Apnea and hypopnea characterization using esophageal pressure, respiratory inductance plethysmography, and suprasternal pressure: a comparative study



To determine if recording of suprasternal pressure (SSP) can classify apneas and hypopneas as reliably as respiratory inductance plethysmography (RIP) belts and to compare the two methods to classification with esophageal pressure (Pes), the reference method for assessing respiratory effort.


In addition to polysomnographic recordings that included Pes, SSP was recorded. Recordings from 32 patients (25 males, mean age 66.7 ± 15.3 years, and mean BMI 30.1 ± 4.5 kg/m2) were used to compare the classification of detected apneas and hypopneas by three methods of respiratory effort evaluation (Pes, RIP belts, and SSP). Signals were analyzed randomly and independently from each other. All recordings were analyzed according to AASM guidelines.


Using Pes as a reference for apnea characterization, the Cohen kappa (κ) was 0.93 for SSP and 0.87 for the RIP. The sensitivity/specificity of SSP was 97.0%/96.9% for obstructive, 93.9%/98.3% for central, and 94.9%/97.9% for mixed apneas. The sensitivity/specificity of the RIP was 97.4%/91.9% for obstructive, 87.5%/97.9% for central, and 85.6%/96.6% for mixed apneas. For hypopnea characterization using the Pes as a reference, κ was 0.92 for SSP and 0.86 for the RIP. The sensitivity/specificity of SSP was 99.7%/97.6% for obstructive and 97.6%/99.7% for central. The sensitivity/specificity of the RIP was 99.8%/81.1% for obstructive and 81.1%/99.8% for central.


These results confirm the excellent agreement in the detection of respiratory effort between SSP, RIP belts, and Pes signals. Thus, we conclude that apnea and hypopnea characterization in adults with SSP is a reliable method.

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American Academy of Sleep Medicine


Apnea Hypopnea Index


Apnea Index


body mass index


European Data Format




sleep apnea syndrome


esophageal pressure


nasal pressure




respiratory inductance plethysmography


suprasternal pressure


total sleep time


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The authors gratefully acknowledge the help of the sleep technicians at both labs as well as the CIDELEC company for lending their CID-LXe system to record the tracheal sound and the suprasternal pressure.

Financial support

The study was financially supported by an unrestricted grant by CIDELEC, France.

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Corresponding author

Correspondence to AbdelKebir Sabil.

Ethics declarations

The study was approved (DRKS-ID: DRKS00012795) by the local Ethics Committee of the Charité university hospital in Berlin.

Conflict of interest

Thomas Penzel has received research grants from Heinen & Löwenstein, Itamar, Philips/Respironics, Resmed, and Somnodent. He received speaker fees and travel support from Bayer, Itamar, Inspire, Somnodent, UCB, and Weinmann. He is a shareholder of Advanced Sleep Research GmbH, The Siestagroup GmbH, and Somnico GmbH. He was supported by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR) and by the project FNUSA-ICRC no. CZ.1.05/1.1.00/02.0123 (OP VaVpI). Ingo Fietze has received research grants from Actelion, Eisai, Heinen & Löwenstein, Jazz Pharmaceuticals, Philips/Respironics, Resmed, Somnodent, UCB, and Vanda.

At the time the study was performed, AbdelKebir Sabil was fully employed by CIDELEC.

All other authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Sabil, A., Schöbel, C., Glos, M. et al. Apnea and hypopnea characterization using esophageal pressure, respiratory inductance plethysmography, and suprasternal pressure: a comparative study. Sleep Breath 23, 1169–1176 (2019). https://doi.org/10.1007/s11325-019-01793-8

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  • Respiratory effort
  • Polysomnography
  • Sleep apnea characterization
  • Suprasternal pressure