSIONS Subjects in this study frequently underestimated their proportion of supine sleep compared to values measured in an HST. Because of the increased supine sleep they exhibited, the severity of their OSA was often greater in the test than it would have been had the subjects slept as they predicted. Sleep physicians should take into account the tendency of people to underestimate supine sleep. If patients with positional sleep apnea assert that they "always sleep laterally" when at home, they may be underestimating their true night-by-night OSA disease burden.
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Douglas JA, Chai-Coetzer CL, McEvoy D, Naughton MT, Neill AM, Rochford P, Wheatley J, Worsnop C. Guidelines for sleep studies in adults – a position statement of the Australasian Sleep Association. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.03.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- Whitney Chiao
- University of California, San Francisco, School of Medicine; San Francisco California
| | - Megan L. Durr
- Department of Head and Neck Surgery; Kaiser Permanente East Bay; Oakland California U.S.A
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506-- or] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506\] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13:479-504. [PMID: 28162150 DOI: 10.5664/jcsm.6506] [Citation(s) in RCA: 1419] [Impact Index Per Article: 202.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506" or "" = "] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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33
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506;] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506"] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506,] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Rousseau E, Melo-Silva CA, Gakwaya S, Sériès F. Effects of repetitive transcranial magnetic stimulation of upper airway muscles during sleep in obstructive sleep apnea patients. J Appl Physiol (1985) 2016; 121:1217-1225. [DOI: 10.1152/japplphysiol.00487.2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 11/22/2022] Open
Abstract
We tested the hypothesis that stimulating the genioglossus by repetitive transcranial magnetic stimulation (rTMS) during the ascendant portion of the inspiratory flow of airflow-limited breaths would sustain the recruitment of upper airway dilator muscles over time and improve airway dynamics without arousing obstructive sleep apnea (OSA) patients. In a cross-sectional design, nine OSA patients underwent a rTMS trial during stable non-rapid eye movement (NREM) sleep. Submental muscle motor threshold (SUB) and motor-evoked potential were evaluated during wakefulness and sleep. During NREM sleep, maximal inspiratory flow, inspiratory volume, inspiratory time, shifts of electroencephalogram frequency, and pulse rate variability were assessed under three different stimulation paradigms completed at 1.2 sleep SUB stimulation output: 1) 5Hz-08 (stimulation frequency: 5 Hz; duration of train stimulation: 0.8 s); 2) 25Hz-02 (stimulation frequency: 25 Hz; duration of train stimulation: 0.2 s); and 3) 25Hz-04 (stimulation frequency: 25 Hz; duration of train stimulation: 0.4 s). SUB increased during NREM sleep (wakefulness: 23.8 ± 6.1%; NREM: 26.8 ± 5.2%; = 0.001). Two distinct airflow patterns were observed in response to rTMS: with and without initial airflow drops, without other airflow variables change regardless the stimulation paradigm applied. Finally, rTMS-induced cortical and/or autonomic arousal were observed in 36, 26, and 35% of all delivered rTMS trains during 5Hz-08, 25Hz-02, and 25Hz-04 stimulation paradigms, respectively. In conclusion, rTMS does not provide any airflow improvement of flow-limited breaths as seen with nonrepetitive TMS of upper airway dilator muscles. However, rTMS trains were free of arousals in the majority of cases.
