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Accuracy of a novel auto-CPAP device to evaluate the residual apnea-hypopnea index in patients with obstructive sleep apnea

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Abstract

Background

Patients under treatment with continuous positive airway pressure (CPAP) may have residual sleep apnea (RSA).

Objective

The main objective of our study was to evaluate a novel auto-CPAP for the diagnosis of RSA.

Methods

All patients referred to the sleep laboratory to undergo CPAP polysomnography were evaluated. Patients treated with oxygen or noninvasive ventilation and split-night polysomnography (PSG), PSG with artifacts, or total sleep time less than 180 min were excluded. The PSG was manually analyzed before generating the automatic report from auto-CPAP. PSG variables (respiratory disturbance index (RDI), obstructive apnea index, hypopnea index, and central apnea index) were compared with their counterparts from auto-CPAP through Bland–Altman plots and intraclass correlation coefficient. The diagnostic accuracy of autoscoring from auto-CPAP using different cutoff points of RDI (≥5 and 10) was evaluated by the receiver operating characteristics (ROCs) curve.

Results

The study included 114 patients (24 women; mean age and BMI, 59 years old and 33 kg/m2; RDI and apnea/hypopnea index (AHI)-auto median, 5 and 2, respectively). The average difference between the AHI-auto and the RDI was −3.5 ± 3.9. The intraclass correlation coefficient (ICC) between the total number of central apneas, obstructive, and hypopneas between the PSG and the auto-CPAP were 0.69, 0.16, and 0.15, respectively. An AHI-auto >2 (RDI ≥ 5) or >4 (RDI ≥ 10) had an area under the ROC curve, sensitivity, specificity, positive likelihood ratio, and negative for diagnosis of residual sleep apnea of 0.84/0.89, 84/81 %, 82/91 %, 4.5/9.5, and 0.22/0.2, respectively.

Conclusions

The automatic analysis from auto-CPAP (S9 Autoset) showed a good diagnostic accuracy to identify residual sleep apnea. The absolute agreement between PSG and auto-CPAP to classify the respiratory events correctly varied from very low (obstructive apneas, hypopneas) to moderate (central apneas).

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Acknowledgments

The authors wish to thank Ms. Jaquelina Mastantuono for revising the English text.

Conflict of interest

This study had no financial support. We declare there were no conflicts of interest related to this investigation.

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Authors and Affiliations

  1. Sleep Laboratory, Hospital Alemán, Pedro Goyena 620 3 B, CP 1424, Buenos Aires, Argentina

    Carlos Alberto Nigro

  2. Sleep Laboratory, Hospital Alemán, Av. Pueyrredón 1640, CP 1118, Buenos Aires, Argentina

    Sergio González & Anabella Arce

  3. Central Laboratory, Hospital Italiano, Potosí 4072, CP 1199, Buenos Aires, Argentina

    María Rosario Aragone

  4. Hospital Ramos Mejia, General Urquiza 609, CP 1221, Buenos Aires, Argentina

    Luciana Nigro

Authors
  1. Carlos Alberto Nigro
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  2. Sergio González
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  3. Anabella Arce
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  4. María Rosario Aragone
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  5. Luciana Nigro
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Correspondence to Carlos Alberto Nigro.

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

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  • DOI: https://doi.org/10.1007/s11325-014-1048-z

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