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Parveen N, Parganiha A. Consequences and factors associated with OSA: a brief review. BIOL RHYTHM RES 2022. [DOI: 10.1080/09291016.2022.2054558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Noorshama Parveen
- School of Studies in Life Science, Pandit Ravishankar Shukla University, Raipur, India
| | - Arti Parganiha
- School of Studies in Life Science, Pandit Ravishankar Shukla University, Raipur, India
- Center for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur, India
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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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Aielo AN, Santos RB, Silva WA, Parise BK, Souza SP, Cunha LF, Giatti S, Lotufo PA, Bensenor IM, Drager LF. Pragmatic Validation of Home Portable Sleep Monitor for diagnosing Obstructive Sleep Apnea in a non-referred population: The ELSA-Brasil study. ACTA ACUST UNITED AC 2019; 12:65-71. [PMID: 31879537 PMCID: PMC6922554 DOI: 10.5935/1984-0063.20190072] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective Polygraphy (PG) is an attractive alternative for diagnosing obstructive sleep apnea (OSA) in patients with high pre-test probability. However, several patients may not present typical symptoms. In this scenario, it is unclear the performance of PG for diagnosing OSA in non-referred populations to sleep laboratories. Methods Data from participants of the ELSA-Brasil cohort were used for this analysis. We performed an overnight home PG (Embletta GoldTM) synchronized with a wrist actigraphy (Actiwatch model 2TM). The validation strategy comprised three scorings from each participant: 1) Original scoring (PG): Routine scoring using data from the exclamation button mark to define “analysis start” and “analysis stop”; 2) Scoring using actigraphy data (PG+actigraphy): total sleep time defined by the actigraphy data; 3) Scoring using diaries (PG+diary): “analysis start” and “analysis stop” based on the diaries. Bland-Altman plots were generated to assess the agreements (Kappa) between each scoring strategy. Results A total of 300 participants were included in the final analysis (45% males, mean age: 48±8 years). The frequency of OSA using the PG score was 27.3%. Despite small differences in the OSA severity index, we obtained a high concordance of AHI comparing the PG vs. PG+actigraphy (Kappa: 0.95) as well as PG+diary vs. PG+actigraphy (Kappa: 0.96). No significant changes in the OSA classification (mild, moderate and severe) were observed in the 3 protocols. Conclusion Using a pragmatic approach to address OSA at home, our results suggest that PG is a useful tool for OSA diagnosis even in subjects not referred to sleep studies.
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Affiliation(s)
- Aline N Aielo
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Renal Division - São Paulo - São Paulo - Brazil
| | - Ronaldo B Santos
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Heart Institute (InCor) - São Paulo - São Paulo - Brazil
| | - Wagner A Silva
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Heart Institute (InCor) - São Paulo - São Paulo - Brazil
| | - Barbara K Parise
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Renal Division - São Paulo - São Paulo - Brazil
| | - Silvana P Souza
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Heart Institute (InCor) - São Paulo - São Paulo - Brazil
| | - Lorenna F Cunha
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil
| | - Soraya Giatti
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Renal Division - São Paulo - São Paulo - Brazil
| | - Paulo A Lotufo
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil
| | - Isabela M Bensenor
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil
| | - Luciano F Drager
- University of Sao Paulo, Center of Clinical and Epidemiologic Research (CPCE) - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Renal Division - São Paulo - São Paulo - Brazil.,University of Sao Paulo, Hypertension Unit, Heart Institute (InCor) - São Paulo - São Paulo - Brazil