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Affiliation(s)
- Eric Rousseau
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec City, Canada; and
| | - César Augusto Melo-Silva
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec City, Canada; and
- Laboratory of Respiratory Physiology, University of Brasília (UnB), Brasília, Federal District, Brazil
| | - Simon Gakwaya
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec City, Canada; and
| | - Frédéric Sériès
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec City, Canada; and
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Shelgikar AV, Anderson PF, Stephens MR. Sleep Tracking, Wearable Technology, and Opportunities for Research and Clinical Care. Chest 2016; 150:732-43. [PMID: 27132701 DOI: 10.1016/j.chest.2016.04.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/21/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022] Open
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Driller M, McQuillan J, O’Donnell S. Inter-device reliability of an automatic-scoring actigraph for measuring sleep in healthy adults. ACTA ACUST UNITED AC 2016; 9:198-201. [PMID: 28123660 PMCID: PMC5241607 DOI: 10.1016/j.slsci.2016.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 11/19/2022]
Abstract
Actigraphy has become a common method of measuring sleep due to its non-invasive, cost-effective nature. An actigraph (Readiband™) that utilizes automatic scoring algorithms has been used in the research, but is yet to be evaluated for its inter-device reliability. A total of 77 nights of sleep data from 11 healthy adult participants was collected while participants were concomitantly wearing two Readiband™ actigraphs attached together (ACT1 and ACT2). Sleep indices including total sleep time (TST), sleep latency (SL), sleep efficiency (SE%), wake after sleep onset (WASO), total time in bed (TTB), wake episodes per night (WE), sleep onset variance (SOV) and wake variance (WV) were assessed between the two devices using mean differences, 95% levels of agreement, intraclass correlation coefficients (ICC), typical error of measurement (TEM) and coefficient of variation (CV%) analysis. There were no significant differences between devices for any of the measured sleep variables (p>0.05). TST, SE, SL, TTB, SOV and WV all resulted in very high ICC's (>0.90), with WASO and WE resulting in high ICC's between devices (0.85 and 0.80, respectively). Mean differences of −2.1 and 0.2 min for TST and SL were associated with a low TEM between devices (9.5 and 3.8 min, respectively). SE resulted in a 0.3% mean difference between devices. The Readiband™ is a reliable tool for researchers using multiple devices of this brand in sleep studies to assess basic measures of sleep quality and quantity in healthy adult populations.
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Garcia-Molina G, Vissapragada S, Mahadevan A, Goodpaster R, Riedner B, Bellesi M, Tononi G. Probabilistic characterization of sleep architecture: home based study on healthy volunteers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:2834-2838. [PMID: 28268907 DOI: 10.1109/embc.2016.7591320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The quantification of sleep architecture has high clinical value for diagnostic purposes. While the clinical standard to assess sleep architecture is in-lab based polysomnography, higher ecological validity can be obtained with multiple sleep recordings at home. In this paper, we use a dataset composed of fifty sleep EEG recordings at home (10 per study participant for five participants) to analyze the sleep stage transition dynamics using Markov chain based modeling. The statistical analysis of the duration of continuous sleep stage bouts is also analyzed to identify the speed of transition between sleep stages. This analysis identified two types of NREM states characterized by fast and slow exit rates which from the EEG analysis appear to correspond to shallow and deep sleep respectively.
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Melatonin-rich milk fortified with alpha s1 casein tryptic hydrolysate improves primary insomnia: a randomized placebo controlled trial. Sleep Biol Rhythms 2016. [DOI: 10.1007/s41105-016-0063-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Myllymaa S, Muraja-Murro A, Westeren-Punnonen S, Hukkanen T, Lappalainen R, Mervaala E, Töyräs J, Sipilä K, Myllymaa K. Assessment of the suitability of using a forehead EEG electrode set and chin EMG electrodes for sleep staging in polysomnography. J Sleep Res 2016; 25:636-645. [PMID: 27230805 DOI: 10.1111/jsr.12425] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/09/2016] [Indexed: 12/01/2022]
Abstract
Recently, a number of portable devices designed for full polysomnography at home have appeared. However, current scalp electrodes used for electroencephalograms are not practical for patient self-application. The aim of this study was to evaluate the suitability of recently introduced forehead electroencephalogram electrode set and supplementary chin electromyogram electrodes for sleep staging. From 31 subjects (10 male, 21 female; age 31.3 ± 11.8 years), sleep was recorded simultaneously with a forehead electroencephalogram electrode set and with a standard polysomnography setup consisting of six recommended electroencephalogram channels, two electrooculogram channels and chin electromyogram. Thereafter, two experienced specialists scored each recording twice, based on either standard polysomnography or forehead recordings. Sleep variables recorded with the forehead electroencephalogram electrode set and separate chin electromyogram electrodes were highly consistent with those obtained with the standard polysomnography. There were no statistically significant differences in total sleep time, sleep efficiency or sleep latencies. However, compared with the standard polysomnography, there was a significant increase in the amount of stage N1 and N2, and a significant reduction in stage N3 and rapid eye movement sleep. Overall, epoch-by-epoch agreement between the methods was 79.5%. Inter-scorer agreement for the forehead electroencephalogram was only slightly lower than that for standard polysomnography (76.1% versus 83.2%). Forehead electroencephalogram electrode set as supplemented with chin electromyogram electrodes may serve as a reliable and simple solution for recording total sleep time, and may be adequate for measuring sleep architecture. Because this electrode concept is well suited for patient's self-application, it may offer a significant advancement in home polysomnography.
