Using a Wrist-Worn Device Based on Peripheral Arterial Tonometry to Diagnose Obstructive Sleep Apnea: In-Laboratory and Ambulatory Validation

bRIEF SUmmARYCurrent knowledge/Study Rationale: Polysomnography is mandatory in drivers older than 45 years old and those with snoring, witnessed apnea and/or day time sleepiness who are younger than 45 years old, before getting a highway bus driver licence in Turkey, but the number of sleep centers are not enough to test all the applicants. This study has been done to test the accuracy of Watch-PAT device in detecting sleep disordered breathing among the highway bus drivers.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reliability of the Watch-PAT 200 in Detecting Sleep Apnea in Highway Bus Drivers

Yüceege

Fırat²,

Demir³

et al. 2013

“…104 Two cross-over studies randomized patients to home-based PAT, and in-laboratory simultaneous PSG and PAT. 105,106 For comparison to in-laboratory PSG, only the home-based PAT data were used for this recommendation. A single study that evaluated the performance of the PAT device in the home against in-laboratory PSG using a cutoff of AHI ≥ 5, 106 reported a specificity of 0.43 (95% CI: 0.22 to 0.66).…”

Section: Accuracymentioning

confidence: 99%

“…When two studies evaluated the home-based PAT device against in-laboratory PSG at an AHI cutoff of ≥ 15, specificity ranged from 0.77 to 1.00 and sensitivity ranged from 0.92 to 0.96. 105,106 A single study evaluated the PAT device at an AHI cutoff of ≥ 30, and reported a specificity of 0.82 (95% CI: 0.57 to 0.96) and sensitivity of 0.92 (95% CI: 0.62 to 1.00) 105 (see supplemental material, Table S55 through Table S57). …”

Section: Accuracymentioning

confidence: 99%

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Kapur

Auckley

Chowdhuri

et al. 2017

2,140

1,498

Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. Recommendations:The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements:Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation. Recommendations:1. We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG) 2. We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG) 3. We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG) 4. We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG) 5. We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protoc...

“…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%

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

Hedner

White

Malhotra

et al. 2011

Self Cite

123

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.