Diagnostic Accuracy of a Portable Sleep Apnea Screener against Standard Polysomnography in Patients Referred to a Sleep Laboratory
AbstractBackground and Objective: Obstructive sleep apnea (OSA) is a disease with serious consequences. Many portable devices have been developed to overwhelm some of limitations in the accessibility of the gold standard test for OSA, polysomnography (PSG). This study aimed to determine diagnostic accuracy of a portable sleep apnea screener against PSG in patients of a sleep clinic.Materials and Methods: Patients admitted to a sleep lab were recruited during a three-month period. Study participants underwent one night simultaneous recording of PSG and a double channel portable sleep apnea screener in the laboratory. A sleep physician scored the PSGs manually according to standard criteria. Portable sleep apnea screener data were analyzed automatically with the manufacturer’s proprietary software. We com- pared the apnea–hypopnea indices (AHI) from the PSG and the portable sleep apnea screener to assess the spec- ificity and sensitivity of the device.Results: A total of 120 patients completed the study. Mean AHI recorded from PSG and portable device were 31.7 and 30.8, respectively. Using a variety of AHI cutoff values (5, 10, 15, 20, 30 and 40), sensitivities of the portable device were 96.9, 88.6, 87.2, 84.1, 79.6, and 83.9 percent and specificities were 45.5, 71.9, 69.0,74.5, 90.1, and 88.8 percent, respectively. The LRs+ were 1.77, 3.15, 2.81, 3.29, 8.04 and 7.49 and the LRs- were 0.06, 0.15, 0.18, 0.21, 0.22 and 0.18. The AUCs were 0.90, 0.88, 0.86, 0.89, 0.90, and 0.92, respectively.Conclusions: In studied participants, portable device showed acceptable sensitivity and specificity in the lab when compared to the standard PSG.
Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007;3:737-47.
Collop NA, Tracy SL, Kapur V, et al. Obstruc- tive sleep apnea devices for out-of-center (OOC)testing: technology evaluation. J Clin Sleep Med.2011;7:531 -48.
Fleetham J, Ayas N, Bradley D, et al. Canadian Thoracic Society 2011 guideline update: diagnosis and treatment of sleep disordered breathing. Can Respir J 2011;18:25-47.
Reichert JA, Bloch DA, Cundiff E, Votteri BA. Comparison of the NovaSom QSG, a new sleep ap-nea home-diagnostic system, and polysomnography.Sleep Med 2003;4:213-8.
Chen H, Lowe AA, Bai Y, Hamilton P, Fleeth- am JA, Almeida FR. Evaluation of a portable record- ing device (ApneaLink) for case selection of obstruc- tive sleep apnea. Sleep Breath 2009;13:213-9.
Bresnitz EA, Goldberg R, Kosinski RM. Epi- demiology of obstructive sleep apnea. Epidemiol Rev 1994;16:210-27.
Olson LG, King MT, Hensley MJ, Saunders NA. A community study of snoring and sleep- disordered breathing. Prevalence. Am J Respir Crit Care Med 1995;152:711-6.
Flemons WW, Douglas NJ, Kuna ST, Ro- denstein DO, Wheatley J. Access to diagnosis and treatment of patients with suspected sleep apnea. AmJ Respir Crit Care Med 2004;169:668-72.
Namen AM, Dunagan DP, Fleischer A, et al.Increased physician-reported sleep apnea: The na- tional ambulatory medical care survey. Chest2002;121:1741-7.
Erman MK, Stewart D, Einhorn D, Gordon N, Casal E. Validation of the ApneaLink for the screen- ing of sleep apnea: a novel and simple single-channel recording device. J Clin Sleep Med 2007;3:387-92..
Ferber R, Millman R, Coppola M, et al. Porta- ble recording in the assessment of obstructive sleep apnea. ASDA standards of practice. Sleep 1994;17:378-92.
Sunwoo B, Kuna ST. Ambulatory manage- ment of patients with sleep apnea: is there a place for portable monitor testing? Clin Chest Med 2010;31:299-308.
Kirsch DB. PRO: sliding into home: portable sleep testing is effective for diagnosis of obstructive sleep apnea. J Clin Sleep Med 2013;9:5-7.
McArdle N, Grove A, Devereux G, Mackay- Brown L, Mackay T, Douglas NJ. Split-night versus full-night studies for sleep apnoea/hypopnoea syn- drome. Eur Respir J 2000;15:670-5.
Wittine LM, Olson EJ, Morgenthaler TI. Ef- fect of recording duration on the diagnostic accuracy of out-of-center sleep testing for obstructive sleep apnea. Sleep 2014;37:969-75.
Ruehland WR, Rochford PD, O'Donoghue FJ, Pierce RJ, Singh P, Thornton AT. The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep 2009;32:150-7.
Barak-Shinar D, Amos Y, Bogan RK. Sleep disordered breathing analysis in a general population using standard pulse oximeter signals. Sleep Breath 2013;17:1109-15.
Rosen CL, Auckley D, Benca R, et al. A mul- tisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laborato- ry-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sleep 2012;35:757-67.
Tan HL, Gozal D, Ramirez HM, Bandla HP, Kheirandish-Gozal L. Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea. Sleep 2014;37:255-60.
Norman MB, Middleton S, Erskine O, Middle- ton PG, Wheatley JR, Sullivan CE. Validation of the Sonomat: a contactless monitoring system used for the diagnosis of sleep disordered breathing. Sleep 2014;37:1477-87.
Littner MR. Portable monitoring in the diagno-sis of the obstructive sleep apnea syndrome. Semin Respir Crit Care Med 2005;26:56-67.