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Affiliation(s)
- Sami Myllymaa
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Anu Muraja-Murro
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | | | - Taina Hukkanen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Reijo Lappalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Kirsi Sipilä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Oral and Maxillofacial Department, Kuopio University Hospital, Kuopio, Finland.,Institute of Dentistry, University of Oulu, Oulu, Finland.,Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Katja Myllymaa
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
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Contributions of Comorbid Diabetes to Sleep Characteristics, Daytime Symptoms, and Physical Function Among Patients With Stable Heart Failure. J Cardiovasc Nurs 2016; 30:411-9. [PMID: 25078876 DOI: 10.1097/jcn.0000000000000183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) and heart failure (HF) are often comorbid. Sleep disturbances, poor physical functioning, and high levels of daytime symptoms are prevalent and contribute to poor quality of life in both populations. However, little is known about the independent and additive effects of comorbid DM on sleep, physical function, and daytime symptoms among patients with HF. OBJECTIVE The aim of this study was to investigate the extent to which comorbid DM confers independent and additive effects on sleep disturbance, physical functioning, and symptoms among patients with stable HF. METHODS This secondary analysis was conducted on a sample of 173 stable class II to IV HF patients. Self-report and polysomnography were used to measure sleep quality, objective sleep characteristics, and sleep-disordered breathing. Physical function measures included wrist actigraphy, the 6-minute walk test (6MWT), and the Medical Outcomes Study 36-item Short Form physical component summary score. Fatigue, sleepiness, and depression were also measured. Univariate analyses and hierarchical regression models were computed. RESULTS The sample included 173 (n = 119/68% HF and n = 54/32% HF plus DM) patients (mean [SD] age, 60.4 [16.1] years). In analyses adjusted for age, gender, body mass index, and New York Heart Association classification, the HF patients with DM had longer sleep latency and spent a greater percentage of time awake after sleep onset than the HF patients who did not have DM (all P < 0.05). There were no statistically significant differences in Respiratory Disturbance Index or self-reported sleep quality. Sleep duration was low in both groups. The patients with DM had shorter 6MWT distance, lower ratio of daytime to nighttime activity, as well as lower general health and self-reported physical function. Hierarchical regression models revealed that age and DM were the only significant correlates of the sleep variables, whereas age, gender, New York Heart Association class, and DM were all associated with 6MWT distance. CONCLUSIONS Comorbid DM contributes independent and additive effects on sleep disturbances and poor physical functioning in patients with stable HF.
