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17.11.2022 | Methods • Original Article

Reliability of respiratory event detection with continuous positive airway pressure in moderate to severe obstructive sleep apnea — comparison of polysomnography with a device-based analysis

verfasst von: Matthias Richter, Maik Schroeder, Ulrike Domanski, Matthias Schwaibold, Georg Nilius

Erschienen in: Sleep and Breathing | Ausgabe 4/2023

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Abstract

Purpose

Monitored polysomnography (PSG) is considered the gold standard technique to diagnose obstructive sleep apnea (OSA) and titrate continuous positive airway pressure (CPAP), the accepted primary treatment method. Currently, the American Academy of Sleep Medicine (AASM) considers automatic PAP therapy initiation at home comparable to laboratory titration and recommends telemonitoring-guided interventions. Advanced CPAP devices evaluate and report the residual apnea–hypopnea index (AHI). However, in order to control the effectiveness of the prescribed therapy outside of a PSG setting, the automatic event detection must provide reliable data.

Methods

A CPAP titration was performed in the sleep laboratory by PSG in patients with OSA. The residual event indices detected by the tested device (prismaLine, Loewenstein Medical Technology) were compared to the manually scored PSG indices. Results of the device (AHI_FLOW) were compared according to the AASM scoring criteria 1A (AHI_1A, hypopneas with a flow signal reduction of ≥ 30% with ≥ 3% oxygen reduction and/or an arousal) and 1B (AHI_1B, hypopneas with a flow signal decrease by ≥ 30% with a ≥ 4% oxygen desaturation).

Results

In 50 patients with OSA, the mean PSG AHI_1A was 10.5 ± 13.8/h and the PSG AHI_1B was 7.4 ± 12.6/h compared to a mean device AHI_Flow of 8.4 ± 10.0/h. The correlation coefficient regarding PSG AHI_1A and AHI_Flow was 0.968. The correlation regarding central hypopneas on the other hand was 0.153. There were few central events to be compared in this patient group.

Conclusion

The device-based analysis showed a high correlation in the determination of residual obstructive AHI under therapy. The recorded residual respiratory event indices in combination with the data about leakage and adherence of the studied device provide reliable information for the implementation and follow-up of CPAP therapy in a typical group of patients with OSA.

Trial Registration Number: ClinicalTrials.gov Identifier: NCT04407949, May 29, 2020, retrospectively registered.

Pinto JA, Ribeiro DK, Cavallini AF, Duarte C, Freitas GS (2016) Comorbidities associated with obstructive sleep apnea: a retrospective study. Int Arch Otorhinolaryngoly 20(2):145–150. https://doi.org/10.1055/s-0036-1579546CrossRef

Osman AM, Carter SG, Carberry JC, Eckert D (2018) Obstructive sleep apnea: current perspectives. Nat Sci Sleep 10:21–34. https://doi.org/10.2147/NSS.S124657 (Published 2018 Jan 23)CrossRefPubMedPubMedCentral

Marin JM, Agusti A, Villar I et al (2012) Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA 307(20):2169–2176. https://doi.org/10.1001/jama.2012.3418CrossRefPubMedPubMedCentral

Gottlieb DJ, Yenokyan G, Newman AB et al (2010) Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 122(4):352–360. https://doi.org/10.1161/CIRCULATIONAHA.109.901801CrossRefPubMedPubMedCentral

Weaver TE, Maislin G, Dinges DF et al (2007) Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 30(6):711–719. https://doi.org/10.1093/sleep/30.6.711CrossRefPubMedPubMedCentral

Deegan PC, McNicholas WT (1995) Pathophysiology of obstructive sleep apnoea. Eur Respir J 8(7):1161–1178. https://doi.org/10.1183/09031936.95.08071161CrossRefPubMed

Senaratna CV, Perret JL, Lodge CJ et al (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81. https://doi.org/10.1016/j.smrv.2016.07.002CrossRefPubMed

Kapur V, Strohl KP, Redline S, Iber C, O’Connor G, Nieto J (2002) Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath 6(2):49–54. https://doi.org/10.1007/s11325-002-0049-5CrossRefPubMed

The Lancet Respiratory Medicine (2020) Time to wake the giant of obstructive sleep apnoea. Lancet Respir Med 8(1):1. https://doi.org/10.1016/S2213-2600(19)30449-7CrossRefPubMed

10.

