Assessment of thoracoabdominal bands to detect respiratory effort-related arousal

Abstract

It would be helpful to be able to identify respiratory effort-related arousal (RERA) without needing to measure oesophageal pressure. Thoracoabdominal movements yield an indirect flow measurement from which reduction of amplitude and alteration of the inspiratory flow curve can be detected. The aim of this study was to evaluate the accuracy of using the shape and amplitude of signals from thoracoabdominal bands (inductance plethysmography) to detect RERAs.Altogether, 94 subjects suspected of having sleep apnoea but with an apnoea/ hypopnoea index f10 in full polysomnography with oesophageal pressure were studied. A routine polysomnographical analysis was carried out. The polysomnographies were then reanalysed at random to determine which of the identified arousals were due to RERA, as determined either by oesophageal pressure or by induction bands without an oesophageal pressure signal. Altogether, 14,617 arousals were analysed.The sensitivity and specificity to find RERA (arousal by arousal) from bands versus oesophageal pressure were both 94%. The average difference of RERA index between oesophageal pressure and bands was -0.6. The correlation between RERA index determined by oesophageal pressure and bands was 0.98. To evaluate the intra and interobserver agreement, 1183 arousals were additionally analysed. The intraobserver agreement was 91% for RERAs by oesophageal pressure and 80% by bands. The interobserver agreement was 89% by oesophageal pressure and 85% by bands.The thoracoabdominal bands can be used to identify respiratory effort-related arousal (obstructive events not detected by thermistor) with similar efficacy to oesophageal pressure measurement. Since bands are routinely used in most polysomnographies, they can be used as the usual method to detect respiratory effort-related arousal, using a thermistor to evaluate apnoeas and hypopnoeas or as a complement to other methods, such as nasal cannula, which can detect apnoeas, hypopnoeas and respiratory effort-related arousal. Eur Respir J 2003; 22: 661-667.

Comparison of the automatic analysis versus the manual scoring from ApneaLink™ device for the diagnosis of obstructive sleep apnoea syndrome

“…The arousals were identified following the American Sleep Disordered Association recommendations [14]. The analysis of apnoeas, hypopnoeas and respiratory effortrelated arousals (RERAs) were in agreement with the international criteria [15][16][17] …”

Validation of a Polyvinylidene Fluoride Impedance Sensor for Respiratory Event Classification during Polysomnography

“…However, because of the burden and limited availability of this technique, RIP was recommended as an acceptable means for measuring breathing effort, 7 noting that data regarding the use of RIP to measure respiratory effort are limited. 8 The AASM recognized that recommendations might change as technologies evolved and new data were generated. …”

Noninvasive monitoring of respiratory mechanics during sleep

“…Besides their application to estimate changes in ventilation, thoraco-abdominal bands are mainly used to semiquantitatively assess the magnitude of the inspiratory efforts in SAHS [21][22][23][24]. The rationale is based on the analysis of the amplitude of the swing movements of the thoracic and the abdominal compartments, and on the comparison of the synchrony between both movements.…”