Diagnostic accuracy of level IV portable sleep monitors versus polysomnography for obstructive sleep apnea: a systematic review and meta-analysis
- 858 Downloads
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. In-laboratory, overnight type I polysomnography (PSG) is the current “gold standard” for diagnosing OSA. Home sleep apnea testing (HSAT) using portable monitors (PMs) is an alternative testing method offering better comfort and lower costs. We aimed to systematically review the evidence on diagnostic ability of type IV PMs compared to PSG in diagnosing OSA.
Participants: patients ≥16 years old with symptoms suggestive of OSA;intervention: type IV PMs (devices with < 2 respiratory channels); comparator: in-laboratory PSG; outcomes: diagnostic accuracy measures;studies: cross-sectional, prospective observational/experimental/quasi-experimental studies; information sources: MEDLINE and Cochrane Library from January 1, 2010 to May 10, 2016. All stages of review were conducted independently by two investigators.
We screened 6054 abstracts and 117 full-text articles to select 24 full-text articles for final review. These 24 studies enrolled a total of 2068 patients with suspected OSA and evaluated 10 different PMs with one to six channels. Only seven (29%) studies tested PMs in the home setting. The mean difference (bias) between PSG-measured and PM-measured apnea-hypopnea index (AHI) ranged from − 14.8 to 10.6 events/h. At AHI ≥ 5 events/h, the sensitivity of type IV PMs ranged from 67.5–100% and specificity ranged from 25 to 100%.
While current evidence is not very strong for the stand-alone use of level IV PMs in clinical practice, they can potentially widen access to diagnosis and treatment of OSA. Policy recommendations regarding HSAT use should also consider the health and broader social implications of false positive and false negative diagnoses.
KeywordsObstructive sleep apnea Home sleep apnea testing Polysomnography Systematic review
The study team would like to thank Dr. Tetyana Kendzerska for providing her expert opinion in making decisions on selecting the final list of articles for this review.
Compliance with ethical standards
The manuscript does not contain clinical studies or patient data.
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T (2008) Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 52(8):686–717. https://doi.org/10.1016/j.jacc.2008.05.002 CrossRefPubMedGoogle Scholar
- 5.Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O'Connor GT, Rapoport DM, Redline S, Resnick HE, Robbins JA, Shahar E, Unruh ML, Samet JM (2009) Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 6(8):e1000132. https://doi.org/10.1371/journal.pmed.1000132 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22(5):667–89Google Scholar
- 10.Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28(4):499–521. https://doi.org/10.1093/sleep/28.4.499 CrossRefPubMedGoogle Scholar
- 11.Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R, Portable Monitoring Task Force of the American Academy of Sleep Medicine (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(7):737–747PubMedGoogle Scholar
- 12.Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 13(3):479–504. https://doi.org/10.5664/jcsm.6506 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.BalkEM, MoorthyD, ObadanNO, PatelK, IpS, ChungM, et al.(2011) Diagnosis and treatment of obstructive sleep apnea in adults. Comparative effectiveness review no. 32. (Prepared by tufts evidence-based practice center under contract no. 290–2007–10055-1). AHRQ Publication No. 11-EHC052-EF. Rockville: Agency for Healthcare Research and QualityGoogle Scholar
- 15.Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269, W64. https://doi.org/10.7326/0003-4819-151-4-200908180-00135 CrossRefPubMedGoogle Scholar
- 17.Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM, QUADAS-2 Group (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536. https://doi.org/10.7326/0003-4819-155-8-201110180-00009 CrossRefPubMedGoogle Scholar
- 18.Lee J, Kim KW, Choi SH, Huh J, Park SH (2015) Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers-part II. Statistical methods of meta-analysis. Korean J Radiol 16(6):1188–1196. https://doi.org/10.3348/kjr.2015.16.6.1188 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Choi JH, Kim EJ, Kim YS, Choi J, Kim TH, Kwon SY, Lee HM, Lee SH, Shin C, Lee SH (2010) Validation study of portable device for the diagnosis of obstructive sleep apnea according to the new AASM scoring criteria: Watch-PAT 100. Acta Otolaryngol 130(7):838–843. https://doi.org/10.3109/00016480903431139 CrossRefPubMedGoogle Scholar
- 25.Crowley KE, Rajaratnam SM, Shea SA, Epstein LJ, Czeisler CA, Lockley SW, Harvard Work Hours, Health and Safety Group (2013) Evaluation of a single-channel nasal pressure device to assess obstructive sleep apnea risk in laboratory and home environments. J Clin Sleep Med 9(2):109–116. https://doi.org/10.5664/jcsm.2400 PubMedPubMedCentralCrossRefGoogle Scholar
- 27.Kobayashi M, Namba K, Tsuiki S, Nakamura M, Hayashi M, Mieno Y, Imizu H, Fujita S, Yoshikawa A, Sakakibara H, Inoue Y (2013) Validity of sheet-type portable monitoring device for screening obstructive sleep apnea syndrome. Sleep Breath 17(2):589–595. https://doi.org/10.1007/s11325-012-0725-z CrossRefPubMedGoogle Scholar
- 30.Nigro CA, Dibur E, Aimaretti S, Gonzalez S, Rhodius E (2011) Comparison of the automatic analysis versus the manual scoring from ApneaLinkTM device for the diagnosis of obstructive sleep apnoea syndrome. Sleep Breath 15(4):679–686. https://doi.org/10.1007/s11325-010-0421-9 CrossRefPubMedGoogle Scholar
- 38.Tsukahara M, Sakao S, Jujo T, Sakurai T, Terada J, Kunii R, Tanabe N, Tatsumi K (2014) The accuracy and uncertainty of a sheet-type portable monitor as a screening device to identify obstructive sleep apnea-hypopnea syndrome. Intern Med 53(12):1307–1313. https://doi.org/10.2169/internalmedicine.53.2208 CrossRefPubMedGoogle Scholar
- 39.Ward KL, McArdle N, James A, Bremner AP, Simpson L, Cooper MN, Palmer LJ, Fedson AC, Mukherjee S, Hillman DR (2015) A comprehensive evaluation of a two-channel portable monitor to “rule in” obstructive sleep apnea. J Clin Sleep Med 11(4):433–444. https://doi.org/10.5664/jcsm.4600 PubMedPubMedCentralCrossRefGoogle Scholar
- 43.El Shayeb M, Topfer LA, Stafinski T, Pawluk L, Menon D (2014) Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ 186(1):E25–E51. https://doi.org/10.1503/cmaj.130952 CrossRefPubMedPubMedCentralGoogle Scholar