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

Abstract

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.

Comparing sleep studies in terms of the Apnea-Hypopnea Index using dedicated Shiny web application

“…As stated in the previous section, the presented sample analysis was carried out on the data from the paper [28].…”

“…The input file should be an Excel spreadsheet with two columns comprising reference AHI values and values from a tested device. Before any file is uploaded, the tabs present the results of the analysis of the default data, coming from [28], a study assessing the agreement between the AHI parameters measured by portable monitor and by reference polysomnogram. The data are not well concordant, which facilitates presentation.…”

Portable Sleep Monitoring for Diagnosing Sleep Apnea in Hospitalized Patients With Heart Failure

“…The available literature on inpatient sleep testing is limited but demonstrates consistency in results, with a high level of concordance seen between portable sleep testing used in the inpatient setting and subsequent outpatient polysomnography for the diagnosis of obstructive sleep apnea. [30][31][32][33] Previous studies have shown that inpatient sleep monitoring, using either high-resolution pulse oximetry 33,34 or portable sleep monitors, is technically feasible 21,30,35,36 with failure rates ranging between 2% and 19%. Findings from the current study are congruent with previous reports, demonstrating a technical failure rate of 3.5% for respiratory polygraphy.…”

“…Executing simultaneous recordings of both types of studies is of considerable value, as it has been previously observed that a significant number of central respiratory events initially noted on inpatient portable monitoring subsequently abated on outpatient polysomnography performed at a later date. 31 Indeed, the uncertainty regarding the reliability of portable sleep monitoring in identifying central sleep apnea has been a limitation in its use. Previous studies have primarily reported agreement on obstructive sleep apnea as the samples had predominantly obstructive disordered breathing events, and agreement for central vs obstructive events was not reported.…”