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Comparison between home and hospital set-up for unattended home-based polysomnography: a prospective randomized study. Sleep Med 2015. [DOI: 10.1016/j.sleep.2015.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Morgenthaler TI, Croft JB, Dort LC, Loeding LD, Mullington JM, Thomas SM. Development of the National Healthy Sleep Awareness Project Sleep Health Surveillance Questions. J Clin Sleep Med 2015; 11:1057-62. [PMID: 26235156 DOI: 10.5664/jcsm.5026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVES For the first time ever, as emphasized by inclusion in the Healthy People 2020 goals, sleep health is an emphasis of national health aims. The National Healthy Sleep Awareness Project (NHSAP) was tasked to propose questions for inclusion in the next Behavioral Risk Factor Surveillance System (BRFSS), a survey that includes a number of questions that target behaviors thought to impact health, as a means to measure community sleep health. The total number of questions could not exceed five, and had to include an assessment of the risk for obstructive sleep apnea (OSA). METHODS An appointed workgroup met via teleconference and face-to-face venues to develop an inventory of published survey questions being used to identify sleep health, to develop a framework on which to analyze the strengths and weaknesses of current survey questions concerning sleep, and to develop recommendations for sleep health and disease surveillance questions going forward. RESULTS The recommendation was to focus on certain existing BRFSS questions pertaining to sleep duration, quality, satisfaction, daytime alertness, and to add to these other BRFSS existing questions to make a modified STOP-BANG questionnaire (minus the N for neck circumference) to assess for risk of OSA. CONCLUSIONS Sleep health is an important dimension of health that has previously received less attention in national health surveys. We believe that 5 questions recommended for the upcoming BRFSS question banks will assist as important measures of sleep health, and may help to evaluate the effectiveness of interventions to improve sleep health in our nation.
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Affiliation(s)
| | - Janet B Croft
- Centers for Disease Control and Prevention, Atlanta, GA
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Carpentier N, Jonas J, Schaff JL, Koessler L, Maillard L, Vespignani H. The feasibility of home polysomnographic recordings prescribed for sleep-related neurological disorders: a prospective observational study. Neurophysiol Clin 2014; 44:251-5. [PMID: 25240558 DOI: 10.1016/j.neucli.2014.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Home polysomnography is being increasingly developed for sleep studies, with various grades of quality. This study aimed to determine the feasibility of affordable, high quality home polysomnographic recordings prescribed for suspected sleep-related neurological disorders. PATIENTS AND METHODS We prospectively screened all patients referred to the specialist sleep disorders clinic in Nancy University Hospital between May 2011 and August 2011. Patients were eligible for inclusion if they required polysomnography for the diagnosis of a sleep-related neurological disorder. One-night, polysomnography was performed in each patient's home by a trained sleep technician. Financial cost was determined prior to inclusion. A recording was considered as satisfactory if all the following criteria were present: at least, one EEG channel with continuous signal allowing determination of sleep stages and wake during more than 66% of sleep time; at least, one usable respiratory channel (airflow or either band) during more than 66% of sleep time; and usable oximetry during more than 66% of sleep time. RESULTS Forty-eight of the 139 screened patients were included. Among the 48 home polysomnography recordings, 35 (72.9%) were satisfactory. Thirteen (27.1%) tracings displayed an unsatisfactory loss of EEG data, including seven (14.6%) tracings with an unsatisfactory loss of respiratory data. CONCLUSION Home polysomnography prescribed for suspected sleep-related neurological disorders is feasible, with affordable costs, whilst maintaining high quality recording. Further studies are needed to measure the real medico-economic impact of promoting outpatient domiciliary explorations for sleep-related neurological disorders.
