Sleep and Breathing

, Volume 15, Issue 4, pp 679–686 | Cite as

Comparison of the automatic analysis versus the manual scoring from ApneaLink™ device for the diagnosis of obstructive sleep apnoea syndrome

  • Carlos Alberto NigroEmail author
  • Eduardo Dibur
  • Silvia Aimaretti
  • Sergio González
  • Edgardo Rhodius
Original Article



The purpose of this study was to compare the performance of the automated detection versus the manual scoring from the ApneaLink™ device to diagnose obstructive sleep apnoea syndrome (OSAS).


All participants (96) performed the ApneaLink™ (AL) and polysomnography (PSG) simultaneously in the sleep laboratory. The two recordings were interpreted blindly. The hypopnoea criterion used for the analysis of both automatic and manual ApneaLink™ was a fall in airflow ≥50% of baseline for ≥10 s. The agreement between AL and PSG and the interobserver concordance was calculated. ROC analysis, sensitivity and specificity were assessed for the different ApneaLink™ and OSAS criteria.


Ninety patients were included (69 men; mean age, 49.6; median RDI, 13.9; median BMI, 29.3 kg/m2). The automatic apnoea/hypopnoea index (AHI-a) showed a lower agreement with the respiratory disturbance index (RDI) than the manual apnoea/hypopnoea (AHI-m) [AHI-a/RDI: intraclass correlation coefficient (ICC) 0.88 versus AHI-m/RDI: ICC 0.91]. The manual scoring (MS) showed a similar sensitivity and a higher specificity than the automatic scoring (AA) for the detection of OSAS, defined as an RDI ≥ 5 (sensitivity and specificity AA and MS: 89%/89%, 60%/86.7%, respectively). The accuracy of the automatic and manual scoring of the AL was similar when OSAS was defined as an RDI ≥ 20 or 30. The ApneaLink™ manual scoring had a very good interobserver agreement (k = 0.86).


The manual scoring of an ApneaLink™ recording was better than the automatic scoring in terms of agreement with RDI and to discriminate patients with OSAS. The hand scoring did not improve the accuracy of automatic scoring in patients with severe OSAS.


Sleep-disordered breathing Sleep apnoea Home sleep study Portable sleep study 



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

Conflicts of interest

We declare that there were no conflicts of interest related to this investigation.


