Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy

Jf, Masa; Corral, Jaime; J, Gomez de Terreros; Durán-Cantolla, Joaquín; Cabello, Marta; Hernández‐Blasco, Luis; Monasterio, Carmen; Alonso, Alicia; Chiner, Eusebi; Aizpuru, Felipe; Zamorano, José Luís; Cano, Ricardo Romero; Montserrat, Josep M.; García-Ledesma, Estefanía; Pereira, Ricardo; Cancelo, Laura; Martínez, A. Martín; Sacristan, Lirios; Salord, Neus; Carrera, Miguel; Jn, Sancho-Chust; Embid, Cristina

doi:10.5665/sleep.2384

Cited by 18 publications

(14 citation statements)

References 31 publications

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“…14 , 15 , 29 HRa, pulse transit time (PTT), post-event hyperventilation, and pulse-wave amplitude (PWA) drops have been used as markers of autonomic arousals in different studies. 14 , 15 , 29 , 30 Due to its accessibility in type 3 recordings, HRa has emerged as an interesting autonomic arousal marker, and its use as a surrogate has been explored already in other investigations. 13 , 15 , 31 Although a previous study from our group showed that a cut-off value of 10 bpm correlated better with RDIe, 14 to perform this proof of concept study we decided to use a cut-off value of 5 bpm based on previous literature and on the empirical impression that such a lower cut-off would help to capture more autonomic arousal events.…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of Autonomic Arousals in Scoring Sleep Respiratory Disturbances with Polysomnography and Portable Monitor Devices: A Proof of Concept Study

Mayer

Babiloni

Beetz

et al. 2020

NSS

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Background: Autonomic arousals can be considered as surrogates of electroencephalography (EEG) arousals when calculating respiratory disturbance index (RDI). The main objective of this proof of concept study was to evaluate the use of heart rate acceleration (HRa) arousals associated with sleep respiratory events in a population undergoing full polysomnography (type 1) and in another undergoing portable monitor study (type 3). Our hypothesis is that when compared to other commonly used indexes, RDI based on HRa will capture more events in both types of recording. Materials and Methods: A retrospective analysis was performed in two different populations of patients with suspected OSA: a) 72 patients undergoing one night of type 1 recording and b) 79 patients undergoing one night of type 3 recording. Variables for type 1 were 4% oxygen desaturation index (ODI), apnea/hypopnea index (AHI), RDI based on EEG arousals (RDIe), and RDI based on HRa with threshold of 5bpm (RDIa5). For type 3, variables were 4% ODI, AHI, and RDIa5 (it is not possible to calculate RDIe due to the absence of EEG). Calculated data were 1) Mean values for each sleep disturbance index in type 1 and 3 recordings; 2) Frequency of migration from lower to higher OSA severity categories using RDIa5 in comparison to AHI (thresholds: ≥5/h mild, ≥15/h moderate, ≥30/h severe); and 3) Bland-Altman plots to assess agreement between AHI vs RDIe and RDIa5 in type 1 population, and AHI vs RDIa5 in type 3 populations. Results: More respiratory disturbance events were captured with RDIa5 index in both type 1 and type 3 recordings when compared to the other indexes. In type 1 recording, when using RDIa5 37% of patients classified as not having OSA with AHI were now identified as having OSA, and a total of 59% migrated to higher severity categories. In type 3 recording, similar results were obtained, as 37% of patients classified as not having OSA with AHI were now identified as having OSA using RDIa5, and a total of 55% patients migrated to higher severity categories. Mean differences for RDIa5 and AHI in type 1 and 3 populations were similar. Conclusion: The use of autonomic arousals such as HRa can help to detect more respiratory disturbance events when compared to other indexes, being a variable that may help to capture borderline mild cases. This becomes especially relevant in type 3 recordings. Future research is needed to determine its validity, optimization, and its clinical significance.

