Evaluation of a Portable Device Based on Peripheral Arterial Tone for Unattended Home Sleep Studiesa

Bar, Amir; Pillar, Giora; Dvir, Itsik; Sheffy, Jacob; Schnall, Robert P.; Lavie, Peretz

doi:10.1378/chest.123.3.695

Cited by 192 publications

(166 citation statements)

References 21 publications

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“…This pattern has also been already described [31], although another study did not report the apparent dilatory response during the respiratory event [29]. One possible explanation of this vasodilation is the result of a return to baseline values after the sharp decline caused by the preceding arousal.…”

Section: Discussionsupporting

confidence: 80%

“…This is the case for the pulse transit time, a non-invasive measure of blood pressure, a semiquantitative measure of respiratory effort [25][26][27] and a sensitive marker of autonomic arousals [20]. The recently developed peripheral arterial tonometry, based on detection of peripheral vasoconstriction, has been shown to be a sensitive marker of sympathetic arousal [28] and apneas [9,29]. In our study, we evaluated changes in peripheral arterial volume by photoplethysmography using a standard oxymeter.…”

Section: Discussionmentioning

confidence: 99%

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Obstructive sleep apnea syndrome: effect of respiratory events and arousal on pulse wave amplitude measured by photoplethysmography in NREM sleep

et al. 2005

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Obstructive sleep apnea syndrome: effect of respiratory events and arousal on pulse wave amplitude measured by photoplethysmography in NREM sleep Abstract The objective of the study is to evaluate changes in finger pulse wave amplitude (PWA), as measured by photoplethysmography, and heart rate (HR), related to obstructive respiratory events and associated arousals during sleep. We analyzed 1,431 respiratory events in NREM sleep from 12 patients according to (1) the type of event (apnea, hypopnea, upper airway resistance episode) and (2) the duration of the associated EEG arousal (>10, 3-10, <3 s). Obstructive respiratory events provoked a relative bradycardia and vasodilation followed by HR increase and vasoconstriction. Relative PWA changes were significantly greater than HR changes. These responses differed significantly according to EEG-arousal grades (time×arousal interaction, p<0.0001), with longer arousals producing greater responses, but not to the type of respiratory event (time×event interaction, p = ns). Obstructive respiratory events provoke HR and PWA changes, the magnitude seemingly related to the intensity of central nervous activation, with PWA changes greater than HR. PWA obtained from a simple pulse oxymeter might be a valuable method to evaluate sleep fragmentation in sleep breathing disorders.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea syndrome: effect of respiratory events and arousal on pulse wave amplitude measured by photoplethysmography in NREM sleep

et al. 2005

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“…Excluding these patients, the bias of AHI was 0Ϯ12 h Ϫ1 . The measure of agreement between the 2 methods was 0.7 on statistics, which is similar to other home-based PSG recording systems [17][18][19] and satisfactory for clinical screening purposes and for monitoring treatment effects. The intraclass correlation coefficient of 0.73 indicates that 73% variation in apnea/hypopnea scores per 5-minute epoch during the entire sleep study was related to variation in reference PSG scores.…”

Section: Discussion Main Findingssupporting

confidence: 66%

Diagnosis of Sleep-Related Breathing Disorders by Visual Analysis of Transthoracic Impedance Signals in Pacemakers

et al. 2004

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Background-Minute ventilation sensors of cardiac pacemakers measure ventilation by means of transthoracic impedance changes between the pacemaker case and the electrode tip. We investigated whether this technique might detect sleep-related breathing disorders. Methods and Results-In 22 patients, analog waveforms of the transthoracic impedance signal measured by the pacemaker minute ventilation sensor over the course of a night were visualized, scored for apnea/hypopnea events, and compared with simultaneous polysomnography. Analysis of transthoracic impedance signals correctly identified the presence or absence of moderate to severe sleep apnea (apnea/hypopnea index, AHI Ͼ20 h Ϫ1 ) in all patients (receiver operating characteristics, ROCϭ1.0). The ROC for AHI scores of Ն5 h Ϫ1 and Ն10 h Ϫ1 showed an area under the curve of 0.95, PϽ0.005, and 0.97, PϽ0.0001, respectively. Accuracy over time assessed by comparing events per 5-minute epochs was high (Cronbach ␣ reliability coefficient, 0.85; intraclass correlation, 0.73). Event-by-event comparison within Ϯ15 seconds revealed agreement in 81% (, 0.77; PϽ0.001). Conclusions-Detection of apnea/hypopnea events by pacemaker minute ventilation sensors is feasible and accurate compared with laboratory polysomnography. This technique might be useful to screen and monitor sleep-related breathing disorders in pacemaker patients.