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Idris G, Galland B, Robertson CJ, Gray A, Farella M. Mandibular advancement appliances for sleep-disordered breathing in children: A randomized crossover clinical trial. J Dent 2018; 71:9-17. [DOI: 10.1016/j.jdent.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 12/16/2022] Open
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Silva JLR, Conde MB, Corrêa KDS, Rabahi H, Rocha AA, Rabahi MF. Sleep-disordered breathing in patients with COPD and mild hypoxemia: prevalence and predictive variables. J Bras Pneumol 2017; 43:176-182. [PMID: 28746527 PMCID: PMC5687947 DOI: 10.1590/s1806-37562016000000051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 10/05/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE: To infer the prevalence and variables predictive of isolated nocturnal hypoxemia and obstructive sleep apnea (OSA) in patients with COPD and mild hypoxemia. METHODS: This was a cross-sectional study involving clinically stable COPD outpatients with mild hypoxemia (oxygen saturation = 90-94%) at a clinical center specializing in respiratory diseases, located in the city of Goiânia, Brazil. The patients underwent clinical evaluation, spirometry, polysomnography, echocardiography, arterial blood gas analysis, six-minute walk test assessment, and chest X-ray. RESULTS: The sample included 64 patients with COPD and mild hypoxemia; 39 (61%) were diagnosed with sleep-disordered breathing (OSA, in 14; and isolated nocturnal hypoxemia, in 25). Correlation analysis showed that PaO2 correlated moderately with mean sleep oxygen saturation (r = 0.45; p = 0.0002), mean rapid eye movement (REM) sleep oxygen saturation (r = 0.43; p = 0.001), and mean non-REM sleep oxygen saturation (r = 0.42; p = 0.001). A cut-off point of PaO2 ≤ 70 mmHg in the arterial blood gas analysis was significantly associated with sleep-disordered breathing (OR = 4.59; 95% CI: 1.54-13.67; p = 0.01). The model showed that, for identifying sleep-disordered breathing, the cut-off point had a specificity of 73.9% (95% CI: 51.6-89.8%), a sensitivity of 63.4% (95% CI: 46.9-77.9%), a positive predictive value of 81.3% (95% CI: 67.7-90.0%), and a negative predictive value of 53.1% (95% CI: 41.4-64.4%), with an area under the ROC curve of 0.69 (95% CI: 0.57-0.80), correctly classifying the observations in 67.2% of the cases. CONCLUSIONS: In our sample of patients with COPD and mild hypoxemia, the prevalence of sleep-disordered breathing was high (61%), suggesting that such patients would benefit from sleep studies. OBJETIVO: Inferir a prevalência e as variáveis preditivas de hipoxemia noturna e apneia obstrutiva do sono (AOS) em pacientes portadores de DPOC com hipoxemia leve. MÉTODOS: Estudo transversal realizado em pacientes ambulatoriais, clinicamente estáveis, portadores de DPOC e hipoxemia leve (saturação de oxigênio = 90-94%) em um centro clínico especializado no atendimento de doenças respiratórias em Goiânia (GO). Os pacientes foram submetidos à avaliação clínica, espirometria, polissonografia, ecocardiografia, gasometria arterial, teste de caminhada de seis minutos e radiografia de tórax. RESULTADOS: Foram avaliados 64 pacientes com DPOC e hipoxemia leve, e 39 (61%) apresentaram distúrbios respiratórios do sono (14 com AOS e 25 com hipoxemia noturna isolada). A análise de correlação mostrou moderada correlação da PaO2 com saturação média do sono (r = 0,45; p = 0,0002), saturação média do sono rapid eye movement (REM; r = 0,43; p = 0,001) e saturação média do sono não-REM (r = 0,42; p = 0,001). Um ponto de corte de PaO2 ≤ 70 mmHg (OR = 4,59; IC95%: 1,54-13,67; p = 0,01) na gasometria arterial foi significativamente associada com distúrbios respiratórios do sono. O modelo mostrou que, para identificar distúrbios respiratórios do sono, o ponto de corte teve uma especificidade de 73,9% (IC95%: 51,6-89,8%), uma sensibilidade de 63,4% (IC95%: 46,9-77,9%) e valores preditivos positivo e negativo de 81,3% (IC95%: 67,7-90,0%) e 53,1% (IC95%: 41,4-64,4%), respectivamente. A área sob a curva ROC foi de 0,69 (IC95%: 0,57-0,80), e a proporção de observações corretamente classificadas foi de 67,2% dos casos. CONCLUSÕES: A elevada prevalência de distúrbios respiratórios do sono em portadores de DPOC e hipoxemia leve nesta amostra (61%) sugere que esses pacientes podem se beneficiar da realização de estudos do sono.