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Section: Discussionmentioning

confidence: 99%

The Evaluation of Autonomic Arousals in Scoring Sleep Respiratory Disturbances with Polysomnography and Portable Monitor Devices: A Proof of Concept Study

Mayer

Babiloni

Beetz

et al. 2020

NSS

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“…Furthermore, none of the above-mentioned studies have had cost analyses to determine viability in clinical practice or multicenter design to minimize inter-center variability. Moreover, all but one 19 of these studies scored the respiratory events automatically. While automatic scoring is simpler, manual scoring has greater agreement with PSG for respiratory polygraphy, 20 and also for a single-channel nasal pressure device measured simultaneously with in-laboratory PSG.…”

Section: Effectiveness Of Home Single-channel Nasal Pressure For Sleementioning

confidence: 99%

Effectiveness of Home Single-Channel Nasal Pressure for Sleep Apnea Diagnosis

Masa

Durán-Cantolla

Capote

et al. 2014

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“…In one study, 312 subjects with all the different degrees of OSA severity were analyzed, and it was concluded that the addition of PWA drops to the definition of hypopnea as a surrogate for EEG arousal could provide a more comprehensive diagnosis of OSA. Similarly, another study considered hyperventilation following flow reduction as another potential surrogate for EEG arousals 21. Nevertheless, the authors of this study concluded that in severe OSA, the use of this marker as a surrogate did not present an additional value to OSA diagnosis with PSG nor PM.…”

Section: Discussionmentioning

confidence: 84%

Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders

Mayer¹,

Babiloni²,

Aubé³

et al. 2019

NSS

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IntroductionPortable monitoring (PM) is an alternative to laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA). However, PM tends to underestimate the apnea-hypopnea index (AHI), as it does not identify non-desaturating events associated with electroencephalographic (EEG) arousal. The objectives were to explore heart rate acceleration (HRa) and decrease in pulse transit time (PTT) as surrogates to EEG arousal for non-desaturating hypopnea and respiratory effort-related arousal (RERA), and to estimate cut-off values for their use with both total sleep time (TST), the standard method for PSG, and total recording time (TRT), the usual method for PM.MethodsTwenty-four consecutive individuals with suspected OSA were studied with PSG. Calculated outcomes were: AHI, respiratory disturbance index with EEG arousal (RDIe) and autonomic arousal by HRa (RDI-HRa) and PTT decreases (RDI-PTT) at different time cut-offs. Using RDIe as reference, Bland Altman and intraclass coefficient of correlation (ICC) were used to calculate agreement between indexes, and receiver operating curves (ROC) for sensitivity/specificity of the different cut-offs.ResultsAutonomic arousals, limited to respiratory events, were present in 36% of non-desaturating hypopneas and 29% of RERAs. Using TST, RDI-HRa of 10 bpm (ICC= 0.89) and RDI-PTT with a decrease of −15 msec (ICC=0.90) agreed better with RDIe. With TRT, the RDI-HRa of 5 bpm agreed better with the RDIe (ICC=0.89). Bland–Altman plots showed mean differences of 1.53 between RDI-HRa10-TST and RDIe and 0.89 between RDI-HRa5-TRT and RDIe.ConclusionAutonomic arousals (HRa and PTT) may be a suitable proxy of EEG arousals associated with respiratory events, using both TST and TRT. Therefore, they could potentially help to capture borderline symptomatic patients and to monitor treatment outcomes.

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Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy

Abstract: Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).

Cited by 18 publications

References 31 publications

<p>The Evaluation of Autonomic Arousals in Scoring Sleep Respiratory Disturbances with Polysomnography and Portable Monitor Devices: A Proof of Concept Study</p>

<p>The Evaluation of Autonomic Arousals in Scoring Sleep Respiratory Disturbances with Polysomnography and Portable Monitor Devices: A Proof of Concept Study</p>

Effectiveness of Home Single-Channel Nasal Pressure for Sleep Apnea Diagnosis

<p>Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders</p>

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