https://doi.org/10.4081/monaldi.2021.1818
Diagnostic accuracy and feasibility of portable sleep monitoring in patients with obstructive sleep apnea: Re-exploring the utility in the current COVID-19 pandemic
Submitted: February 24, 2021
Accepted: August 3, 2021
Published: September 14, 2021
Accepted: August 3, 2021
Abstract Views: 1551
PDF: 697
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Portable sleep monitoring (PSM) is a promising alternative diagnostic tool for Obstructive Sleep Apnea (OSA) especially in high burden resource limited settings. We aimed to determine the diagnostic accuracy and feasibility of PSM device-based studies in patients presenting for evaluation of OSA at a tertiary care hospital in North-India. PSM studies (using a Type-III PSM device) were compared for technical reliability and diagnostic accuracy with the standard laboratory-based Type-I polysomnography (PSG). Patients were also interviewed about their experience on undergoing an unsupervised PSM studies. Fifty patients (68% males) were enrolled in the study, of which only 30% patients expressed their concerns about undergoing unsupervised PSM studies which included safety issues, ease of use, diagnostic accuracy, etc. Technical acceptability criteria were easily met by the PSM studies with signal loss in 12% studies (complete data loss and inaccessible data in 6% studies), warranting repetition sleep studies in four patients. The overall sensitivity of PSM device (AHI ≥5) was 93.5% (area under curve; AUC: 0.87). The diagnostic accuracy was 68.5%, 80%, and 91.4% for mild, moderate, and severe cases of OSA, respectively. An overall strong correlation was observed between PSM-AHI (apnoea-hypopnoea index) and PSG (r>0.85, p≤0.001), especially in severe OSA. The observed sensitivity was >90% for AHI>20 (clinically significant OSA), with high specificity of 91% for severe OSA (AUC: 0.94, 0.97 for AHI>20, AHI>30 respectively). The overall Bland-Altman concordance analysis also demonstrated only a small dispersion for PSM studies with a Cronbach’s coefficient of 0.95. Therefore, there is good diagnostic accuracy as well as feasibility of home-based portable sleep studies in Indian patients. It can be promoted for widespread use in high burden countries like India for diagnosing and managing appropriately selected stable patients with high clinical probability of OSA, especially during the ongoing crises of COVID-19 pandemic.
Young T, Palta M, Dempsey J, et al. The occurrence of sleep disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–5.
DOI: https://doi.org/10.1056/NEJM199304293281704
Bixler EO, Vgontzas AN, Ten Have T, et al. Effects of age on sleep apnea in men: Prevalence and severity. Am J Respir Crit Care Med 1998;157:144-8.
DOI: https://doi.org/10.1164/ajrccm.157.1.9706079
Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008;5:136-43.
DOI: https://doi.org/10.1513/pats.200709-155MG
Hashim Z, Nath A, Gupta M, et al. Diagnosis of obstructive sleep apnea in women: Is there any difference? - Experience from a tertiary care hospital of North India. J Family Med Prim Care 2019;8:3276-81.
DOI: https://doi.org/10.4103/jfmpc.jfmpc_609_19
Peppard PE, Young T, Barent HG, et al. Increased prevalence of sleep disordered breathing in adults. Am J Epidemiol 2013;177:1006-9.
DOI: https://doi.org/10.1093/aje/kws342
Young T, Palta M, Dempsey J, et al. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ 2009;108:246‐9.
Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2017;13:479–504.
DOI: https://doi.org/10.5664/jcsm.6506
Polese JF, Santos-Silva R, Kobayashi RF, et al. Portable monitoring devices in the diagnosis of obstructive sleep apnea: current status, advantages, and limitations. J Bras Pneumol 2010;36:498-505.
DOI: https://doi.org/10.1590/S1806-37132010000400017
Chesson AL Jr, Ferber RA, Fry JM, et al. The indications for polysomnography and related procedures. Sleep 1997;20:423‐487.
DOI: https://doi.org/10.1093/sleep/20.6.423
Collop NA, Tracy SL, Kapur V, et al. Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med 2011;7:531‐48.
DOI: https://doi.org/10.5664/JCSM.1328
Berry RB, Hill G, Thompson L, McLaurin V. Portable monitoring and autotitration versus polysomnography for the diagnosis and treatment of sleep apnea. Sleep 2008;31:1423‐31.
Garg N, Rolle AJ, Lee TA, Prasad B. Home-based diagnosis of obstructive sleep apnea in an urban population. J Clin Sleep Med 2014;10:879885.
Krishnaswamy U, Aneja A, Kumar RM, Kumar TP. Utility of portable monitoring in the diagnosis of obstructive sleep apnea. J Postgrad Med 2015;61:223‐9.
DOI: https://doi.org/10.4103/0022-3859.166509
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.
DOI: https://doi.org/10.5664/jcsm.27032
El Shayeb M, Topfer LA, Stafinski T, et al. Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ 2014;186:E25–51.
DOI: https://doi.org/10.1503/cmaj.130952
Senaratna CV, Perret JL, Matheson MC, et al. Validity of the Berlin questionnaire in detecting obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2017;36:116124.
DOI: https://doi.org/10.1016/j.smrv.2017.04.001
Chiu HY, Chen PY, Chuang LP, et al. Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bi-variate meta-analysis. Sleep Med Rev 2017;36:57‐70.
DOI: https://doi.org/10.1016/j.smrv.2016.10.004
Iber C, Ancoli-Israel S, Chesson A, Quan SF. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester: American Academy of Sleep Medicine; 2007.