Peppard PE, Young T, Barnet JH et al (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177(9):1006–1014. https://doi.org/10.1093/aje/kws342.10.1093/aje/kws342CrossRefPubMedPubMedCentral

11.

Young T, Palta M, Dempsey J et al (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235. https://doi.org/10.1056/NEJM199304293281704CrossRefPubMed

12.

Heinzer R, Vat S, Marques-Vidal P et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3(4):310–318. https://doi.org/10.1016/S2213-2600(15)00043-0CrossRefPubMedPubMedCentral

13.

Berry RB, Brooks R, Gamaldo CE, for the American Academy of Sleep Medicine et al (2017) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Darien, IL: American Academy of Sleep Medicine; Version 2.4. J Clin Sleep Med 13(5):665–666. https://doi.org/10.5664/jcsm.6576CrossRefPubMedPubMedCentral

14.

Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG (2019) Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 15(2):335–343. https://doi.org/10.5664/jcsm.7640 (Published 2019 Feb 15)CrossRefPubMedPubMedCentral

15.

Singh J, Badr MS, Diebert W et al (2015) American Academy of Sleep Medicine (AASM) position paper for the use of telemedicine for the diagnosis and treatment of sleep disorders. J Clin Sleep Med 11(10):1187–1198. https://doi.org/10.5664/jcsm.5098 (Published 2015 Oct 15)CrossRefPubMedPubMedCentral

16.

Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG (2019) Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. J Clin Sleep Med 15(2):301–334. https://doi.org/10.5664/jcsm.7638 (Published 2019 Feb 15)CrossRefPubMedPubMedCentral

17.

Bertelli F, Suehs CM, Mallet JP et al (2021) Apnoea-hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis. BMJ Open 11(5):e044499. https://doi.org/10.1136/bmjopen-2020-044499 (Published 2021 May 10)CrossRefPubMedPubMedCentral

18.

Randerath W, Bögel M, Franke C, Hellmann A, Jany B, Nilius G, Penzel T, Voshaar T, Wiater A (2017) Positionspapier zum Telemonitoring bei schlafbezogenen Atmungsstörungen [Positionpaper on Telemonitoring in Sleep-Related Breathing Disorders]. Pneumologie (Stuttgart Germany) 71(2):81–85. https://doi.org/10.1055/s-0042-124083CrossRefPubMed

19.

Borel JC, Palot A, Patout M (2019) Technological advances in home non-invasive ventilation monitoring: reliability of data and effect on patient outcomes. Respirology 24(12):1143–1151. https://doi.org/10.1111/resp.13497CrossRefPubMed

20.

Schwab RJ, Badr SM, Epstein LJ et al (2013) An official American Thoracic Society statement: continuous positive airway pressure adherence tracking systems. The optimal monitoring strategies and outcome measures in adults. Am J Respir Crit Care Med 188(5):613–620. https://doi.org/10.1164/rccm.201307-1282STCrossRefPubMedPubMedCentral

21.

Nilius G, Schroeder M, Domanski U, Richter M (2020) A comparison of sleep disordered breathing events detected by CPAP devices with in-lab polysomnography. Eur Respir J 56:2491. https://doi.org/10.1183/13993003.congress-2020.2491CrossRef

22.

Herkenrath SD, Treml M, Anduleit N et al (2020) Extended evaluation of the efficacy of a proactive forced oscillation technique-based auto-CPAP algorithm. Sleep Breath 24(3):825–833. https://doi.org/10.1007/s11325-019-01901-8CrossRefPubMed

23.

Huang HC, Hillman DR, McArdle N (2012) Control of OSA during automatic positive airway pressure titration in a clinical case series: predictors and accuracy of device download data. Sleep 35(9):1277–83A. https://doi.org/10.5665/sleep.2086 (Published 2012 Sep 1)CrossRefPubMedPubMedCentral

24.

Nigro CA, González S, Arce A, Aragone MR, Nigro L (2015) Accuracy of a novel auto-CPAP device to evaluate the residual apnea-hypopnea index in patients with obstructive sleep apnea. Sleep Breath 19(2):569–578. https://doi.org/10.1007/s11325-014-1048-zCrossRefPubMed

25.

Berry RB, Kushida CA, Kryger MH, Soto-Calderon H, Staley B, Kuna ST (2012) Respiratory event detection by a positive airway pressure device. Sleep 35(3):361–367. https://doi.org/10.5665/sleep.1696 (Published 2012 Mar 1)CrossRefPubMedPubMedCentral

26.

