Management of Sleep Apnea without High Pretest Probability or with Comorbidities by Three Nights of Portable Sleep Monitoring

Guerrero, Arnoldo; Embid, Cristina; Isetta, Valentina; Farré, Ramón; Durán-Cantolla, Joaquín; Parra, Olga; Barbé, Ferrán; Montserrat, Josep M.; Masa, Juan F.

doi:10.5665/sleep.3932

Cited by 48 publications

(30 citation statements)

References 40 publications

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“…[28,29] However, Guerrero and colleagues reported that a 3-night PM was also accurate in ambulatory patients with mild comorbidities. [30] Our study expands on these results because the patients included in our study not only had more serious comorbidities, but they were also acutely ill; and yet, we were able to show that PM was as accurate in these patients as it is in stable patients tested at home.…”

Section: Discussionmentioning

confidence: 58%

The Accuracy of Portable Monitoring in Diagnosing Significant Sleep Disordered Breathing in Hospitalized Patients

et al. 2016

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BackgroundPolysomnograms are not always feasible when sleep disordered breathing (SDB) is suspected in hospitalized patients. Portable monitoring is a practical alternative; however, it has not been recommended in patients with comorbidities.ObjectiveWe evaluated the accuracy of portable monitoring in hospitalized patients suspected of having SDB.DesignProspective observational study.SettingLarge, public, urban, teaching hospital in the United States.ParticipantsHospitalized patients suspected of having SDB.MethodsPatients underwent portable monitoring combined with actigraphy during the hospitalization and then polysomnography after discharge. We determined the accuracy of portable monitoring in predicting moderate to severe SDB and the agreement between the apnea hypopnea index measured by portable monitor (AHIPM) and by polysomnogram (AHIPSG).ResultsSeventy-one symptomatic patients completed both tests. The median time between the two tests was 97 days (IQR 25–75: 24–109). Forty-five percent were hospitalized for cardiovascular disease. Mean age was 52±10 years, 41% were women, and the majority had symptoms of SDB. Based on AHIPSG, SDB was moderate in 9 patients and severe in 39. The area under the receiver operator characteristics curve for AHIPM was 0.8, and increased to 0.86 in patients without central sleep apnea; it was 0.88 in the 31 patients with hypercapnia. For predicting moderate to severe SDB, an AHIPM of 14 had a sensitivity of 90%, and an AHIPM of 36 had a specificity of 87%. The mean±SD difference between AHIPM and AHIPSG was 2±29 event/hr.ConclusionIn hospitalized, symptomatic patients, portable monitoring is reasonably accurate in detecting moderate to severe SDB.

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Section: Discussionmentioning

confidence: 58%

The Accuracy of Portable Monitoring in Diagnosing Significant Sleep Disordered Breathing in Hospitalized Patients

et al. 2016

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“…Based on current recommendations, the preponderance of the available literature has assessed the use of home sleep testing primarily in clinic-based populations with a high pretest probability of the disease. In the only available study exploring the use of home sleep testing in subjects with a low pretest probability, 16 it was demonstrated that three nights of home sleep testing can effectively and economically diagnose obstructive sleep apnea. However, given that a sleep clinic sample was assessed and the enrolled patients were not subjected to a standardized pretest assessment of risk, the results of that study are not generalizable to other patient samples.…”

Section: Discussionmentioning

confidence: 99%

Agreement Between Results of Home Sleep Testing for Obstructive Sleep Apnea with and Without a Sleep Specialist

