Evaluation of a portable recording device (ApneaLink™) for case selection of obstructive sleep apnea
- 576 Downloads
This study was designed to assess the sensitivity and specificity of a portable sleep apnea recording device (ApneaLink™) using standard polysomnography (PSG) as a reference and to evaluate the possibility of using the ApneaLink™ as a case selection technique for patients with suspected obstructive sleep apnea (OSA).
Materials and methods
Fifty patients (mean age 48.7 ± 12.6 years, 32 males) were recruited during a 4-week period. A simultaneous recording of both the standard in-laboratory PSG and an ambulatory level 4 sleep monitor (ApneaLink™) was performed during an overnight study for each patient. PSG sleep and respiratory events were scored manually according to standard criteria. ApneaLink™ data were analyzed either with the automated computerized algorithm provided by the manufacturer following the American Academy of Sleep Medicine standards (default setting DFAL) or The University of British Columbia Hospital sleep laboratory standards (alternative setting, ATAL). The ApneaLink respiratory disturbance indices (RDI), PSG apnea–hypopnea indices (AHI), and PSG oxygen desaturation index (ODI) were compared.
The mean PSG-AHI was 30.0 ± 25.8 events per hour. The means of DFAL-RDI and ATAL-RDI were 23.8 ± 21.9 events per hour and 29.5 ± 22.2 events per hour, respectively. Intraclass correlation coefficients were 0.958 between PSG-AHI and DFAL-RDI and 0.966 between PSG-AHI and ATAL-RDI. Receiver operator characteristic curves were constructed using a variety of PSG-AHI cutoff values (5, 10, 15, 20, and 30 events per hour). Optimal combinations of sensitivity and specificity for the various cutoffs were 97.7/66.7, 95.0/90.0, 87.5/88.9, 88.0/88.0, and 88.2/93.9, respectively for the default setting. The ApneaLink™ demonstrated the best agreement with laboratory PSG data at cutoffs of AHI ≥ 10. There were no significant differences among PSG-AHI, DFAL-RDI, and ATAL-RDI when all subjects were considered as one group. ODI at 2%, 3%, and 4% desaturation levels showed significant differences (p < 0.05) compared with PSG-AHI, DFAL-RDI, and ATAL-RDI for the entire group.
The ApneaLink™ is an ambulatory sleep monitor that can detect OSA and/or hypopnea with acceptable reliability. The screening and diagnostic capability needs to be verified by further evaluation and manual scoring of the ApneaLink™. It could be a better choice than traditional oximetry in terms of recording respiratory events, although severity may be under- or overestimated.
KeywordsHome monitoring Obstructive sleep apnea Polysomnography Oral appliance ApneaLink™
The authors would like to thank Mrs. Ingrid Ellis for her editorial assistance in the final preparation of this manuscript and the polysomnographic technologists in UBC Hospital sleep disorder laboratory. As a postdoctoral fellow, Dr. Hui Chen was supported in part from royalties paid to The University of British Columbia from worldwide Klearway™ sales.
- 5.The Report of an American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689Google Scholar
- 6.Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee (1997) Practice parameters for the indications for polysomnography and related procedures. Sleep 20:406–422Google Scholar
- 7.Flemons WW, Littner MR, Rowley JA, Gay P, Anderson WM, Hudgel DW et al (2003) Home diagnosis of sleep apnea: a systematic review of the literature. An evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society. Chest 124:1543–1579, doi: 10.1378/chest.124.4.1543 PubMedCrossRefGoogle Scholar
- 9.Standards of Practice Committee of the American Sleep Disorders Association (1994) Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Sleep 17:372–377Google Scholar
- 11.Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ et al (2007) 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 3:737–747PubMedGoogle Scholar