Portable Monitoring for the Diagnosis of OSA

Mind reading dysfunctions in patients with obstructive sleep apnoea: A neuropsychological approach

Obstructive sleep apnoea syndrome (OSAS) is a prevalent sleep-related breathing disorder that has been extensively studied for its effects on cognitive functions. However, little attention has been given to investigating Mind Reading (MR) skills in patients with OSAS. In this study, we employed a neuropsychological approach to thoroughly assess various facets of MR skills in patients with OSAS. Forty-two patients with untreated moderate or severe OSAS (AHI ≥15; 30 men, 12 women) and 16 healthy controls (7 men and 9 women), matched by age, were enrolled. To assess MR skills, we used: (i) The Story-based Empathy Task (SET), which includes three experimental conditions: identifying intentions (SET-IA), emotional states (SET-EA), and a control condition for inferring causality reactions (SET-CI); (ii) the Ekman 60 Faces Test (Ek60), which measures emotion recognition from facial expressions. Our findings revealed that patients with OSAS exhibit deficits in emotion-related MR skills, while their ability to make inferences about the cognitive states of social partners remains largely preserved. This finding corroborates previous evidence indicating that social cognition, particularly MR skills, may be one of the cognitive domains affected by OSAS. It emphasizes the significance of investigating social cognition and the relationship between MR skills and social functioning as a new and intriguing area of research in patients with OSAS.

The Impact of Diagnostic Imaging on Obstructive Sleep Apnea: Feedback from a Narrative Review

Obstructive Sleep Apnea is a prevalent sleep disorder characterized by repeated episodes of partial or complete upper airway obstruction during sleep, leading to disrupted sleep and associated comorbidities. Effective, traditional diagnostic methods, such as polysomnography, have limitations in providing comprehensive anatomical detail. Recent advancements in imaging technology have the potential to revolutionize the diagnosis and management of OSA, offering detailed insights into airway anatomy, function, and dynamics. This paper explores the latest innovations in imaging modalities, including high-resolution magnetic resonance imaging, functional MRI, three-dimensional airway reconstructions, and the integration of artificial intelligence algorithms for enhanced image analysis. We discuss the potential of these technologies to improve the precision of OSA diagnosis, tailor treatment strategies, and predict treatment outcomes. Moreover, we examine the challenges of implementing these advanced imaging techniques in clinical practice, such as cost, accessibility, and the need for validation in diverse patient populations. We also consider the ethical implications of widespread imaging, particularly regarding data security and patient privacy. The future of OSA management is poised for transformation as these imaging technologies promise to provide a more nuanced understanding of the disorder and facilitate personalized treatment approaches. This paper calls for continued research and collaboration across disciplines to ensure these innovations lead to improved patient care and outcomes in the field of sleep medicine.

Wireless wearable sensors can facilitate rapid detection of sleep apnea in hospitalized stroke patients

STUDY OBJECTIVES

To evaluate wearable devices and machine learning for detecting sleep apnea in patients with stroke at an acute inpatient rehabilitation facility (IRF).

METHODS

A total of 76 individuals with stroke wore a standard home sleep apnea test (ApneaLink Air), a multimodal, wireless wearable sensor system (ANNE), and a research-grade actigraphy device (ActiWatch) for at least 1 night during their first week after IRF admission as part of a larger clinical trial. Logistic regression algorithms were trained to detect sleep apnea using biometric features obtained from the ANNE sensors and ground truth apnea rating from the ApneaLink Air. Multiple algorithms were evaluated using different sensor combinations and different apnea detection criteria based on the apnea-hypopnea index (AHI ≥ 5, AHI ≥ 15).

RESULTS

Seventy-one (96%) participants wore the ANNE sensors for multiple nights. In contrast, only 48 participants (63%) could be successfully assessed for obstructive sleep apnea by ApneaLink; 28 (37%) refused testing. The best-performing model utilized photoplethysmography (PPG) and finger-temperature features to detect moderate-severe sleep apnea (AHI ≥ 15), with 88% sensitivity and a positive likelihood ratio (LR+) of 44.00. This model was tested on additional nights of ANNE data achieving 71% sensitivity (10.14 LR+) when considering each night independently and 86% accuracy when averaging multi-night predictions.

CONCLUSIONS

This research demonstrates the feasibility of accurately detecting moderate-severe sleep apnea early in the stroke recovery process using wearable sensors and machine learning techniques. These findings can inform future efforts to improve early detection for post-stroke sleep disorders, thereby enhancing patient recovery and long-term outcomes.

CLINICAL TRIAL

SIESTA (Sleep of Inpatients: Empower Staff to Act) for Acute Stroke Rehabilitation, https://clinicaltrials.gov/study/NCT04254484?term=SIESTA&checkSpell=false&rank=1, NCT04254484.

Assessing actigraphy performance for daytime sleep detection following stroke: insights from inpatient monitoring in a rehabilitation hospital

Study Objectives

Stroke can result in or exacerbate various sleep disorders. The presence of behaviors such as daytime sleepiness poststroke can indicate underlying sleep disorders which can significantly impact functional recovery and thus require prompt detection and monitoring for improved care. Actigraphy, a quantitative measurement technology, has been primarily validated for nighttime sleep in healthy adults; however, its validity for daytime sleep monitoring is currently unknown. Therefore this study aims to identify the best-performing actigraphy sensor and algorithm for detecting daytime sleep in poststroke individuals.

Methods

Participants wore Actiwatch Spectrum and ActiGraph wGT3X-BT on their less-affected wrist, while trained observers recorded daytime sleep occurrences and activity levels (active, sedentary, and asleep) during non-therapy times. Algorithms, Actiwatch (Autoscore AMRI) and ActiGraph (Cole-Kripke, Sadeh), were compared with on-site observations and assessed using F2 scores, emphasizing sensitivity to detect daytime sleep.

Results

Twenty-seven participants from an inpatient stroke rehabilitation unit contributed 173.5 hours of data. The ActiGraph Cole-Kripke algorithm (minute sleep time = 15 minutes, bedtime = 10 minutes, and wake time = 10 minutes) achieved the highest F2 score (0.59). Notably, when participants were in bed, the ActiGraph Cole-Kripke algorithm continued to outperform Sadeh and Actiwatch AMRI, with an F2 score of 0.69.

