Role of portable sleep studies for diagnosis of obstructive sleep apnea

Current Opinion in Pulmonary Medicine

Volumn 9, Issue 6, 2003, Pages 465-470

  Boyer, Suzanne ^a,b   Kapur, Vishesh ^a  

^a UNIVERSITY OF WASHINGTON   (United States)

^b UNIVERSITY OF WASHINGTON   (United States)

Author keywords

Diagnosis; Obstructive sleep apnea; Polysomnography; Portable sleep study

Indexed keywords

ACTIMETRY; AMBULATORY MONITORING; CARDIOVASCULAR SYSTEM EXAMINATION; CLINICAL TRIAL; COST BENEFIT ANALYSIS; DIAGNOSTIC ACCURACY; DIAGNOSTIC PROCEDURE; HUMAN; INTERMETHOD COMPARISON; LABORATORY DIAGNOSIS; MANOMETRY; MEDICAL RESEARCH; METHODOLOGY; POLYSOMNOGRAPHY; REVIEW; SLEEP; SLEEP APNEA SYNDROME; TONOMETRY;

EID: 0142042490     PISSN: 10705287     EISSN: None     Source Type: Journal    
DOI: 10.1097/00063198-200311000-00003     Document Type: Review

References (38)

1. Ferber R, Millman R, Coppoly M, et al.: American Sleep Disorders Association Review: portable recording in the assessment of obstructive sleep apnea. Sleep 1994, 17:378-392.
2. Chesson AL, Ferber RA, Fry JM, et al.: American Sleep Disorders Association Review: the indications for polysomnography and related procedures. Sleep 1997, 20:423-487.
3. Redline S, Sanders M: Hypopnea, a floating metric: implications for prevalence, morbidity estimates and case finding. Sleep 1997, 20:1209-1217.
4. Hernandez L, Ballester E, Farre R, et al.: Performance of nasal prongs in sleep studies. Spectrum of flow-related events. Chest 2001, 119:442-450.
5. Hosselet J, Ayappa I, Norman RG, et al.: Classification os sleep-disordered breathing. Am J Resp Crit Care Med 2001, 163:398-405.
6. Kingshott RN, Douglas NJ: The effect of in-laboratory polysomnography on sleep and objective daytime sleepiness. Sleep 2000, 23:1109-1113.
7. LeBon O, Hoffman G, Tecco J, et al.: Mild to moderate sleep respiratory events. One negative might not be enough. Chest 2000, 118:353-359.
8. Meyer TJ, Eveloff SE, Kline LR, et al.: One negative polysomnogram does not exclude obstructive sleep apnea. Chest 1993, 103:756-760.
9. Netzer N, Eliasson AH, Netzer C, et al.: Overnight pulse oximetry for sleep-disordered breathing in adults: a review. Chest 2001, 120:625-633.
10. Fry JM, DiPhillipo MA, Curran K, et al.: Full polysomnography in the home. Sleep 1998, 21:635-642.
11. Mykytyn IJ, Sajkov D, Neill AM, et al.: Portable computerized polysomnography in attended and unattended settings. Chest 1999, 115:114-122.
12. Orr WC, Eiken T, Pegram V, et al.: A laboratory validation stud of a portable system fr remote recording of sleep-related respiratory disorders. Chest 1994, 105:160-162.
13. Portier F, Portmann A, Czernichow P, et al.: Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome. Am J Respir Crit Care Med 2000, 162:814-818.
14. Gagnadoux F, Pelletier-Fleury N, Philippe C, et al.: Home unattended vs hospital telemonitored polysomnography in suspected obstructive sleep apnea syndrome: a randomized crossover trial. Chest 2002, 121:753-758. Novel approach utilizing nurse-attended PSG in a local hospital with telemonitoring by a sleep laboratory versus unattended home PSG. High technical failure rate in unattended studies. Good diagnostic agreement. Patients preferred hospital-based testing.
15. Redline S, Sanders M, Lind B, et al.: Methods for obtaining and analyzing unattended polysomnography data for a multicenter study. Sleep 1998, 21:759-767.
16. Quan SF, Griswold ME, Iber C, et al.: Short-term variability of respiration and sleep during unattended nonlaboratory polysomnography - the Sleep Heart Health Study. Sleep 2002, 25:8-14. Subgroup of 99 participants of Sleep Heart Health Study underwent two level II sleep studies demonstrating high internight correlation of AHI measurement and good agreement in diagnostic classification. The SHHS is the only study evaluating a level II device applied to a general community (rather than sleep clinic referral-based population).
17. Claman D, Murr A, Trotter K: Clinical validation of the Bedbugg in detection of obstructive sleep apnea. Otolaryngol Head Neck Surg 2001, 125:227-230.
18. Whittle AT, Finch SP, Mortimore IL, et al.: Use of home sleep studies for diagnosis of the sleep apnoea/hypopnoea syndrome. Thorax 1997, 52:1068-1073.
19. Dingli K, Coleman EL, Vennelle M, et al.: Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 2003, 21:253-259. Phase one, validation study showed high correlation between simultaneous standard PSG and Embletta. Phase two prospectively applied diagnostic strategy using Embletta compared with standard PSG on the second night. Good diagnostic agreement, though nearly half of studies were "inconclusive" or technical failures.