  1. 1.
    Koziej M, Cieslicki JK, Gorzelak K, Sliwinski P, Zielinski J (1994) Hand-scoring of MESAM 4 recordings is more accurate than automatic analysis in screening for obstructive sleep apnoea. Eur Respir J 7:1771–1775. doi: 10.1183/09031936.94.07101771 PubMedCrossRefGoogle Scholar
  2. 2.
    Esnaola S, Duran J, Infante-Rivard C, Rubio R, Fernandez A (1996) Diagnostic accuracy of a portable recording device (MESAM IV) in suspected obstructive sleep apnoea. Eur Respir J 9:2597–2605PubMedCrossRefGoogle Scholar
  3. 3.
    Calleja JM, Esnaola S, Rubio R, Duran J (2002) Comparison of a cardiorespiratory device versus polysomnography for diagnosis of sleep apnoea. Eur Respir J 20:1505–1510PubMedCrossRefGoogle Scholar
  4. 4.
    Golpe R, Jiménez A, Carpizo R (2002) Home sleep studies in the assessment of sleep apnea/hypopneas syndrome. Chest 122:1156–1161PubMedCrossRefGoogle Scholar
  5. 5.
    Dingli K, Coleman EL, Vennelle M, Finch SP, Wraith PK, Mackay TW, Douglas NJ (2003) Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 21:253–259PubMedCrossRefGoogle Scholar
  6. 6.
    Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R (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
  7. 7.
    Wang Y, Teschler T, Weinreich G, Hess S, Wessendorf TE, Teschler H (2003) Validation of microMESAM as screening device for sleep disordered breathing. Pneumologie 57:734–740PubMedCrossRefGoogle Scholar
  8. 8.
    Erman MK, Stewart D, Einhorn D, Gordon N, Casal E (2007) Validation of the ApneaLink for the screening of sleep apnea: a novel and simple single-channel recording device. J Clin Sleep Med 3:387–392PubMedGoogle Scholar
  9. 9.
    Chen H, Lowe AA, Bai Y, Hamilton P, Fleetham JA, Almeida FR (2009) Evaluation of a portable recording device (ApneaLink) for case selection of obstructive sleep apnea. Sleep Breath 13:213–219PubMedCrossRefGoogle Scholar
  10. 10.
    Ragette R, Wang Y, Weinreich G, Teschler H (2010) Diagnostic performance of single airflow channel recording (ApneaLink) in home diagnosis of sleep apnea. Sleep Breath 14:109–114, PubMed PMID: 19714380PubMedCrossRefGoogle Scholar
  11. 11.
    Nigro CA, Serrano F, Aimaretti S, Gonzalez S, Codinardo C, Rhodius E (2010) Utility of ApneaLink for the diagnosis of sleep apnea-hypopnea syndrome. Medicina (B Aires) 70:53–59Google Scholar
  12. 12.
    Ng SS, Chan TO, To KW, Ngai J, Tung A, Ko FW, Hui DS (2009) Validation of a portable recording device (ApneaLink) for identifying patients with suspected obstructive sleep apnoea syndrome. Intern Med J 39:757–762PubMedCrossRefGoogle Scholar
  13. 13.
    Rechtschafen A, Kales A (1968) A manual of standarized technology, techniques and scoring system for sleep stages of human subjects. Brain Information Service, Los AngelesGoogle Scholar
  14. 14.
    American Sleep Disorders Association (1992) EEG arousals: scoring rules and examples: a preliminary report from the sleep disorders atlas task force of the American Sleep Disorders Association. Sleep 15:173–184Google Scholar
  15. 15.
    Masa JF, Corral J, Martín MJ, Riesco JA, Sojo A, Hernández M, Douglas NJ (2003) Assessment of thoracoabdominal bands to detect respiratory effort-related arousal. Eur Respir J 22:661–667PubMedCrossRefGoogle Scholar
  16. 16.
    Ayappa I, Norman RG, Krieger AC, Rosen A, O’malley RL, Rapoport DM (2000) Non-invasive detection of respiratory effort-related arousals (REras) by a nasal cannula/pressure transducer system. Sleep 23:763–771PubMedGoogle Scholar
  17. 17.
    Consenso Nacional sobre el Síndrome Apneas-Hipopneas del Sueño del Grupo Español de Sueño. Definición y concepto, fisiopatología, clínica y exploración del SAHS (2005). Arch bronconeumol 2005; 41, Extraordinario 4: 12–29Google Scholar
  18. 18.
    Guilleminault C, Bassiri A (2005) Clinical features and evaluation of obstructive sleep apnea–hypopnea syndrome and upper airway resistance syndrome. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine, 4th edn. Elsevier, Philadelphia, pp 1043–1052CrossRefGoogle Scholar
  19. 19.
    Sala H, Nigro C, Rabec C, Guardia AS, Smurra M (2001) Consenso Argentino de Trastornos Respiratorios Vinculados al Sueño. Medicina (B Aires) 61:351–363Google Scholar
  20. 20.
    Farré R, Rigau J, Montserrat JM, Ballester E, Navajas D (2001) Relevance of linearizing nasal prongs for assessing hypopneas and flow limitation during sleep. Am J Respir Crit Care Med 163:494–497PubMedGoogle Scholar
  21. 21.
    Pita Fernández S, Pértega Díaz S (2003) Pruebas diagnósticas. Cad Aten Prim 10:120–124Google Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Carlos Alberto Nigro
    • 1
    • 3
    Email author
  • Eduardo Dibur
    • 1
    • 4
  • Silvia Aimaretti
    • 1
    • 4
  • Sergio González
    • 1
    • 4
  • Edgardo Rhodius
    • 2
    • 4
  1. 1.Sleep Laboratory, Pneumonology UnitHospital AlemánBuenos AiresArgentina
  2. 2.Pneumonology UnitHospital AlemánBuenos AiresArgentina
  3. 3.Buenos AiresArgentina
  4. 4.Buenos AiresArgentina

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