Conclusions

The study demonstrates both Actiwatch and ActiGraph's ability to detect daytime sleep, particularly during bed rest. ActiGraph (Cole-Kripke) algorithm exhibited a more balanced sleep detection profile and higher F2 scores compared to Actiwatch, offering valuable insights for optimizing daytime sleep monitoring with actigraphy in stroke patients.

Self-applied somnography: technical feasibility of electroencephalography and electro-oculography signal characteristics in sleep staging of suspected sleep-disordered adults

Sleep recordings are increasingly being conducted in patients' homes where patients apply the sensors themselves according to instructions. However, certain sensor types such as cup electrodes used in conventional polysomnography are unfeasible for self-application. To overcome this, self-applied forehead montages with electroencephalography and electro-oculography sensors have been developed. We evaluated the technical feasibility of a self-applied electrode set from Nox Medical (Reykjavik, Iceland) through home sleep recordings of healthy and suspected sleep-disordered adults (n = 174) in the context of sleep staging. Subjects slept with a double setup of conventional type II polysomnography sensors and self-applied forehead sensors. We found that the self-applied electroencephalography and electro-oculography electrodes had acceptable impedance levels but were more prone to losing proper skin-electrode contact than the conventional cup electrodes. Moreover, the forehead electroencephalography signals recorded using the self-applied electrodes expressed lower amplitudes (difference 25.3%-43.9%, p < 0.001) and less absolute power (at 1-40 Hz, p < 0.001) than the polysomnography electroencephalography signals in all sleep stages. However, the signals recorded with the self-applied electroencephalography electrodes expressed more relative power (p < 0.001) at very low frequencies (0.3-1.0 Hz) in all sleep stages. The electro-oculography signals recorded with the self-applied electrodes expressed comparable characteristics with standard electro-oculography. In conclusion, the results support the technical feasibility of the self-applied electroencephalography and electro-oculography for sleep staging in home sleep recordings, after adjustment for amplitude differences, especially for scoring Stage N3 sleep.

Preliminary assessment of portable sleep monitoring for diagnosis of obstructive sleep apnea in children

OBJECTIVE

By observing the differences in sleep parameters between portable sleep monitoring (PM) and polysomnography (PSG) in children, we aimed to investigate the diagnostic value and feasibility of PM in children with suspected obstructive sleep apnea (OSA).

STUDY DESIGN

This prospective study enrolled consecutive children (aged 3-14 years) with suspected OSA in Shenzhen Children's Hospital. They had PSG and PM in the sleep laboratory. Clinical parameters of the two sleep monitoring methods were compared.

RESULTS

A total of 58 children participated. They were classified into two groups according to age: 28 children aged 3 to 5 years and 30 children aged 6 to 14 years. No significant differences were observed in apnea-hypopnea index (AHI), lowest oxygen saturation (LSaO2), and mean oxygen saturation (MSaO2) between PM and PSG, but the sleep efficiency with PM was significantly higher (3-5 years age: 92.2 ± 11.3% vs 85.2 ± 14.3%, 6-14 years age: 93.2 ± 14.5% vs 84.8 ± 16.3%, both P < 0.05) than the sleep efficiency with PSG. Pearson correlation analysis indicated a strong correlation between AHI, LSaO2, MSaO2, and sleep efficiency measured by PSG and PM. Receiver operating characteristic curve (ROC) analysis showed that PM was a reliable diagnostic tool for OSA. PM has high sensitivity (3-5 years age: 95.8%, 6-14 years age: 96.3%) and low specificity (3-5 years age: 25.0%, 6-14 years age: 33.3%) for OSA in children. Thus, there is a low rate of missed diagnoses, but there is some inaccuracy in excluding children who do not have OSA.

CONCLUSION

The results showed that PM has a good correlation with the various parameters of PSG. PM may be a reliable tool for diagnosing moderate and severe OSA in children, especially those who cannot cooperate with PSG or who have limited access to PSG.

A Soft Bioelectronic Patch for Simultaneous Respiratory and Cardiovascular Monitoring

Sleep is critical to maintaining physical and mental health. Measuring physiological parameters to quantify sleep quality without uncomfortable user experience remains highly desired but a challenge. Here, this work develops a soft bioelectronic patch to perform simultaneous respiration and cardiovascular monitoring during sleep in a wearable and non-invasive manner. The soft bioelectronic patch system is mainly composed of a pressure sensor, a flexible printed circuit for signal processing, and a soft thermoplastic urethane mold for assembling different functional modules. The soft bioelectronic patch holds a sensitivity of >0.12 V kPa-1 and a remarkable low-frequency response from 0.5 to 15 Hz. It is demonstrated to continuously monitor respiration and heartbeat during the whole night, which could be harnessed for sleep monitoring and obstructive sleep apnea-hypopnea syndrome diagnosis. The reported soft bioelectronic patch represents a simple and convenient platform technology for sleep study.

A Prediction Nomogram for Severe Obstructive Sleep Apnea in Snoring Patients: A Retrospective Study

Purpose

Snoring patients, as a high-risk group for OSA, are prone to the combination of severe OSA and face serious health threats. The aim of our study was to develop and validate a nomogram to predict the occurrence of severe OSA in snorers, in order to improve the diagnosis rate and treatment rate in this population.

Patients and Methods

A training cohort of 464 snoring patients treated at our institution from May 2021 to October 2022 was divided into severe OSA and non-severe OSA groups. Univariate and multivariate logistic regression were used to identify potential predictors of severe OSA, and a nomogram model was constructed. An external hospital cohort of 210 patients was utilized as an external validation cohort to test the model. Area under the receiver operating characteristic curve, calibration curve, and decision curve analyses were used to assess the discriminatory power, calibration, and clinical utility of the nomogram, respectively.

Results

Multivariate logistic regression demonstrated that body mass index, Epworth Sleepiness Scale total score, smoking history, morning dry mouth, dream recall, and hypertension were independent predictors of severe OSA. The area under the curve (AUC) of the nomogram constructed from the above six factors is 0.820 (95% CI: 0.782-0.857). The Hosmer-Lemeshow test showed that the model had a good fit (P = 0.972). Both the calibration curve and decision curve of the nomogram demonstrated the corresponding dominance. Moreover, external validation further confirmed the reliability of the predicted nomograms (AUC=0.805, 95% CI: 0.748-0.862).