20. Esnaola S, Duran J, Infante-Rivard C, et al.: Diagnostic accuracy of a portable recording device (MESAM IV) in suspected obstructive sleep apnoea. Eur Respir J 1996, 9:2597-2605.
21. Calleja JM, Esnaola S, Rubio R, et al.: Comparison of a cardiorespiratory device versus polysomnography for diagnosis of sleep apnoea. Eur Respir J 2002, 20:1505-1510. Validation study testing "unattended" MERLIN versus simultaneous PSG in laboratory setting; 8% failure rate, good accuracy, manual scoring superior to automatic.
22. Parra O, Garcia-Esclasans N, Montserrat JM, et al.: Should patients with sleep apnoea/hypopnoea syndrome be diagnosed and managed on the basis of home sleep studies? Eur Respir J 1997, 10:1720-1724.
23. Cole RJ, Kripke DF, Gruen W, et al.: Automatic sleep/wake identification from wrist actigraphy. Sleep 1992, 15:461-469.
24. Sadeh A, Hauri P, Kripke D, et al.: The role of actigraphy I the evaluation of sleep disorders. Sleep 1995, 18:288-302.
25. Elbez M, Roue GM, Lofaso F, et al.: Utility of actigraphy in the diagnosis of obstructive sleep apnea. Sleep 2002, 25:527-531. The addition of actigraphy to cardiorespiratory parameters offered slight benefit over cardiorespiratory parameters alone (comparison of AHI based on "sleep time" vs. "time in bed").
26. Kushida C, Chang A, Gadkary C, et al.: Comparison study of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients. Sleep Medicine 2001, 2:389-396.
27. Golpe R, Jimenez A, Carpizo R: Home sleep studies in the assessment of sleep apnea/hypopnea syndrome. Chest 2002, 122:1156-1161. Compared home study with level III system including actigraphy to standard PSG and demonstrated good diagnostic agreement. One third of home studies were " inconclusive" or technical failures.
28. Reuven H, Schweitzer E, Tarasiuk A: A cost-effectiveness analysis of alternative at-home or in-laboratory technologies for the diagnosis of obstructive sleep apnea syndrome. Med Decis Making 2001, 21:451-458.
29. Chervin RD, Murman DL, Malow BW, et al.: Cost-utility of three approaches to the diagnosis of sleep apnea: polysomnography, home testing and empirical therapy. Ann Intern Med 1999, 130:496-505.
30. Pitson DJ, Stradling JR: Autonomic markers of arousal during sleep in patients undergoing investigation for obstructive sleep apnea, their relationship to EEG arousals, respiratory events and subjective sleepiness. J Sleep Res 1998, 7:53-59.
31. Schnall RP, Shlitner A, Sheffy J, et al.: Periodic, profound peripheral vasoconstriction-a new marker of obstructive sleep apnea. Sleep 1999, 22:939-946.
32. Pillar G, Bar A, Shlitner A, et al.: Autonomic arousal index: an automated detection based on peripheral arterial tonometry. Sleep 2002, 25:543-549. The "autonomic arousal index" measured via peripheral arterial tonometry is well correlated with cortical arousals measured on simultaneous EEG.
33. O'Donnell CP, Allan L, Atkinson P, et al.: The effect of upper airway obstruction and arousal on peripheral arterial tonometry in obstructive sleep apnea. Am J Respir Crit Care Med 2002, 166:965-971. Both airflow obstruction and arousal from sleep result in increased sympathetic activation causing digital vasoconstriction, which can be reliably measured as a change in peripheral arterial tonometry (PAT) signal.
34. Sforza E: EEG and cardiac activation during periodic leg movements in sleep: support for a hierarchy of arousal responses. Neurology 1999, 52:786-791.
35. Winkelman W: The evoked heart rate response to periodic leg movements of sleep. Sleep 1999, 22:575-580.
36. Bar A, Pillar G, Dvir I, et al.: Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies. Chest 2003, 123:695-703. The first study to validate peripheral arterial tonometry as a tool to indirectly estimate AHI. The WatchPAT100, using PAT signal, oxygen saturation, heart rate, and actigraphy, provides highly correlated AHI measurements (rho = 0.88) and accurate diagnosis of OSA (AUC ROC 0.82 for AHI >10) in comparison with standard PSG.
37. Thorpy M, Chesson A, Ferber R, et al.: American Sleep Disorders Association Standards of Practice: practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Sleep 1994, 17:372-377.
38. Chesson AL, Ferber RA, Fry JM, et al.: American Sleep Disorders Association Standards of Practice: practice parameters for the indications for polysomnography and related procedures. Sleep 1997, 20:406-422.