Ikeda Y, Kasai T, Kawana F et al (2012) Comparison between the apnea-hypopnea indices determined by the REMstar Auto M series and those determined by standard in-laboratory polysomnography in patients with obstructive sleep apnea. Intern Med 51(20):2877–2885. https://doi.org/10.2169/internalmedicine.51.8249CrossRefPubMed

27.

Ueno K, Kasai T, Brewer G et al (2010) Evaluation of the apnea-hypopnea index determined by the S8 auto-CPAP, a continuous positive airway pressure device, in patients with obstructive sleep apnea-hypopnea syndrome. J Clin Sleep Med 6(2):146–151CrossRefPubMedPubMedCentral

28.

Pittman SD, Pillar G, Berry RB, Malhotra A, MacDonald MM, White DP (2006) Follow-up assessment of CPAP efficacy in patients with obstructive sleep apnea using an ambulatory device based on peripheral arterial tonometry. Sleep Breath 10(3):123–131. https://doi.org/10.1007/s11325-006-0058-xCrossRefPubMed

29.

Baltzan MA, Kassissia I, Elkholi O, Palayew M, Dabrusin R, Wolkove N (2006) Prevalence of persistent sleep apnea in patients treated with continuous positive airway pressure. Sleep 29(4):557–563PubMed

30.

Rotty MC, Suehs CM, Mallet JP et al (2021) Mask side-effects in long-term CPAP-patients impact adherence and sleepiness: the InterfaceVent real-life study. Respir Res 22(1):17. https://doi.org/10.1186/s12931-021-01618-xCrossRefPubMedPubMedCentral

31.

Grote L, Theorell-Haglöw J, Ulander M, Hedner J (2021) Prolonged effects of the COVID-19 pandemic on sleep medicine services-longitudinal data from the Swedish Sleep Apnea Registry. Sleep Med Clin 16(3):409–416. https://doi.org/10.1016/j.jsmc.2021.05.008CrossRefPubMedPubMedCentral

32.

Grote L, McNicholas WT, Hedner J, ESADA collaborators (2020) Sleep apnoea management in Europe during the COVID-19 pandemic: data from the European Sleep Apnoea Database (ESADA). Eur Respir J 55(6):2001323. https://doi.org/10.1183/13993003.01323-2020 (Published 2020 Jun 18)CrossRefPubMedPubMedCentral

33.

Johnson KG, Sullivan SS, Nti A et al (2021) The impact of the COVID-19 pandemic on sleep medicine practices. J Clin Sleep Med 17(1):79–87. https://doi.org/10.5664/jcsm.8830CrossRefPubMedPubMedCentral

34.

Zhang XL, Wang W, Xiao Y (2021) Members of the assembly of sleep disordered breathing of the Chinese thoracic society. Sleep disordered breathing diagnosis and treatment during the COVID-19 pandemic: a nationwide survey in China. Nat Sci Sleep 13:21–30. https://doi.org/10.2147/NSS.S292373CrossRefPubMedPubMedCentral

35.

Penzel T, Schöbel C, Fietze I (n.d.) New technology to assess sleep apnea: wearables, smartphones, and accessories. F1000Res 7:413. Published 2018 Mar 29. https://doi.org/10.12688/f1000research.13010.1

36.

Roeder M, Bradicich M, Schwarz EI et al (2020) Night-to-night variability of respiratory events in obstructive sleep apnoea: a systematic review and meta-analysis. Thorax 75(12):1095–1102. https://doi.org/10.1136/thoraxjnl-2020-214544CrossRefPubMed

37.

38.

Rowland S, Aiyappan V, Hennessy C et al (2018) Comparing the efficacy, mask leak, patient adherence, and patient preference of three different CPAP interfaces to treat moderate-severe obstructive sleep apnea. J Clin Sleep Med 14:101–108. https://doi.org/10.5664/jcsm.6892CrossRefPubMedPubMedCentral

Titel: Reliability of respiratory event detection with continuous positive airway pressure in moderate to severe obstructive sleep apnea — comparison of polysomnography with a device-based analysis
verfasst von: Matthias Richter
Maik Schroeder
Ulrike Domanski
Matthias Schwaibold
Georg Nilius
Publikationsdatum: 17.11.2022
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 4/2023
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-022-02740-w

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Reliability of respiratory event detection with continuous positive airway pressure in moderate to severe obstructive sleep apnea — comparison of polysomnography with a device-based analysis

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