Conclusion

A nomogram predicting the occurrence of severe OSA in snoring patients was constructed and validated with external data for the first time, and the findings all confirmed the validity of the model. This may help to improve existing clinical decision making, especially at institutions that do not yet have devices for diagnosing OSA.

Prevalence of sleep apnea in children and adolescents in Colombia according to the national health registry 2017–2021

Objective

To describe the sociodemographic and epidemiological characteristics of diagnosis and treatment of pediatric patients with sleep apnea, both central and obstructive, in Colombia between 2017 and 2021.

Methods

Observational, descriptive, cross-sectional, epidemiological study using the International Classification of Diseases and Related Health Problems as search terms for sleep apnea, based on SISPRO, the Colombian national health registry. Stratification by gender and age groups was performed. We also generated data of the amount of diagnostic and therapeutic procedures performed. A map of prevalence by place of residency was performed.

Results

National records report 15200 cases of SA between 2017 and 2021, for an estimated prevalence of 21.1 cases by 100000 inhabitants in 2019 the year with the most cases (4769), being more frequent and in the 6 to 11 age group and in males, with a male to female ratio of 1.54:1. The number of cases declined in 2020 and 2021. The map showed a concentration of cases in the more developed departments of the country.

Discussion

This is the first approximation to a nation-wide prevalence of sleep apnea in Colombia which is lower to what is found in the literature worldwide, including studies performed in Latin America and in Colombia, this could reflect sub diagnosis and sub report. The fact that the highest prevalence was found in males and in the 6–11 age group is consistent with reports in literature. The decrease in cases in 2020 and 2021 could be related to the COVID-19 pandemic impact in sleep medicine services.

Quantitative Data Integration Analysis Method for Cross-Studies: Obstructive Sleep Apnea as an Example

Objective

In recent years, the prevalence of obstructive sleep apnea (OSA) has gradually increased. The diagnosis of this multiphenotypic disorder requires a combination of several indicators. The objective of this study was to find significant apnea monitor indicators of OSA by developing a strategy for cross-study screening and integration of quantitative data.

Methods

Articles related to sleep disorders were obtained from the PubMed database. A sleep disorder dataset and an OSA dataset were manually curated from these articles. Two evaluation indexes, the indicator coverage ratio (ICR) and the study integrity ratio (SIR), were used to filter out OSA indicators from the OSA dataset and create profiles including different numbers of indicators and studies for analysis. Data were analyzed by the meta 4.18-0 package of R, and the p value and standard mean difference (SMD) values were calculated to evaluate the change of each indicator.

Results

The sleep disorder dataset was constructed based on 178 studies from 119 publications, the OSA dataset was extracted from 89 studies, 284 sleep-related indicators were filtered out, and 22 profiles were constructed. Apnea hypopnea index was significantly decreased in all 22 profiles. Total sleep time (TST) (min) showed no significant differences in 21 profiles. There were significant increases in rapid eye movement (REM) (%TST) in 18 profiles, minimum arterial oxygen saturation (SaO₂) in 9 profiles, REM duration in 3 profiles, and slow wave sleep duration (%TST) and pulse oximetry lowest point in 2 profiles. There were significant decreases in apnea index (AI) in 14 profiles; arousal index and SaO₂ < 90 (%TST) in 8 profiles; N1 stage (%TST) in 7 profiles; and hypopnea index, N1 stage (% sleep period time (%SPT)), N2 stage (%SPT), respiratory arousal index, and respiratory disorder index in 2 profiles.

Conclusion

The proposed data integration strategy successfully identified multiple significant OSA indicators.

Accuracy and usability of AcuPebble SA100 for automated diagnosis of obstructive sleep apnoea in the home environment setting: an evaluation study

OBJECTIVES

Obstructive sleep apnoea (OSA) is a heavily underdiagnosed condition, which can lead to significant multimorbidity. Underdiagnosis is often secondary to limitations in existing diagnostic methods. We conducted a diagnostic accuracy and usability study, to evaluate the efficacy of a novel, low-cost, small, wearable medical device, AcuPebble_SA100, for automated diagnosis of OSA in the home environment.

SETTINGS

Patients were recruited to a standard OSA diagnostic pathway in an UK hospital. They were trained on the use of type-III-cardiorespiratory polygraphy, which they took to use at home. They were also given AcuPebble_SA100; but they were not trained on how to use it.

PARTICIPANTS

182 consecutive patients had been referred for OSA diagnosis in which 150 successfully completed the study.

PRIMARY OUTCOME MEASURES

Efficacy of AcuPebble_SA100 for automated diagnosis of moderate-severe-OSA against cardiorespiratory polygraphy (sensitivity/specificity/likelihood ratios/predictive values) and validation of usability by patients themselves in their home environment.

RESULTS

After returning the systems, two expert clinicians, blinded to AcuPebble_SA100's output, manually scored the cardiorespiratory polygraphy signals to reach a diagnosis. AcuPebble_SA100 generated automated diagnosis corresponding to four, typically followed, diagnostic criteria: Apnoea Hypopnoea Index (AHI) using 3% as criteria for oxygen desaturation; Oxygen Desaturation Index (ODI) for 3% and 4% desaturation criteria and AHI using 4% as desaturation criteria. In all cases, AcuPebble_SA100 matched the experts' diagnosis with positive and negative likelihood ratios over 10 and below 0.1, respectively. Comparing against the current American Academy of Sleep Medicine's AHI-based criteria demonstrated 95.33% accuracy (95% CI (90·62% to 98·10%)), 96.84% specificity (95% CI (91·05% to 99·34%)), 92.73% sensitivity (95% CI (82·41% to 97·98%)), 94.4% positive-predictive value (95% CI (84·78% to 98·11%)) and 95.83% negative-predictive value (95% CI (89·94% to 98·34%)). All patients used AcuPebble_SA100 correctly. Over 97% reported a strong preference for AcuPebble_SA100 over cardiorespiratory polygraphy.

CONCLUSIONS

These results validate the efficacy of AcuPebble_SA100 as an automated diagnosis alternative to cardiorespiratory polygraphy; also demonstrating that AcuPebble_SA100 can be used by patients without requiring human training/assistance. This opens the doors for more efficient patient pathways for OSA diagnosis.