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Affiliation(s)
- José Laerte Rodrigues Silva
- . Faculdade de Medicina, Universidade Federal de Goiás, Goiânia (GO) Brasil
- . Clínica do Aparelho Respiratório - CLARE - Goiânia (GO) Brasil
| | - Marcus Barreto Conde
- . Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
- . Faculdade de Medicina de Petrópolis/Faculdade Arthur Sá Earp Neto - FMP/FASE - Petrópolis (RJ) Brasil
| | | | - Helena Rabahi
- . Clínica do Aparelho Respiratório - CLARE - Goiânia (GO) Brasil
| | | | - Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás, Goiânia (GO) Brasil
- . Clínica do Aparelho Respiratório - CLARE - Goiânia (GO) Brasil
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Idris G, Galland B, Robertson CJ, Farella M. Efficacy of a Mandibular Advancement Appliance on Sleep Disordered Breathing in Children: A Study Protocol of a Crossover Randomized Controlled Trial. Front Physiol 2016; 7:353. [PMID: 27594841 PMCID: PMC4990554 DOI: 10.3389/fphys.2016.00353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 08/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sleep-Disordered Breathing (SDB) varies from habitual snoring to partial or complete obstruction of the upper airway and can be found in up to 10% of children. SDB can significantly affect children's wellbeing, as it can cause growth disorders, educational and behavioral problems, and even life-threatening conditions, such as cardiorespiratory failure. Adenotonsillectomy represents the primary treatment for pediatric SDB where adeno-tonsillar hypertrophy is indicated. For those with craniofacial anomalies, or for whom adenotonsillectomy or other treatment modalities have failed, or surgery is contra-indicated, mandibular advancement splints (MAS) may represent a viable treatment option. Whilst the efficacy of these appliances has been consistently demonstrated in adults, there is little information about their effectiveness in children. AIMS To determine the efficacy of mandibular advancement appliances for the management of SDB and related health problems in children. METHODS/DESIGN The study will be designed as a single-blind crossover randomized controlled trial with administration of both an "Active MAS" (Twin-block) and a "Sham MAS." Eligible participants will be children aged 8-12 years whose parents report they snore ≥3 nights per week. Sixteen children will enter the full study after confirming other inclusion criteria, particularly Skeletal class I or class II confirmed by lateral cephalometric radiograph. Each child will be randomly assigned to either a treatment sequence starting with the Active or the Sham MAS. Participants will wear the appliances for 3 weeks separated by a 2-week washout period. For each participant, home-based polysomnographic data will be collected four times; once before and once after each treatment period. The Apnea Hypopnea Index (AHI) will represent the main outcome variable. Secondary outcomes will include, snoring frequency, masseter muscle activity, sleep symptoms, quality of life, daytime sleepiness, children behavior, and nocturnal enuresis. In addition, blood samples will be collected to assess growth hormone changes. TRIAL REGISTRATION This study was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR): [ACTRN12614001013651].
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Affiliation(s)
- Ghassan Idris
- Craniofacial Biology and Clinical Oral Physiology Research Programme, Sir John Walsh Research Institute, University of Otago Dunedin, New Zealand
| | - Barbara Galland
- Department of Women's and Children's Health, University of Otago Dunedin, New Zealand
| | - Christopher J Robertson
- Craniofacial Biology and Clinical Oral Physiology Research Programme, Sir John Walsh Research Institute, University of Otago Dunedin, New Zealand
| | - Mauro Farella
- Craniofacial Biology and Clinical Oral Physiology Research Programme, Sir John Walsh Research Institute, University of Otago Dunedin, New Zealand
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7
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Oliveira MG, Treptow EC, Fukuda C, Nery LE, Valadares RM, Tufik S, Bittencourt L, Togeiro SM. Diagnostic accuracy of home-based monitoring system in morbidly obese patients with high risk for sleep apnea. Obes Surg 2015; 25:845-51. [PMID: 25344466 DOI: 10.1007/s11695-014-1469-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND No previous studies have validated the use of portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) in morbidly obese individuals. Our aim was to investigate the accuracy of PM for detecting respiratory events in morbidly obese patients that will be undergoing bariatric surgery. METHODS This was a prospective study involving patients with body mass index (BMI) ≥35 kg/m(2) who were recruited from the Sleep Clinic of Universidade Federal de São Paulo. Sleep-disordered breathing (SDB) was evaluated during full-night polysomnography (PSG). PM use was randomized and used on two consecutive nights: (1) at home (STDHome) and (2) at the sleep laboratory with PSG (PSG_STDLab). RESULTS Although 58 participants initially underwent the recordings, 26 (45%) were excluded because of technical problems. The patients' mean age was 42.9 ± 10.9 (SD) years, and 56% were female. The mean BMI was 40.8 ± 5.2 kg/m(2). All patients had high risk for OSA, as defined by the Stop-Bang questionnaire, and the mean apnea-hypopnea index (AHI) was 46.9 ± 30.4/h. The intraclass coefficient of the correlation between AHI_PSG and AHI_STDLab was r = 0.92 (p = 0.0001); the intraclass coefficient for AHI_PSG and AHI_STDHome was r = 0.84 (p = 0.0001). The Kappa index was 0.87 (p > 0.0001) for severe cases. The sensitivity and the positive predictive value increased with the disease severity. A Bland-Altman analysis showed good agreement between the investigated methods. CONCLUSIONS PM is an efficacious method for diagnosing OSA in obese patients who have a high clinical probability of the disease. The method displays good sensitivity and specificity in severe cases; nevertheless, the high rate of data loss must be taken into account.
