Association of alternative polysomnographic features with patient outcomes in obstructive sleep apnea: a systematic review

Hajipour, Mohammadreza; Baumann, Brett; Azarbarzin, Ali; Allen, A J Hirsch; Liu, Yu; Fels, Sidney; Goodfellow, Sebastian D.; Singh, Amrit; Jen, Rachel; Ayas, Najib

doi:10.5664/jcsm.10298

Cited by 14 publications

(7 citation statements)

References 54 publications

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“… 59–64 Most of these markers rely on EEG advanced analyses, but some of them focus on others signals such as heart rate variability, oximetry or respiratory signals. 58 , 65 …”

Section: Signal Perspective: Which Signal(s) Are Needed To Score Sleep?mentioning

confidence: 99%

Spotlight on Sleep Stage Classification Based on EEG

Lambert¹,

Peter‐Derex²

2023

NSS

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The recommendations for identifying sleep stages based on the interpretation of electrophysiological signals (electroencephalography [EEG], electro-oculography [EOG], and electromyography [EMG]), derived from the Rechtschaffen and Kales manual, were published in 2007 at the initiative of the American Academy of Sleep Medicine, and regularly updated over years. They offer an important tool to assess objective markers in different types of sleep/wake subjective complaints. With the aims and advantages of simplicity, reproducibility and standardization of practices in research and, most of all, in sleep medicine, they have overall changed little in the way they describe sleep. However, our knowledge on sleep/wake physiology and sleep disorders has evolved since then. High-density electroencephalography and intracranial electroencephalography studies have highlighted local regulation of sleep mechanisms, with spatio-temporal heterogeneity in vigilance states. Progress in the understanding of sleep disorders has allowed the identification of electrophysiological biomarkers better correlated with clinical symptoms and outcomes than standard sleep parameters. Finally, the huge development of sleep medicine, with a demand for explorations far exceeding the supply, has led to the development of alternative studies, which can be carried out at home, based on a smaller number of electrophysiological signals and on their automatic analysis. In this perspective article, we aim to examine how our description of sleep has been constructed, has evolved, and may still be reshaped in the light of advances in knowledge of sleep physiology and the development of technical recording and analysis tools. After presenting the strengths and limitations of the classification of sleep stages, we propose to challenge the “EEG-EOG-EMG” paradigm by discussing the physiological signals required for sleep stages identification, provide an overview of new tools and automatic analysis methods and propose avenues for the development of new approaches to describe and understand sleep/wake states.

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“… 59–64 Most of these markers rely on EEG advanced analyses, but some of them focus on others signals such as heart rate variability, oximetry or respiratory signals. 58 , 65 …”

Section: Signal Perspective: Which Signal(s) Are Needed To Score Sleep?mentioning

confidence: 99%

Spotlight on Sleep Stage Classification Based on EEG

Lambert¹,

Peter‐Derex²

2023

NSS

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“…Thus substantial interest has been reported in alternative metrics that can be extracted from polysomnograms that might reflect the severity of obstructive sleep apnoea and predict long term health complications better than the apnoea-hypopnoea index. 42 New polysomnographic metrics, such as hypoxic burden, heart rate response to arousal, odds ratio product, quantitative EEG related metrics, and respiratory events load (eg, apnoea load), aim to use polysomnography to improve our understanding of sleep and sleep disorders 43 44 (table 1). Specifically, hypoxic burden 45 46 is calculated by assessing the area under the oximetry desaturation curve coupled with respiratory events.…”

Section: Advanced Polysomnographic Metricsmentioning

confidence: 99%

“…These metrics need to be validated in other cohorts, however, before they can be used in medical decision making. 42 Circulating biomarkers of risk Biomarkers refer to a broad subcategory of medical signs. 60 For this review, however, we will focus on recent data on circulating molecular markers of the risk of cardiovascular disease in obstructive sleep apnoea.…”

Section: Advanced Polysomnographic Metricsmentioning

confidence: 99%

Role of precision medicine in obstructive sleep apnoea

Liu

Ghafoor

Hajipour

et al. 2023

bmjmed

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Obstructive sleep apnoea is a substantial clinical and public health problem because it contributes to harmful effects on quality of life, daytime symptoms, road traffic incidents, and cardiometabolic disease. Increasingly, obstructive sleep apnoea is recognised as a heterogeneous disease, and patients have varied susceptibility to long term complications and different responses to treatment. This narrative review summarises the current knowledge of precision medicine in obstructive sleep apnoea, particularly the role of symptom clusters, polysomnogram phenotypes, physiological endotypes, and circulating biomarkers in defining subtypes. In the near future, the prognostic accuracy of these measures in predicting long term complications in obstructive sleep apnoea will likely be improved, together with better matching of treatments to disease subtypes.

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“…Better understanding of patient phenotypes will allow specific characteristics to be linked to treatment outcomes (Mazzotti et al, 2019). The variety of accurate data obtained from new connected devices could be used to inform both diagnostics and clinical decision making based on sleep-related breathing parameters, age, symptoms and risks (Hajipour et al, 2023), and in accordance with current clinical recommendations and guidelines (Patil et al, 2019;Randerath et al, 2021;Grote et al, 2023). The new capabilities provided by new technologies and innovations bring new capabilities, such as use of the same device to diagnose sleep apnea and then monitor therapy compliance and efficacy.…”

Section: Looking To the (Not Too Distant) Futurementioning

confidence: 99%

A new approach to streamline obstructive sleep apnea therapy access using peripheral arterial tone-based home sleep test devices

Zou,

Vits,

Egea

et al. 2023

Front. Sleep

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Obstructive sleep apnea (OSA) is a prevalent condition that negatively impacts cardiovascular, metabolic and mental health. A high proportion of individuals with OSA remain undiagnosed and incur significant healthcare costs. The gold standard OSA diagnostic is in-lab polysomnography, but this is costly and time-consuming. Home sleep apnea tests (HSATs), including cardiorespiratory polygraphy and peripheral artery tonometry technology, provide an alternative. Advances in HSAT technology include non-invasive, easy-to-use medical devices that could allow unobtrusive, accessible, multi-night, cost-effective diagnosis and management of sleep-disordered breathing. One type of these devices is based on determination of peripheral arterial tone, and use photoplethysmography signals from the finger (oxygen saturation, pulse wave amplitude and pulse rate). The devices contain algorithms that use these data to generate the traditional metrics required by the American Academy of Sleep Medicine. They can be used to record sleep parameters over multiple nights at home, and can also provide information on total sleep time (TST) and sleep stages (including time spent in rapid eye movement sleep). The combination of objective measures (apnea-hypopnea index, oxygen desaturation index, respiratory disturbance index, TST) and subjective measures (symptoms and other patient-reported outcome measures) could facilitate the development of a personalized therapeutic plan for OSA patients. It is anticipated that the streamlined digital pathway facilitated by new peripheral artery tone-based technology could contribute to reducing the underdiagnosis of OSA, accelerating access to appropriate treatment, and the optimization of OSA therapy.

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Association of alternative polysomnographic features with patient outcomes in obstructive sleep apnea: a systematic review

Cited by 14 publications

References 54 publications

Spotlight on Sleep Stage Classification Based on EEG

Spotlight on Sleep Stage Classification Based on EEG

Role of precision medicine in obstructive sleep apnoea

A new approach to streamline obstructive sleep apnea therapy access using peripheral arterial tone-based home sleep test devices

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