TRIAL REGISTRATION NUMBER

NCT03544086; ClinicalTrials.gov.

A Minimum Set of Physiological Parameters to Diagnose Obstructive Sleep Apnea Syndrome Using Non-Invasive Portable Monitors. A Systematic Review

Introduction. Despite its high accuracy, polysomnography (PSG) has several drawbacks for diagnosing obstructive sleep apnea (OSA). Consequently, multiple portable monitors (PMs) have been proposed. Objective. This systematic review aims to investigate the current literature to analyze the sets of physiological parameters captured by a PM to select the minimum number of such physiological signals while maintaining accurate results in OSA detection. Methods. Inclusion and exclusion criteria for the selection of publications were established prior to the search. The evaluation of the publications was made based on one central question and several specific questions. Results. The abilities to detect hypopneas, sleep time, or awakenings were some of the features studied to investigate the full functionality of the PMs to select the most relevant set of physiological signals. Based on the physiological parameters collected (one to six), the PMs were classified into sets according to the level of evidence. The advantages and the disadvantages of each possible set of signals were explained by answering the research questions proposed in the methods. Conclusions. The minimum number of physiological signals detected by PMs for the detection of OSA depends mainly on the purpose and context of the sleep study. The set of three physiological signals showed the best results in the detection of OSA.

Obstructive sleep apnea syndrome in non-obese patients

Obstructive sleep apnea syndrome (OSAS) is characterized by symptoms and signs of more than 5 apneas per hour (AHI) at polysomnography or 15 or more apneas per hour without symptoms. In this review, the focus will be a subgroup of patients: adult non-obese subjects with OSA and their specific features. In non-obese OSA patients (patients with BMI < 30 kg/m²), there are specific polysomnographic features which reflect specific pathophysiological traits. Previous authors identified an anatomical factor (cranial anatomical factors, retrognatia, etc.) in OSA non-obese. We have hypothesized that in this subgroup of patients, there could be a non-anatomical pathological prevalent trait. Little evidence exists regarding the role of low arousal threshold. This factor could explain the difficulty in treating OSA in non-obese patients and emphasizes the importance of a specific therapeutic approach for each patient.

Neuropsychological and socio-cognitive deficits in patients with obstructive sleep apnea

Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive deficits. We investigated the cognitive and socio-cognitive profiles of patients with severe OSA, controlling for potentially relevant mediating variables (i.e. age, body-mass index, cognitive reserve and depression). Moreover, we studied the neuropsychological profile of a high-risk OSA phenotype characterized by severe OSA and severe nocturnal hypoxemia.Method: We assessed 29 previously untreated severe OSA patients with a mean age of 55.6 (± 9.9 years) and a mean apnea-hypopnea index (AHI) of 53.1 (± 17.4). A control group of 34 healthy participants was also enrolled. Participants completed an extensive neuropsychological battery that included social cognition, a relatively new investigation area among OSA patients.Data analysis: Data were analyzed with a Bayesian approach. Specifically, Bayesian ANCOVA was used to investigate whether the grouping variable could predict test performance. Age, body-mass index, cognitive reserve and state of depression were added as covariates to the null model to weight the effects of these potential confounding factors. Three groups were analyzed: healthy controls (H), OSA with severe apnea and severe nocturnal oxygen desaturation (D⁺), and OSA with severe apnea non-desaturators (D^-). Performances on the various neuropsychological tests were treated as the dependent variables.Results: The results indicate that non-verbal reasoning, the theory of mind skills, and mental shifting ability were impaired in OSA patients. Patients with severe nocturnal hypoxemia underperformed compared to patients with the same severity of apnea but non-desaturators. Additionally, we observed a trend toward a worse performance among OSA desaturator patients in the following abilities: constructional ability, short term verbal memory, phonological fluency, and the ability to inhibit automatic and dominant responses.Conclusion: The data suggest a key role of hypoxemia in affecting cognitive functioning in OSA patients. Executive functions and the concomitant involvement of social cognition are particularly affected.

Morbidity and mortality reduction associated with polysomnography testing in idiopathic pulmonary fibrosis: a population-based cohort study

Background

It is not well-known if diagnosing and treating sleep breathing disorders among individuals with idiopathic pulmonary fibrosis (IPF) improves health outcomes. We evaluated the association between receipt of laboratory-based polysomnography (which is the first step in the diagnosis and treatment of sleep breathing disorders in Ontario, Canada) and respiratory-related hospitalization and all-cause mortality among individuals with IPF.

Methods

We used a retrospective, population-based, cohort study design, analyzing health administrative data from Ontario, Canada, from 2007 to 2019. Individuals with IPF were identified using an algorithm based on health administrative codes previously developed by IPF experts. Propensity score matching was used to account for potential differences in 41 relevant covariates between individuals that underwent polysomnography (exposed) and individuals that did not undergo polysomnography (controls), in order minimize potential confounding. Respiratory-related hospitalization and all-cause mortality were evaluated up to 12 months after the index date.

Results

Out of 5044 individuals with IPF identified, 201 (4.0%) received polysomnography, and 189 (94.0%) were matched to an equal number of controls. Compared to controls, exposed individuals had significantly reduced rates of respiratory-related hospitalization (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.24–0.75), p = 0.003) and all-cause mortality (HR 0.49, 95% CI 0.30–0.80), p = 0.004). Significantly reduced rate of respiratory-related hospitalization (but not all-cause mortality) was also observed among those with >  = 1 respiratory-related hospitalization (HR 0.38, 95% CI 0.15–0.99) and systemic corticosteroid receipt (HR 0.37, 95% CI 0.19–0.94) in the year prior to the index date, which reflect sicker subgroups of persons.

Conclusions

Undergoing polysomnography was associated with significantly improved clinically-important health outcomes among individuals with IPF, highlighting the potential importance of incorporating this testing in IPF disease management.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-021-01555-x.