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Affiliation(s)
- Márcia G Oliveira
- Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de Sao Paulo - UNIFESP, Rua Pedro de Toledo, 720, Sao Paulo, SP, 04039-034, Brazil,
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8
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Min HJ, Cho YJ, Kim CH, Kim DH, Kim HY, Choi JI, Lee JG, Park S, Cho HJ. Clinical Features of Obstructive Sleep Apnea That Determine Its High Prevalence in Resistant Hypertension. Yonsei Med J 2015; 56:1258-65. [PMID: 26256968 PMCID: PMC4541655 DOI: 10.3349/ymj.2015.56.5.1258] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/23/2015] [Accepted: 05/08/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Resistant hypertension (HTN) occurs in 15-20% of treated hypertensive patients, and 70-80% of resistant hypertensive patients have obstructive sleep apnea (OSA). The characteristics of resistant HTN that predispose patients to OSA have not been reported. Therefore, we aimed to determine the clinical, laboratory, and polysomnographic features of resistant HTN that are significantly associated with OSA. MATERIALS AND METHODS Hypertensive patients (n=475) who underwent portable polysomnography were enrolled. The patients were categorized into controlled (n=410) and resistant HTN (n=65) groups. The risk factors for the occurrence of OSA in controlled and resistant hypertensive patients were compared, and independent risk factors that are associated with OSA were analyzed. RESULTS Out of 475 patients, 359 (75.6%) were diagnosed with OSA. The prevalence of OSA in resistant HTN was 87.7%, which was significantly higher than that in controlled HTN (73.7%). Age, body mass index, neck circumference, waist circumference, and hip circumference were significantly higher in OSA. However, stepwise multivariate analyses revealed that resistant HTN was not an independent risk factor of OSA. CONCLUSION The higher prevalence and severity of OSA in resistant HTN may be due to the association of risk factors that are common to both conditions.
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Affiliation(s)
- Hyun Jin Min
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yang-Je Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Da Hee Kim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Ji In Choi
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Jeung-Gweon Lee
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Hyung-Ju Cho
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Treptow E, Oliveira MG, Moreira GA, Togeiro S, Nery LE, Tufik S, Bittencourt L. Update on the use of portable monitoring system for the diagnosis of sleep apnea in specific population. World J Respirol 2015; 5:17-27. [DOI: 10.5320/wjr.v5.i1.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/10/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
The prevalence and severity of obstructive sleep apnea (OSA) is higher in specific population: children, elderly, obese and patients with pulmonary and cardiovascular diseases, compared to the general population. OSA is associated with greater morbidity and mortality in these patients. Although full-night polysomnography is still the gold standard diagnostic sleep study for OSA, it is a time consuming, expensive and technically demanding exam. Over the last few years, there is growing evidence on the use of portable monitors (PM) as an alternative for the diagnosis of OSA. These devices were developed specially for sleep evaluation at home, at a familiar environment, with easy self-application of monitoring, unattended. The use of PM is stablished for populations with high pre-test probability of OSA. However, there is a lack of studies on the use of PM in age extremes and patients with comorbidities. The purpose of this review is to present the studies that evaluated the use of PM in specific population, as well as to describe the advantages, limitations and applications of these devices in this particular group of patients. Although the total loss rate of recordings is variable in different studies, the agreement with full-night polysomnography justifies the use of PM in this population.