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Affiliation(s)
- N Carpentier
- Neurology Department, University Hospital of Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
| | - J Jonas
- Neurology Department, University Hospital of Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Faculty of Medicine, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; UMR 7039, Center for Automatic Control of Nancy (CRAN), CNRS University of Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - J-L Schaff
- Neurology Department, University Hospital of Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - L Koessler
- UMR 7039, Center for Automatic Control of Nancy (CRAN), CNRS University of Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - L Maillard
- Neurology Department, University Hospital of Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Faculty of Medicine, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; UMR 7039, Center for Automatic Control of Nancy (CRAN), CNRS University of Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - H Vespignani
- Neurology Department, University Hospital of Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Faculty of Medicine, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; UMR 7039, Center for Automatic Control of Nancy (CRAN), CNRS University of Lorraine, 54500 Vandœuvre-lès-Nancy, France
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Garg N, Rolle AJ, Lee TA, Prasad B. Home-based diagnosis of obstructive sleep apnea in an urban population. J Clin Sleep Med 2014; 10:879-85. [PMID: 25126034 DOI: 10.5664/jcsm.3960] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Home-based diagnosis of obstructive sleep apnea (OSA) with portable monitoring (PM) is increasingly utilized, but remains understudied in underserved and minority populations. We tested the feasibility of home PM in an urban population at risk for OSA compared to in-laboratory polysomnography (PSG) and examined patient preference with respect to home PM versus PSG. METHODS Randomized crossover study of home PM (WatchPAT200) and in-laboratory simultaneous PSG and PM in 75 urban African Americans with high pre-test probability of OSA, identified with the Berlin questionnaire. RESULTS Fifty-seven of 75 participants were women, average age 45 ± 11 years (mean ± SD), 35% with ≤ high school education, and 76% with annual household income < $50,000. Technical failure rates were 5.3% for home vs. 3.1% for in-laboratory PM. There was good agreement between apnea hypopnea index on PSG; AHIPSG and AHI on home PM (mean ± 2 SD of the differences = 0.64 ± 46.5 and intraclass correlation coefficient; ICC = 0.73). The areas under the curve for the receiver-operator characteristic curves for home PM were 0.90 for AHIPSG ≥ 5, 0.95 for AHIPSG ≥ 10, and 0.92 for AHIPSG ≥ 15. 62/75 (82%) participants preferred home over in-laboratory testing. CONCLUSIONS Home PM for diagnosis of OSA in a high risk urban population is feasible, accurate, and preferred by patients. As home PM may improve access to care, the cost-effectiveness of this diagnostic strategy for OSA should be examined in underserved urban and rural populations. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov, identifier: NCT01997723.
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Affiliation(s)
- Natasha Garg
- Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL
| | - Andrew J Rolle
- Population Health Sciences, Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL
| | - Bharati Prasad
- Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL; ; Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL
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Guerrero A, Embid C, Isetta V, Farre R, Duran-Cantolla J, Parra O, Barbé F, Montserrat JM, Masa JF. Management of sleep apnea without high pretest probability or with comorbidities by three nights of portable sleep monitoring. Sleep 2014; 37:1363-73. [PMID: 25083017 DOI: 10.5665/sleep.3932] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) diagnosis using simplified methods such as portable sleep monitoring (PM) is only recommended in patients with a high pretest probability. The aim is to determine the diagnostic efficacy, consequent therapeutic decision-making, and costs of OSA diagnosis using polysomnography (PSG) versus three consecutive studies of PM in patients with mild to moderate suspicion of sleep apnea or with comorbidity that can mask OSA symptoms. DESIGN AND SETTING Randomized, blinded, crossover study of 3 nights of PM (3N-PM) versus PSG. The diagnostic efficacy was evaluated with receiver operating characteristic (ROC) curves. Therapeutic decisions to assess concordance between the two different approaches were performed by sleep physicians and respiratory physicians (staff and residents) using agreement level and kappa coefficient. The costs of each diagnostic strategy were considered. PATIENTS AND RESULTS Fifty-six patients were selected. Epworth Sleepiness Scale was 10.1 (5.3) points. Bland-Altman plot for apnea-hypopnea index (AHI) showed good agreement. ROC curves showed the best area under the curve in patients with PSG AHI ≥ 5 [0.955 (confidence interval = 0.862-0.993)]. For a PSG AHI ≥ 5, a PM AHI of 5 would effectively exclude and confirm OSA diagnosis. For a PSG AHI ≥ 15, a PM AHI ≥ 22 would confirm and PM AHI < 7 would exclude OSA. The best agreement of therapeutic decisions was achieved by the sleep medicine specialists (81.8%). The best cost-diagnostic efficacy was obtained by the 3N-PM. CONCLUSIONS Three consecutive nights of portable monitoring at home evaluated by a qualified sleep specialist is useful for the management of patients without high pretest probability of obstructive sleep apnea or with comorbidities. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov, registration number: NCT01820156. CITATION Guerrero A, Embid C, Isetta V, Farre R, Duran-Cantolla J, Parra O, Barbé F, Montserrat JM, Masa JF. Management of sleep apnea without high pretest probability or with comorbidities by three nights of portable sleep monitoring.