[Cellex in the therapy of patients with complex and central apnea in the early recovery period of ischemic stroke]

A variety of structural and functional post-stroke disturbances demands an integrated clinical/diagnostic approach. Persistent hypoxemia due to disturbance of a saturation of blood oxygen in sleep can decrease the effectiveness of neurorehabilitation. In some cases of sleep apnea, the efficiency of continuous positive airway pressure therapy is insufficient and it should be combined with course neuroprotective therapy. Modern approaches to neuroprotective and neuroreparative therapy are considered as the independent direction for treatment of the central sleep apnea syndromes in patients with stroke consequences that is obviously important aspect of secondary prevention of a stroke.

Quantitative detection of sleep apnea with wearable watch device

The spread of wearable watch devices with photoplethysmography (PPG) sensors has made it possible to use continuous pulse wave data during daily life. We examined if PPG pulse wave data can be used to detect sleep apnea, a common but underdiagnosed health problem associated with impaired quality of life and increased cardiovascular risk. In 41 patients undergoing diagnostic polysomnography (PSG) for sleep apnea, PPG was recorded simultaneously with a wearable watch device. The pulse interval data were analyzed by an automated algorithm called auto-correlated wave detection with adaptive threshold (ACAT) which was developed for electrocardiogram (ECG) to detect the cyclic variation of heart rate (CVHR), a characteristic heart rate pattern accompanying sleep apnea episodes. The median (IQR) apnea-hypopnea index (AHI) was 17.2 (4.4–28.4) and 22 (54%) subjects had AHI ≥15. The hourly frequency of CVHR (Fcv) detected by the ACAT algorithm closely correlated with AHI (r = 0.81), while none of the time-domain, frequency-domain, or non-linear indices of pulse interval variability showed significant correlation. The Fcv was greater in subjects with AHI ≥15 (19.6 ± 12.3 /h) than in those with AHI <15 (6.4 ± 4.6 /h), and was able to discriminate them with 82% sensitivity, 89% specificity, and 85% accuracy. The classification performance was comparable to that obtained when the ACAT algorithm was applied to ECG R-R intervals during the PSG. The analysis of wearable watch PPG by the ACAT algorithm could be used for the quantitative screening of sleep apnea.

The role of dry mouth in screening sleep apnea

PURPOSE OF THE STUDY

Effective screening questionnaires are essential for early detection of obstructive sleep apnea (OSA). The STOP-Bang questionnaire has high sensitivity but low specificity. Dry mouth is a typical clinical sign of OSA. We hypothesised that adding dry mouth in the STOP-Bang questionnaire would improve its specificity.

STUDY DESIGN

A survey of the incidence of dry mouth was performed in a general population group and suspected sleep apnea clinical population group. Patients with suspected OSA were assessed by laboratory polysomnography and STOP-Bang questionnaire was performed. Adding the option of dry mouth to the OSA screening questionnaire resulted in a new quesionnaire, where cut-off value, diagnostic efficacy and the predictive parameters (sensitivity, specificity, positive predictive value and negative predictive value) were explored.

RESULTS

(In the 912 general population group, the incidence of dry mouth in the snoring group (54.0%) was much higher than that in the non-snoring group (30.5%) (p<0.05). In 207 patients with suspected OSA, the incidence of dry mouth in the OSA group was much higher than that in the non-OSA group (p<0.05). The sensitivity and specificity of the STOP-Bang questionnaire were 88.8% and 23.7% for identifying OSA, and 92.2% and 23.1% for identifying moderate and severe OSA, respectively. Adding the option of dry mouth (dry mouth every morning) to the STOP-Bang questionare resulted in a new questionnaire (STOP-Bang-dry-mouth questionnarie) with 9 items. Its sensitivity and specificity were 81.70% and 42.10% for identifying OSA, and 89.10% and 42.30% for identifying moderate and severe OSA, respectively.

CONCLUSIONS

The dry mouth symptom correlated with snoring and sleep apnea. The specificity of the STOP-Bang questionnaire can be improved by integrating dry mouth. The diagnostic accuracy of the STOP-Bang-dry mouth questionnaire is yet to be further verified in prospective studies.

Diagnostic Value of Sestrin2 in Patients with Obstructive Sleep Apnea

Background: Obstructive sleep apnea (OSA) is a serious threat to individual health. Diagnosis of OSA is mainly polysomnography (PSG). However, PSG monitoring is costly and time-consuming. At present, increasing studies are exploring new diagnostic methods for OSA. This study aimed to explore the diagnostic role of Sestrin2 in OSA.

Materials and Methods: Sixty-four subjects were recruited in this study. The concentration of plasma Sestrin2 of all subjects were measured and compared. Spearman's correlation analysis was used to investigate the correlation between plasma Sestrin2 concentration and other factors. Receiver-operating characteristic (ROC) curve was used to investigate the role of Sestrin2 in the diagnosis of OSA, moderate-severe and severe OSA.

Results: Subjects were divided into OSA group (n = 38) and control (n = 26). Levels of Plasma Sestrin2 were significantly higher in OSA patients than in controls. Sestrin2 was positively correlated with oxygen reduction index and negatively correlated with mean oxygen saturation and lowest oxygen saturation. The area under ROC curve (AUC) of Sestrin2 for OSA diagnosis was 0.740 [95% confidence interval (CI), 0.615–0.842], the cutoff value was 1.86 ng/mL, and the sensitivity and specificity were 81.58% and 61.54%, respectively. The AUC of Sestrin2 for the diagnosis of severe OSA was 0.801 (95% CI, 0.682–0.890), and the cutoff value was 5.21 ng/mL exhibiting the sensitivity and specificity of 61.90% and 90.70%, respectively.

Conclusion: Setrin2 is a marker for OSA and may be helpful in the diagnosis of OSA.