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Park DY, Kim HJ, Kim CH, Kim YS, Choi JH, Hong SY, Jung JJ, Lee KI, Lee HS. Reliability and validity testing of automated scoring in obstructive sleep apnea diagnosis with the Embletta X100. Laryngoscope 2014; 125:493-7. [PMID: 25124863 DOI: 10.1002/lary.24878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/10/2014] [Accepted: 07/21/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS To verify the reliability and validity of automated scoring and compare it to that of manual scoring for diagnosing obstructive sleep apnea using an Embletta X100 level 2 portable device. STUDY DESIGN Retrospective study. METHODS A total of 116 patients with suspected obstructive sleep apnea who had successfully received portable polysomnography with the Embletta X100 were examined. All polysomnography data were analyzed by automated and manual methods. Manual scoring was performed according to the revised American Academy of Sleep Medicine 2012 criteria. Automated scoring was analyzed using the automatic algorithm, which was updated with the American Academy of Sleep Medicine 2012 criteria. All parameters were evaluated statistically using correlation analysis and paired t tests. RESULTS The apnea-hypopnea index for automated scoring and manual scoring with the Embletta X100 were moderately correlated (r = 0.76, P < .001). However, there was poor agreement (Bland-Altman plot, κ = 0.34, 0.33, and 0.26; cutoff value = 5, 15, and 30), and the apnea-hypopnea index data were generally excessively underestimated based on diagnostic agreement and disagreement criteria. Furthermore, the apnea-hypopnea index severity (Kendall tau-b = 0.62) between automated and manual scoring lacked good concordance. CONCLUSIONS Automated scoring using the Embletta X100 was statistically moderately related to the manual scoring results. However, automated scoring tended to excessively underestimate the apnea-hypopnea index data compared to manual scoring. Thus, manual scoring by a sleep expert is essential for obstructive sleep apnea diagnosis with the Embletta X100. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Do Y Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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11
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Oliveira MG, Garbuio S, Treptow EC, Polese JF, Tufik S, Nery LE, Bittencourt L. The use of portable monitoring for sleep apnea diagnosis in adults. Expert Rev Respir Med 2013; 8:123-32. [PMID: 24308652 DOI: 10.1586/17476348.2014.850421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea (OSA). The implementation of alternative approaches to the current management by full polysomnography (PSG) in the sleep laboratory is necessary for diagnosing this syndrome due to the high cost of full-night PSG. A good alternative option for OSA diagnosis is portable monitoring (PM), which is known for its accuracy, ease of management and lower cost when compared with full PSG. PM has not been well validated for OSA diagnosis in patients with medical comorbidities or in elderly individuals and children. PM may be recommended as an alternative method to PSG for patients with high clinical risk for OSA. In the present review, we describe the use of PM for OSA diagnosis and evaluate the current progress, costs, limitations and applications of these devices in various groups of patients, particularly for patients with comorbid diseases.
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Affiliation(s)
- Marcia G Oliveira
- Departamento de Medicina - Universidade Federal de São Paulo, Disciplina de Pneumologia. Rua Pedro de Toledo, 720 - 3° andar - CEP: 04039-002 - São Paulo, Brasil
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Oliveira MG, Nery LE, Santos-Silva R, Sartori DE, Alonso FF, Togeiro SM, Tufik S, Bittencourt L. Is portable monitoring accurate in the diagnosis of obstructive sleep apnea syndrome in chronic pulmonary obstructive disease? Sleep Med 2012; 13:1033-8. [PMID: 22841038 DOI: 10.1016/j.sleep.2012.06.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/09/2012] [Accepted: 06/14/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND No scientific evidence supports the use of portable devices to diagnose obstructive sleep apnea syndrome (OSAS) in patients with co-morbities. Our aim was to evaluate the accuracy of a portable monitoring device (Stardust - STD) in the detection of patients with chronic obstructive pulmonary disease (COPD). METHODS Patients with COPD and clinical suspicion of OSAS were recruited for a prospective randomized study. The STD was used on two different nights: (1) at home (STDHome) and (2) at the sleep laboratory simultaneous with polysomnography (PSG-STDLab). RESULTS A total of 72 patients underwent the proposed recordings. Forty-six volunteers were excluded due to recording problems, and data from 26 subjects were analyzed. The mean age was (mean±SD) 62.8±8.5 years, 50% were male, and the mean forced expiratory volume in the first second was 55±11%. Significant intraclass correlation was observed between apnea-hypopnea index (AHI)-PSG vs. AHI-STDLab (r=0.61, p<0.0001) and AHI-STDHome (r=0.47, p<0.007). Kappa analysis also showed a significant agreement for severe group. CONCLUSION Despite the agreement found in a small number of patients between AHI, a large number of failures in the recording limits the use of this portable device for the diagnosis of OSAS in patients with COPD.
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Affiliation(s)
- Marcia Gonçalves Oliveira
- Disciplina de Pneumologia, Departamento de Clínica Médica, Universidade Federal de Sao Paulo - UNIFESP, Sao Paulo/SP, Brazil
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