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Affiliation(s)
- Arnoldo Guerrero
- Pulmonary and Critical Care Service. Dr. José Eleuterio González University Hospital. UANL. Monterrey, México ; Pulmonary Service. Clínic Hospital. UB-IDIBAPS. Barcelona, Spain
| | - Cristina Embid
- Pulmonary Service. Clínic Hospital. UB-IDIBAPS. Barcelona, Spain ; CIBER de enfermedades respiratorias (CIBERES). Madrid, Spain
| | - Valentina Isetta
- CIBER de enfermedades respiratorias (CIBERES). Madrid, Spain ; Unit of Biophysics and Bioengineering. Faculty of Medicine. IDIBAPS. University of Barcelona. Barcelona, Spain
| | - Ramón Farre
- CIBER de enfermedades respiratorias (CIBERES). Madrid, Spain ; Unit of Biophysics and Bioengineering. Faculty of Medicine. IDIBAPS. University of Barcelona. Barcelona, Spain
| | - Joaquin Duran-Cantolla
- CIBER de enfermedades respiratorias (CIBERES). Madrid, Spain ; Bio-Araba Research Institute and Clinical Research Unit, Hospital Universitario Araba. Vitoria, Spain
| | - Olga Parra
- CIBER de enfermedades respiratorias (CIBERES). Madrid, Spain ; Pulmonary Service. Sagrat Cor Hospital. Barcelona, Spain
| | - Ferran Barbé
- CIBER de enfermedades respiratorias (CIBERES). Madrid, Spain ; Respiratory Dept. IRBLleida. Lleida, Spain
| | - Josep M Montserrat
- Pulmonary Service. Clínic Hospital. UB-IDIBAPS. Barcelona, Spain ; CIBER de enfermedades respiratorias (CIBERES). Madrid, Spain
| | - Juan F Masa
- CIBER de enfermedades respiratorias (CIBERES). Madrid, Spain ; Pulmonary Service. Hospital San Pedro de Alcantara. Cáceres. Spain
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Romigi A, Vitrani G, D'Aniello A, Di Gennaro G. Can nocturnal groaning be suspected by cardiorespiratory polygraphy? Sleep Med 2014; 15:1002-4. [PMID: 24916096 DOI: 10.1016/j.sleep.2014.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Andrea Romigi
- IRCCS Neuromed, Pozzilli (IS), Italy; Università di Roma Tor Vergata, Neurophysiopathology Department, Sleep & Epilepsy Centre, Italy.
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Romigi A, Izzi F, Mercuri NB, Albanese M, Liguori C, Placidi F. Effects of epilepsy treatment on sleep architecture and daytime sleepiness: An evidence‐based review of objective sleep metrics. Epilepsia 2014; 55:777-778. [DOI: 10.1111/epi.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Romigi
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
| | - Francesca Izzi
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
| | - Nicola B. Mercuri
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
- IRCCS Santa Lucia Foundation Rome Italy
| | - Maria Albanese
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
| | - Claudio Liguori
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
| | - Fabio Placidi
- Neurophysiopathology Unit Sleep and Epilepsy Center Department of Systems Medicine University of Rome Tor Vergata General Hospital Rome Italy
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50
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Crescimanno G, Greco F, Marrone O. Monitoring noninvasive ventilation in neuromuscular patients: feasibility of unattended home polysomnography and reliability of sleep diaries. Sleep Med 2014; 15:336-41. [DOI: 10.1016/j.sleep.2013.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/19/2013] [Accepted: 09/11/2013] [Indexed: 10/25/2022]
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