The Neuropsychological Profile of Attention Deficits of Patients with Obstructive Sleep Apnea: An Update on the Daytime Attentional Impairment

Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive disturbances. One of the neuropsychological processes most investigated in OSA patients is attention, but the results have been controversial. Here, we update the attention profile of OSA patients with the final aim to improve attention assessment, with a possible impact on clinical and medical-legal practices, in terms of which attention subdomains and parameters need consideration and which one is a high-risk OSA phenotype for attention dysfunctions. Method: For this purpose, we assessed 32 previously untreated OSA patients (26 men and 6 women) under 65 years of age (mean age 53.2 ± 7.3; mean education level 10.4 ± 3.4 years) suffering from moderate to severe sleep apnea and hypopnea (mean apnea-hypopnea index (AHI) 45.3 ± 22.9, range 16.1–69.6). A control group of 34 healthy participants matched with OSA patients for age, education level, and general cognitive functioning were also enrolled. The OSA patients and healthy participants were tested through an extensive computerized battery (Test of Attentional Performance, TAP) that evaluated intensive (i.e., alertness and vigilance) and selective (i.e., divided and selective) dimensions of attention and returned different outcome parameters (i.e., reaction time, stability of performance, and various types of errors). Data analysis: The data were analyzed by ANCOVA which compared the speed and accuracy performance of the OSA and control participants (cognitive reserve was treated as a covariate). The possible mechanisms underlying attention deficits in OSA patients were examined through correlation analysis among AHI, oxygenation parameters, sleepiness scores, and TAP outcomes and by comparing the following three phenotypes of patients: severe OSA and severe nocturnal desaturators (AHI⁺⁺D⁺), severe OSA nondesaturators (AHI⁺⁺D⁻), and moderate OSA nondesaturators (AHI⁺D⁻). Results: The results suggest that the OSA patients manifest deficits in both intensive and selective attention processes and that reaction time (RT) alone is ineffective for detecting and characterizing their problems, for which error analysis and stability of performance also have to be considered. Patients with severe OSA and severe hypoxemia underperformed on alertness and vigilance attention subtests. Conclusions: The data suggest the importance of evaluating attention deficits among OSA patients through several parameters (including performance instability). Moreover, the data suggest a multifaceted mechanism underlying attention dysfunction in OSA patients.

Validation of novel automatic ultra-wideband radar for sleep apnea detection

Background

To validate the accuracy of ultra-wideband (UWB) wireless radar for the screening diagnosis of sleep apnea.

Methods

One hundred and seventy-six qualified participants were successfully recruited. Apnea-hypopnea index (AHI) results from polysomnography (PSG) were reviewed by physicians, while the radar device automatically calculated AHI values with an embedded chip. All results were statistically analyzed.

Results

A UWB radar-based AHI algorithm was successfully developed according to respiratory movement and body motion signals. Of all 176 participants, 63 exhibited normal results (AHI <5/hr) and the remaining 113 were diagnosed with obstructive sleep apnea. Significant correlation was detected between radar AHI and PSG AHI (Intraclass correlation coefficient 0.98, P<0.001). Receiver operating characteristic curve (ROC) analysis revealed high sensitivity and specificity. High concordance in participants with varying gender, age, BMI, and PSG AHI was reached.

Conclusions

The UWB radar may be a portable, convenient, and reliable device for obstructive sleep apnea screening.

Single-layered ultra-soft washable smart textiles for all-around ballistocardiograph, respiration, and posture monitoring during sleep

Good sleep is considered to be the cornerstone for maintaining both physical and mental health. However, nearly one billion people worldwide suffer from various sleep disorders. To date, polysomnography (PSG) is the most commonly used sleep-monitoring technology,however, it is complex, intrusive, expensive and uncomfortable. Unfortunately, present noninvasive monitoring technologies cannot simultaneously achieve high sensitivity, multi-parameter monitoring and comfort. Here, we present a single-layered, ultra-soft, smart textile for all-around physiological parameters monitoring and healthcare during sleep. With a high-pressure sensitivity of 10.79 mV/Pa, a wide working frequency bandwidth from 0 Hz to 40 Hz, good stability, and decent washability, the single-layered ultra-soft smart textile is simultaneously capable of real-time detection and tracking of dynamic changes in sleep posture, and subtle respiration and ballistocardiograph (BCG) monitoring. Using the set of patient generated health data, an obstructive sleep apnea-hypopnea syndrome (OSAHS) monitoring and intervention system was also developed to improve the sleep quality and prevent sudden death during sleep. This work is expected to pave a new and practical pathway for physiological monitoring during sleep.

The Clinical Value of N-Terminal Pro B-Type Natriuretic Peptide in Evaluating Obstructive Sleep Apnea in Patients With Coronary Artery Disease

STUDY OBJECTIVES

Natriuretic peptides have been identified as biomarkers of increased myocardial wall stress in the context of obstructive sleep apnea (OSA) in the general population. However, the relationship between N-terminal pro B-type natriuretic peptide (NT-proBNP) and OSA remains unclear in patients with coronary artery disease (CAD). Hence, we aimed to investigate the clinical value of NT-proBNP in evaluating OSA in a large population of patients with CAD.

METHODS

Consecutive patients with CAD were prospectively enrolled between February 2015 and March 2018. Portable respiratory monitoring was applied to facilitate the diagnosis of sleep apnea. Patients were as assigned to the non-OSA (when the respiratory events index [REI] or 3% oxygen desaturation index [ODI] < 15 events/h) and OSA (when the REI or 3% ODI ≥ 15 events/h) groups. Multivariate analyses were used to explore the independent association between NT-proBNP levels and OSA.

RESULTS

A total of 1,292 consecutive patients were included with a mean NT-proBNP value of 826.57 μg/L. Patients with high levels of NT-proBNP experienced increasing severity of OSA in those with CAD (P = .0004). Univariate analysis demonstrated that NT-proBNP was a risk factor for OSA (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.03-1.18, P = .005). In addition, multivariate analysis revealed that NT-proBNP was independently associated with the presence of OSA (OR 1.11, 95% CI 1.02-1.20, P = .012) even after adjusting for other cofounding factors.

CONCLUSIONS

Elevated levels of NT-proBNP were independently associated with a higher likelihood of OSA in patients with CAD. Periodically screening for NT-proBNP levels may provide early identification of OSA.

Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management

Among obese pregnant women, 15%-20% have obstructive sleep apnea (OSA) and this prevalence increases along with body mass index and in the presence of other comorbidities. Prepregnancy obesity and pregnancy-related weight gain are certainly risk factors for sleep-disordered breathing in pregnancy, but certain physiologic changes of pregnancy may also increase a woman's risk of developing or worsening OSA. While it has been shown that untreated OSA in postmenopausal women is associated with a range of cardiovascular, pulmonary, and metabolic comorbidities, a body of literature is emerging that suggests OSA may also have serious implications for the health of mothers and fetuses during and after pregnancy. In this review, we discuss the following: pregnancy as a vulnerable period for the development or worsening of OSA; the associations between OSA and maternal and fetal outcomes; the current screening modalities for OSA in pregnancy; and current recommendations regarding peripartum management of OSA.