Berry RB, Brooks R, Gamaldo C, et al. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med 2017;13:665‐6.
DOI: https://doi.org/10.5664/jcsm.6576
Iber C, Redline S, Kaplan Gilpin AM, et al. Polysomnography performed in the unattended home versus the attended laboratory setting – Sleep Heart Health Study methodology. Sleep 2004;27:536-40.
DOI: https://doi.org/10.1093/sleep/27.3.536
Kapur V, Rapoport D, Sanders M, et al. Rates of sensor loss in unattended home polysomnography: the influence of age, gender, obesity and sleep disordered breathing. Sleep 2000;23:682–8.
He J, Kryger MH, Zorick FJ, et al. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988;94:9‐14.
DOI: https://doi.org/10.1378/chest.94.1.9
Ge X, Han F, Huang Y, et al. Is obstructive sleep apnea associated with cardiovascular and all-cause mortality? PLoS One 2013;8:e69432.
DOI: https://doi.org/10.1371/journal.pone.0069432
Corral J, Sánchez-Quiroga MÁ, Carmona-Bernal C, et al. Conventional polysomnography is not necessary for the management of most patients with suspected obstructive sleep apnea. Noninferiority, randomized controlled trial. Am J Respir Crit Care Med 2017;196:1181‐90.
DOI: https://doi.org/10.1164/rccm.201612-2497OC
Tonelli de Oliveira AC, Martinez D, Vasconcelos LF, et al. Diagnosis of obstructive sleep apnea syndrome and its outcomes with home portable monitoring. Chest 2009;135:330–3.
DOI: https://doi.org/10.1378/chest.08-1859
Santos-Silva R, Sartori DE, Truksinas V, et al. Validation of a portable monitoring system for the diagnosis of obstructive sleep apnea syndrome. Sleep 2009;32:629-36.
DOI: https://doi.org/10.1093/sleep/32.5.629
Skomro RP, Gjevre J, Reid J, et al. Outcomes of home-based diagnosis and treatment of obstructive sleep apnea. Chest 2010;138:257–63.
DOI: https://doi.org/10.1378/chest.09-0577
Campbell AJ, Neill AM. Home set-up polysomnography in the assessment of suspected obstructive sleep apnea. J Sleep Res 2011;20:207‐13.
DOI: https://doi.org/10.1111/j.1365-2869.2010.00854.x
Aung K. In suspected OSA, home respiratory polygraphy was non-inferior to polysomnography for reducing symptoms. Ann Intern Med 2018;168:JC20.
DOI: https://doi.org/10.7326/ACPJC-2018-168-4-020
Rosen CL, Auckley D, Benca R, et al. A multisite randomized trial of portable sleep studies and positive airway pressure auto titration versus laboratory-based PSG for diagnosis and treatment of obstructive sleep apnea: The Home PAP Study. Sleep 2012;35:757-67.
DOI: https://doi.org/10.5665/sleep.1870
Ballester E, Solans M, Vila X, et al. Evaluation of a portable respiratory recording device for detecting apnoeas and hypopnoeas in subjects from a general population. Eur Respir J 2000;16:123-7.
DOI: https://doi.org/10.1034/j.1399-3003.2000.16a22.x
Us S, Baroody FM, Kohrman M, Suskind D. A comparison of polysomnography and a portable home sleep study in the diagnosis of obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 2004;131 844-50.
DOI: https://doi.org/10.1016/j.otohns.2004.07.014
Reichert JA, Bloch DA, Cundiff E, et al. Comparison of the NovaSom QSG, a new sleep apnea home-diagnostic system, and polysomnography. Sleep Med 2003;4:213–8.
DOI: https://doi.org/10.1016/S1389-9457(02)00234-4
Berry RB, Sriram P. Auto-adjusting positive airway pressure treatment for sleep apnea diagnosed by home sleeps testing. J Clin Sleep Med 2014;10:1269–75.
DOI: https://doi.org/10.5664/jcsm.4272
Garg N, Rolle AJ, Lee TA, et al. Home-based diagnosis of obstructive sleep apnea in an urban population. J Clin Sleep Med 2014;10:879–85.
DOI: https://doi.org/10.5664/jcsm.3960
Masa JF, Corral J, Sanchez de Cos J, et al. Effectiveness of three sleep apnea management alternatives. Sleep 2013;36:1799‐807.
DOI: https://doi.org/10.5665/sleep.3204
Hernández-Bendezú MDC, Arias-Peña MY, Torres-Fraga MG, Carrillo-Alduenda JL. Quality of an ambulatory monitoring technique for diagnosing obstructive sleep apnea under conditions of limited resources. Sleep Sci 2018;11:269‐73.
DOI: https://doi.org/10.5935/1984-0063.20180042
Gay PC, Selecky PA. Are sleep studies appropriately done in the home? Respir Care 2010;55:66-73.
Maestri R, Robbi E, Lovagnini M, et al. Quantitative assessment of the quality of home sleep studies: A computer-assisted approach. J Sleep Res 2020;29:e12899.
DOI: https://doi.org/10.1111/jsr.12899
How to Cite
Gupta, Mansi, Pranav Ish, Shibdas Chakrabarti, Manas Kamal Sen, Prabhakar Mishra, and Jagdish Chander Suri. 2021. “Diagnostic Accuracy and Feasibility of Portable Sleep Monitoring in Patients With Obstructive Sleep Apnea: Re-Exploring the Utility in the Current COVID-19 Pandemic”. Monaldi Archives for Chest Disease 92 (1). https://doi.org/10.4081/monaldi.2021.1818.
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