Home sleep apnea testing: comparison of manual and automated scoring across international sleep centers

Abstract

Purpose

To determine the agreement between the manual scoring of home sleep apnea tests (HSATs) by international sleep technologists and automated scoring systems.

Methods

Fifteen HSATs, previously recorded using a type 3 monitor, were saved in European Data Format. The studies were scored by nine experienced technologists from the sleep centers of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) using the locally available software. Each study was scored separately by human scorers using the nasal pressure (NP), flow derived from the NP signal (transformed NP), or respiratory inductive plethysmography (RIP) flow. The same procedure was followed using two automated scoring systems: Remlogic (RLG) and Noxturnal (NOX).

Results

The intra-class correlation coefficients (ICCs) of the apnea-hypopnea index (AHI) scoring using the NP, transformed NP, and RIP flow were 0.96 [95% CI 0.93–0.99], 0.98 [0.96–0.99], and 0.97 [0.95–0.99], respectively. Using the NP signal, the mean differences in AHI between the average of the manual scoring and the automated systems were − 0.9 ± 3.1/h (AHIRLG vs AHIMANUAL) and − 1.3 ± 2.6/h (AHINOX vs AHIMANUAL). Using the transformed NP, the mean differences in AHI were − 1.9 ± 3.3/h (AHIRLG vs AHIMANUAL) and 1.6 ± 3.0/h (AHINOX vs AHIMANUAL). Using the RIP flow, the mean differences in AHI were − 2.7 ± 4.5/h (AHIRLG vs AHIMANUAL) and 2.3 ± 3.4/h (AHINOX vs AHIMANUAL).

Conclusions

There is very strong agreement in the scoring of the AHI for HSATs between the automated systems and experienced international technologists. Automated scoring of HSATs using commercially available software may be useful to standardize scoring in future endeavors involving international sleep centers.

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Abbreviations

AHI:

apnea-hypopnea Index

EDF:

European data format

HSAT:

home sleep apnea testing

ICC:

intra-class correlation coefficient

MEANdiff :

mean difference

NOX:

Noxturnal

NP:

nasal pressure

PSG:

polysomnography

RIP:

respiratory inductive plethysmography

RLG:

Remlogic

SAGIC:

Sleep Apnea Global Interdisciplinary Consortium

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Acknowledgments

The authors would like to thank the following individuals who helped in this project: Mohammad Ahmadi, Alexander Blau, Petra Cornell, Silverio Garbuio, Su-Lan Liu, João Reinfelderon, Beth Staley, Magdalena Ósk Sigurgunnarsdóttir, and Sandra Zimmermann.

Funding

Supported by NHLBI award P01 HL094307 (AIP), Conselho Nacional de Desenvolvimento Cientffico e Tecnologico (CNPq) grant 309336/2017–1 (LRB), Conselho Nacional de Desenvolvimento Cientffico e Tecno1ogico (CNPq), Grant 401569/2016–0 (LRB), and Award grant number UL1TR001070 from the National Center for Advancing Translational Sciences. The sponsor had no role in the design or conduct of the research.

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Correspondence to Ulysses J. Magalang.

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Magalang, U.J., Johns, J.N., Wood, K.A. et al. Home sleep apnea testing: comparison of manual and automated scoring across international sleep centers. Sleep Breath 23, 25–31 (2019). https://doi.org/10.1007/s11325-018-1715-6

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Keywords

  • Sleep apnea
  • Automation
  • Computer-assisted diagnosis