Cost-effectiveness strategies in OSAS management: a short review

Obstructive sleep apnoea (OSAS) is an underdiagnosed chronic disease with a high prevalence in adults. It is becoming a significant social problem, since it is associated with a worsening in quality of life and increase in mortality. The cost-effectiveness ratio of diagnostic and therapeutic management of OSAS is a strategic issue to counteract the expected increasing demand of objective testing. OSAS patients with any clinical evidence of comorbidities must be studied using simplified and less expensive systems such as Home Sleep Testing (HST). On the other hand, Sleep Laboratory Polysomnography (PSG) is the gold standard to manage OSAS patients with comorbidities. It should be pointed out that the use of HST can lead to incorrect diagnosis in poorly selected OSAS subjects. This short review discusses various topics for the proper diagnosis and treatment of OSAS in view of epidemiological factors and results in terms of costs and social benefit of the disease. Whatever the strategy chosen and/or the organisational model adopted for managing OSAS, it cannot and should not take into account only cost-effectiveness. Long-term prospective studies evaluating cost-effectiveness ratios and outcomes of OSAS treatment of hospital management models versus home care models are needed.

Oximetry use in obstructive sleep apnea

INTRODUCTION

Overnight oximetry has been proposed as an accessible, simple, and reliable technique for obstructive sleep apnea syndrome (OSAS) diagnosis. From visual inspection to advanced signal processing, several studies have demonstrated the usefulness of oximetry as a screening tool. However, there is still controversy regarding the general application of oximetry as a single screening methodology for OSAS. Areas covered: Currently, high-resolution portable devices combined with pattern recognition-based applications are able to achieve high performance in the detection of this disease. In this review, recent studies involving automated analysis of oximetry by means of advanced signal processing and machine learning algorithms are analyzed. Advantages and limitations are highlighted and novel research lines aimed at improving the screening ability of oximetry are proposed. Expert commentary: Oximetry is a cost-effective tool for OSAS screening in patients showing high pretest probability for the disease. Nevertheless, exhaustive analyses are still needed to further assess unattended oximetry monitoring as a single diagnostic test for sleep apnea, particularly in the pediatric population and in populations with significant comorbidities. In the following years, communication technologies and big data analyses will overcome current limitations of simplified sleep testing approaches, changing the detection and management of OSAS.

Obstructive sleep apnea syndrome and olfactory perception: An OERP study

Obstructive Sleep Apnea Syndrome (OSA) is characterized by snoring associated with repeated apnea and/or obstructive hypopnea. The nasal airways of OSA patients, measured via acoustic rhinometry, could be significantly narrower than healthy subjects and this reduced nasal structure can impair olfactory function. The relationship between nasal structure and olfactory function, assessed via behavioral test results, indicates that there is a high prevalence of nasal airflow problems. Based on these assumptions, the purpose of this study was to carry out an assessment of olfactory perception in OSA patients through the Chemosensory Event-Related Potentials (CSERP), investigating the N1 component and the Late Positive Component (LPC). Twelve OSA patients, non-smokers, were recruited in the Pulmonary Rehabilitation Unit, scored with the Epworth Sleepiness Scales, after Polygraphic Recording, Apnea Hypopnea Index and Body Mass Index evaluation. The control group consisted of twelve healthy controls, non-smokers, recruited as volunteers. Subjects, during an EEG recording, performed an oddball olfactory recognition task based on two scents: rose and eucalyptus. Main results highlighted differences in N1 and LPC between OSA and controls. OSA patients presented faster N1 latencies and greater amplitude. The same trend was found in LPC, where OSA showed decreased latency and increased amplitude during rose stimulation, in the right inferior frontal cortex. and faster latencies in left centroparietal cortex OERP results can suggest an impairment in endogenous components. This result could be the consequence of the exogenous perceptual difficulty highlighted in N1 component. The increased arousal could also be related to the respiratory activity involved during the olfactory task.

Assessment of automated analysis of portable oximetry as a screening test for moderate-to-severe sleep apnea in patients with chronic obstructive pulmonary disease

BACKGROUND

The coexistence of obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) leads to increased morbidity and mortality. The development of home-based screening tests is essential to expedite diagnosis. Nevertheless, there is still very limited evidence on the effectiveness of portable monitoring to diagnose OSAS in patients with pulmonary comorbidities.

OBJECTIVE

To assess the influence of suffering from COPD in the performance of an oximetry-based screening test for moderate-to-severe OSAS, both in the hospital and at home.

METHODS

A total of 407 patients showing moderate-to-high clinical suspicion of OSAS were involved in the study. All subjects underwent (i) supervised portable oximetry simultaneously to in-hospital polysomnography (PSG) and (ii) unsupervised portable oximetry at home. A regression-based multilayer perceptron (MLP) artificial neural network (ANN) was trained to estimate the apnea-hypopnea index (AHI) from portable oximetry recordings. Two independent validation datasets were analyzed: COPD versus non-COPD.

RESULTS

The portable oximetry-based MLP ANN reached similar intra-class correlation coefficient (ICC) values between the estimated AHI and the actual AHI for the non-COPD and the COPD groups either in the hospital (non-COPD: 0.937, 0.909-0.956 CI95%; COPD: 0.936, 0.899-0.960 CI95%) and at home (non-COPD: 0.731, 0.631-0.808 CI95%; COPD: 0.788, 0.678-0.864 CI95%). Regarding the area under the receiver operating characteristics curve (AUC), no statistically significant differences (p >0.01) between COPD and non-COPD groups were found in both settings, particularly for severe OSAS (AHI ≥30 events/h): 0.97 (0.92-0.99 CI95%) non-COPD vs. 0.98 (0.92-1.0 CI95%) COPD in the hospital, and 0.87 (0.79-0.92 CI95%) non-COPD vs. 0.86 (0.75-0.93 CI95%) COPD at home.

CONCLUSION

The agreement and the diagnostic performance of the estimated AHI from automated analysis of portable oximetry were similar regardless of the presence of COPD both in-lab and at-home. Particularly, portable oximetry could be used as an abbreviated screening test for moderate-to-severe OSAS in patients with COPD.