Aurora

Putcha

Swartz

et al. 2016

The American Journal of Medicine

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Background Obstructive sleep apnea is a prevalent yet underdiagnosed condition associated with cardiovascular morbidity and mortality. Home sleep testing offers an efficient means for diagnosing obstructive sleep apnea but has primarily been deployed in clinical samples with a high pretest probability. The current study sought to assess if obstructive sleep apnea can be diagnosed with home sleep testing in a non-referred sample without involvement of a sleep medicine specialist. Methods A study of community-based adults with untreated obstructive sleep apnea was undertaken. Misclassification of disease severity based on home sleep testing with and without involvement of a sleep medicine specialist was assessed, and agreement was characterized using scatter plots, Pearson's correlation coefficient, Bland-Altman analysis, and the kappa statistic. Analyses were also conducted to assess whether any observed differences varied as a function of pretest probability of obstructive sleep apnea or subjective sleepiness. Results The sample consisted of 191 subjects with over half (56.5%) having obstructive sleep apnea. Without involvement of a sleep medicine specialist, obstructive sleep apnea was not identified in only 5.8% of the sample. Analyses comparing the categorical assessment of disease severity with and without a sleep medicine specialist showed that in total, 32 subjects (16.8%) were misclassified. Agreement in the disease severity with and without a sleep medicine specialist was not influenced by the pretest probability or daytime sleep tendency. Conclusion Obstructive sleep apnea can be reliably identified with home sleep testing in a non-referred sample irrespective of the pretest probability of the disease.

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“…Furthermore, a type 3 portable monitoring (PM) device (Stardust II Sleep Recorder; Philips Respironics, Inc.) has been recommended for use in a clinical environment if the recordings are reviewed manually (21). However, the use of PM also has limitations, since the device is sophisticated and causes patient discomfort, as a finger probe, nasal cannula and belt must be attached to the body (24). In addition, PM is not recommended in suspected OSA patients with comorbid conditions, such as insomnia, depression and mania, which may mask symptoms of OSA (25).…”

Section: Discussionmentioning

confidence: 99%

Validation of a novel sleep-monitoring system for diagnosing obstructive sleep apnea: A comparison with polysomnography

Meng

Guan

et al. 2016

Experimental and Therapeutic Medicine

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Overnight polysomnography (PSG) is currently the gold standard for diagnosing obstructive sleep apnea (OSA); however, it is time-consuming, expensive and uncomfortable for the patient. A micromovement sensitive mattress (MSM) sleep-monitoring system was developed as an alternative to PSG, however, there has yet to be a study verifying the accuracy of diagnosing OSA with this device. Therefore, the present study assessed the validity of the MSM sleep-monitoring system. Chinese Han participants who were suspected of having OSA were recruited between June 2013 and June 2014. The MSM sleep-monitoring system and PSG were utilized simultaneously overnight on each subject. The apnea-hypopnea index (AHI) was measured by the MSM sleep-monitoring system (AHIMSM) and compared with that determined by PSG (AHIPSG), revealing a significant correlation between the two values (r=0.97, P<0.001). Bland-Altman plots also indicated good agreement (97%) between MSM and PSG. Using an AHIPSG cut-off of ≥5, ≥15 and ≥30 events/h, the sensitivity (specificity) of detecting an AHIMSM of ≥5, ≥15, and ≥30 events/h were 94.9 (100%), 89.9 (96.9%) and 90.3% (94.9%), respectively. The areas under the receiver operating characteristic curve, which were used to differentiate an AHIPSG of ≥5, ≥15 and ≥30 events/h in clinically diagnosed OSA, were 0.984, 0.982 and 0.980, respectively. Thus, the MSM sleeping system may accurately diagnose OSA in the Chinese Han population. Further community-based studies with larger sample sizes are warranted to confirm the validity of this MSM sleeping system.

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Management of Sleep Apnea without High Pretest Probability or with Comorbidities by Three Nights of Portable Sleep Monitoring

Abstract: Guerrero A, Embid C, Isetta V, Farre R, Duran-Cantolla J, Parra O, Barbé F, Montserrat JM, Masa JF. Management of sleep apnea without high pretest probability or with comorbidities by three nights of portable sleep monitoring.

Cited by 48 publications

References 40 publications

The Accuracy of Portable Monitoring in Diagnosing Significant Sleep Disordered Breathing in Hospitalized Patients

The Accuracy of Portable Monitoring in Diagnosing Significant Sleep Disordered Breathing in Hospitalized Patients

Agreement Between Results of Home Sleep Testing for Obstructive Sleep Apnea with and Without a Sleep Specialist

Validation of a novel sleep-monitoring system for diagnosing obstructive sleep apnea: A comparison with polysomnography

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