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“…5 It has been shown to accurately detect OSA (in laboratory and ambulatory settings), [5][6][7][8] autonomic arousals, 9 and sleep/wake status. 10 The validity of using PAT and actigraphy signals derived from the PAT recorder to detect REM 11 and light/deep 12 sleep has also been demonstrated in two small studies.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…5,10 Briefly, this battery-powered, wrist-mounted device records PAT signal (finger arterial pulse wave volume), pulse rate derived from the PAT signal, oxyhemoglobin saturation, and wrist activity (derived from actigraphy). A continuous synchronization signal generated by the PAT recorder was recorded on both the PAT recorder device and the PSG for epoch-byepoch comparison.…”

Section: Wp100 Recordingmentioning

confidence: 99%

Sleep Staging Based on Autonomic Signals: A Multi-Center Validation Study

Hedner

White

Malhotra

et al. 2011

Journal of Clinical Sleep Medicine

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Study Objectives: One of the most important caveats of ambulatory devices is the inability to record and stage sleep. We assessed an algorithm determining 4 different stages: wake, light sleep, deep sleep, and REM sleep using signals derived from the portable monitor Watch-PAT100 (PAT recorder). Methods: Participants (38 normal subjects and 189 patients with obstructive sleep apnea [OSA]) underwent simultaneous overnight recordings with polysomnography (PSG) and the PAT recorder in a study originally designed to assess the accuracy of the PAT recorder in diagnosing OSA. Light/deep sleep and REM sleep from the PAT recorder recording were automatically scored based on features extracted from time series of peripheral arterial tone amplitudes and inter pulse periods. The PSG scored sleep stages 1 and 2 were classified as light sleep for epoch-by-epoch comparisons. Results:The overall agreement in detecting light/deep and REM sleep were 88.6% ± 5.9% and 88.7% ± 5.5%, respectively. There was a good agreement between PSG and the PAT recorder in quantifying sleep efficiency (78.4% ± 9.9% vs. 78.8% ± 13.4%), REM latency (237 ± 148 vs. 225 ± 159 epochs), and REM percentage (14.4% ± 6.5% vs. 19.3% ± 8.7%). OSA severity did not affect the sensitivity and specificity of the algorithm. The Cohen κ coefficient for detecting all sleep stages: sleep from wake, REM from NREM sleep, and deep from light sleep were 0.48, 0.55, 0.59, and 0.46, respectively. Conclusions: Analysis of autonomic signals from the PAT recorder can detect sleep stages with moderate agreement to more standard techniques in normal subjects and OSA patients. This novel algorithm may provide insights on sleep and sleep architecture when applying the PAT recorder for OSA diagnosis.

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Evaluation of a Portable Device Based on Peripheral Arterial Tone for Unattended Home Sleep Studiesa

Cited by 192 publications

References 21 publications

Obstructive sleep apnea syndrome: effect of respiratory events and arousal on pulse wave amplitude measured by photoplethysmography in NREM sleep

Obstructive sleep apnea syndrome: effect of respiratory events and arousal on pulse wave amplitude measured by photoplethysmography in NREM sleep

Diagnosis of Sleep-Related Breathing Disorders by Visual Analysis of Transthoracic Impedance Signals in Pacemakers

Sleep Staging Based on Autonomic Signals: A Multi-Center Validation Study

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