Sleep and Long-Term Care

Long-term care (LTC) involves a range of support and services for people with chronic illness and disabilities who can not perform activities of daily living independently. Poor sleep increases the risk of LTC placement, and sleep disturbance is extremely common among LTC residents. The identification and management of sleep disturbance in LTC residents is a vital, but perhaps underappreciated, aspect of offering high-quality care for this already compromised population. This review describes the nature and consequences of sleep disturbances in LTC, clinical assessment and management of sleep disturbances in LTC, and implications for future research and clinical practice.

Outpatient Anesthetic Safety Considerations for Obstructive Sleep Apnea

Most patients with obstructive sleep apnea (OSA) are not diagnosed preoperatively. The STOP-Bang questionnaire may identify patients at risk of OSA, especially those with severe OSA. Patients with mild to moderate OSA, with optimized comorbidities, can usually safely undergo outpatient surgery. Patients with severe OSA, who are not optimized medically, should avoid outpatient surgery.

Validity of the Berlin questionnaire in detecting obstructive sleep apnea: A systematic review and meta-analysis

We aimed to systematically review the Berlin questionnaire as a screening tool for obstructive sleep apnea. We systematically searched PubMed, Embase, and Scopus databases, reviewed articles reporting the Berlin questionnaire's diagnostic utility as measured against type-1 polysomnography, and performed meta-analyses where possible. Thirty five eligible articles showed that the Berlin questionnaire's diagnostic utility varied by study population, definition of hypopnea used, and apnea-hypopnea index threshold used. It had good sensitivity and specificity for detecting clinically relevant obstructive sleep apnea as well as any obstructive sleep apnea in the sleep clinic population. Despite limited evidence, it showed modest to high sensitivity for detecting clinically relevant obstructive sleep apnea or any obstructive sleep apnea in other clinical and general population subgroups. Its specificity was relatively low. Possible reasons for variability in reported diagnostic utility of the Berlin questionnaire are multifaceted. We conclude that the Berlin questionnaire is useful as a clinical screening test and epidemiological tool in the sleep clinic population. Despite limited evidence, it likely has potential clinical and research utility in other populations. Adopting more consistent methodological definitions and focussing more on the general population and specific clinical populations to determine its usefulness as a clinical or epidemiological screening tool are recommended.

Impact of Portable Sleep Testing

This article provides the current state of evidence on the socioeconomic impact of portable testing (PT) for sleep apnea. It seems the traditional in-laboratory polysomnography and the newer home-based PT model for sleep apnea diagnosis both have places in sleep medicine diagnostic algorithm. PT would be cost-effective in a selected group of patients as long as certain criteria, discussed in this article, are carefully considered.

Nasal nitric oxide improved by continuous positive airway pressure therapy for upper airway inflammation in obstructive sleep apnea

PURPOSE

In this report, we examined the association between obstructive sleep apnea (OSA) and upper and lower airway inflammation based on nitric oxide (NO) measurements.

METHODS

Study subjects included 51 consecutive participants. Sleep-disordered breathing was evaluated by a type 3 portable monitor and quantified by respiratory disturbance index (RDI). Airway inflammation was noninvasively analyzed by the measurement of nasally and orally exhaled NO; nasal value was presented as nasally exhaled NO minus orally exhaled NO. In 15 patients prescribed nasal continuous positive airway pressure (nCPAP) therapy, exhaled NO was re-evaluated in 10.7 ± 6.3 months after nCPAP therapy.

RESULTS

Nasal NO was significantly higher in patients with severe OSA (RDI ≥ 30/h) than those with non-OSA (RDI < 10/h) (76.9 ± 26.0 ppb vs. 47.9 ± 22.0 ppb, respectively, p = 0.016) and correlated with RDI (rho = 0.36, p = 0.0099), whereas orally exhaled NO did not differ between non-OSA and OSA patients and was not correlated with RDI. In 15 patients, nasal NO after nCPAP therapy was significantly decreased than that before nCPAP therapy (81.9 ± 31.2 ppb vs. 53.7 ± 27.2 ppb, respectively, p = 0.0046); in 11 patients having good compliance to nCPAP therapy (nCPAP use >4 h per night on more than 70% of nights), this association was more remarkable.

CONCLUSIONS

In OSA, upper but not lower airway inflammation can be increased by repetitive collapse of the upper airway. Future studies are required to determine the role of nasal NO in OSA.

Sleep apnea syndrome and patent foramen ovale: a dangerous association in ischemic stroke?

BACKGROUND

The coexistence of patent foramen ovale (PFO) and sleep apnea syndrome (SAS) might be related to the pathogenesis of cryptogenic stroke (CS). We aimed to determine the prevalence of SAS in patients with cryptogenic stroke and PFO.

METHODS

This is a prospective case-control study in which we included ischemic stroke patients consecutively admitted to our hospital's Acute Stroke Unit. Contrast transcranial Doppler (c-TCD) and sleep polygraphy within the first 72 h after stroke onset were performed to detect PFO and SAS. Demographic and clinical characteristics, time of stroke onset, score in the National Institute of Health Stroke Scale (NIHSS), and stroke subtype were registered.

RESULTS

A total of 97 patients were studied. Overall, 76% were men, with a mean ± SD age of 61 ± 13 years, and an NIHSS of 5 ± 5. Subtype of stroke was cryptogenic (CS) in 28 (29%) and non-CS in 69 (71%) of patients. PFO was more frequent among patients with CS (64% vs 29%, p = 0.002) and without SAS (60% vs 32%, p = 0.013). SAS was diagnosed in 74% of the whole group, with a higher prevalence in patients with known stroke etiology (83% vs 53%, p = 0.003). Finally, the prevalence of SAS and PFO coexistence was similar in patients with or without cryptogenic stroke (25% vs 22%, p = 1), and when comparing the group of patients with cryptogenic wake-up stroke to the other stroke patients (43% vs 21%, p = 0.35).

CONCLUSIONS

According to our results, there is no evidence of an association of PFO and SAS in the pathogenesis of cryptogenic stroke.

Should the diagnosis and management of OSA move into general practice?

Sleep apnoea is a common disease that for accurate management requires the participation of primary care medicine http://ow.ly/G6Mq301zcaM.