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Validation of a portable monitoring device for the diagnosis of obstructive sleep apnea: electrocardiogram-based cardiopulmonary coupling

  • Mi Lu
  • Fang Fang
  • John E. Sanderson
  • Chenyao Ma
  • Qianqian Wang
  • Xiaojun Zhan
  • Fei Xie
  • Lei Xiao
  • Hu Liu
  • Hongyan Liu
  • Yongxiang WeiEmail author
Methods • Original Article
  • 43 Downloads

Abstract

Purpose

We aimed to evaluate the validity of the cardiopulmonary coupling (CPC) device, a limited-channel portable monitoring device for obstructive sleep apnea (OSA) screening in one single-center cohort, in particular in those with some cardiovascular diseases since the cardiopulmonary coupling might be different from those without.

Methods

Consecutive patients referred to the sleep medical center for assessment of possible OSA were enrolled in this study. Patients were examined with standard polysomnography (PSG) and CPC evaluation simultaneously. The results of the two examinations were compared in all subjects and in those with or without cardiovascular abnormalities.

Results

A total of 179 subjects suspected with OSA were finally analyzed. According to OSA severity degree based on AHI, the area under ROC curve for the CPC device in the whole cohort patients was 0.79 (mild), 0.79 (moderate), and 0.86 (severe OSA), respectively (all p < 0.001). For patients with cardiovascular disease with different OSA severity, the area under the ROC curve was 0.86 (mild), 0.73 (moderate), and 0.83 (severe OSA), respectively (all p < 0.0001), and 0.74 (mild), 0.85 (moderate), and 0.91 (severe OSA), respectively in patients without cardiovascular disease (all p < 0.0001).

Conclusions

The overall performance of CPC technique was acceptable to assess OSA in subjects with clinical suspicion of OSA, and thus it might act as a fast tool to screen OSA patients. However, the sensitivity of CPC technology for patients with cardiovascular disease was relatively insufficient. Therefore, CPC technology should be carefully interpreted in OSA screening in those with cardiovascular disease.

Keywords

Cardiopulmonary coupling analysis Validation Obstructive sleep apnea Cardiovascular disease 

Abbreviations

AASM

American Academy of Sleep Medicine

AHI

apnea-hypopnea index

AUC

area under the ROC curve

BMI

body mass index

CI

confidence interval

CPAP

continuous positive airway pressure

CPC

cardiopulmonary coupling

ECG

electrocardiogram

EDR

ECG-derived respiration

EEG

electroencephalogram

EMG

electromyogram

e-LFC

elevated low-frequency coupling

EOG

electro-oculogram

ESS

Epworth Sleepiness Scale

HFC

high-frequency coupling

ICC

intraclass correlation

LFC

low-frequency coupling

LL

lower limit

+LR

positive likelihood ratio

−LR

negative likelihood ratio

NPV

negative predictive value

OSA

obstructive sleep apnea

PPV

positive predictive value

PSG

polysomnography

ROC

receiver operating characteristics

SD

standard deviation

SE

sleep efficiency

Sen

sensitivity

Spec

specificity

TST

total sleep time

UL

upper limit

VLFC

very-low-frequency coupling

Notes

Acknowledgments

The authors gratefully acknowledge the patients who have participated in this study and thank the staff at the sleep medical center, Beijing Anzhen Hospital, China, for scoring the PSG studies according to the updated AASM scoring guidelines. In addition, we also thank Nanjing Fengsheng Yongkang Software Technology Co., Ltd. for providing the CPC devices.

Authors’ contribution

Conception and design: Mi Lu, Fang Fang, and Yongxiang Wei. Collection and assembly of data: Mi Lu, Qianqian Wang, and Chenyao Ma. Data analysis and interpretation: Mi Lu and Fang Fang. PSG data scoring: Fei Xie, Lei Xiao, Hu Liu, Xiaojun Zhan, and Hongyan Liu. Manuscript writing: Mi Lu, Fang Fang, and John E. Sanderson. Revised the language/article: Mi Lu, Fang Fang, John E. Sanderson, and Xiaojun Zhan. Final approval of manuscript: all authors.

Funding

This study was supported by NSFC (Project 81870335), Beijing Medical Project 2016-4, the Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases (BZ0377), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201605), Beijing Municipal Science and Technology Commission (Z141100006014057), and the project of Beijing Institute of Heart Lung and Blood Vessel Diseases (2018S14).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the local institutional review board of Beijing Anzhen Hospital (Capital Medical University, Beijing, China). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular DiseasesBeijing Institute of Heart, Lung and Blood Vessel DiseasesBeijingChina
  2. 2.Department of Sleep Medical Center, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina

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