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Diagnostic Accuracy of Home-Based Monitoring System in Morbidly Obese Patients with High Risk for Sleep Apnea

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Abstract

Background

No previous studies have validated the use of portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) in morbidly obese individuals. Our aim was to investigate the accuracy of PM for detecting respiratory events in morbidly obese patients that will be undergoing bariatric surgery.

Methods

This was a prospective study involving patients with body mass index (BMI) ≥35 kg/m2 who were recruited from the Sleep Clinic of Universidade Federal de São Paulo. Sleep-disordered breathing (SDB) was evaluated during full-night polysomnography (PSG). PM use was randomized and used on two consecutive nights: (1) at home (STDHome) and (2) at the sleep laboratory with PSG (PSG_STDLab).

Results

Although 58 participants initially underwent the recordings, 26 (45 %) were excluded because of technical problems. The patients’ mean age was 42.9 ± 10.9 (SD) years, and 56 % were female. The mean BMI was 40.8 ± 5.2 kg/m2. All patients had high risk for OSA, as defined by the Stop-Bang questionnaire, and the mean apnea-hypopnea index (AHI) was 46.9 ± 30.4/h. The intraclass coefficient of the correlation between AHI_PSG and AHI_STDLab was r = 0.92 (p = 0.0001); the intraclass coefficient for AHI_PSG and AHI_STDHome was r = 0.84 (p = 0.0001). The Kappa index was 0.87 (p > 0.0001) for severe cases. The sensitivity and the positive predictive value increased with the disease severity. A Bland-Altman analysis showed good agreement between the investigated methods.

Conclusions

PM is an efficacious method for diagnosing OSA in obese patients who have a high clinical probability of the disease. The method displays good sensitivity and specificity in severe cases; nevertheless, the high rate of data loss must be taken into account.

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Acknowledgments

We would like to thank Laura Castro, MsC, and Altay Souza, PhD, for their valuable suggestions and statistical analyses.

Conflict of Interest

Márcia G. Oliveira, Erika C. Treptow, Cesar Fukuda, Luiz E. Nery, Rosana M. Valadares, Sérgio Tufik, Lia Bittencourt, and Sonia M. Togeiro had no conflict of interest.

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Authors and Affiliations

  1. Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de Sao Paulo – UNIFESP, Rua Pedro de Toledo, 720, Sao Paulo, SP, 04039-034, Brazil

    Márcia G. Oliveira, Erika C. Treptow, Cesar Fukuda, Luiz E. Nery, Rosana M. Valadares & Lia Bittencourt

  2. Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de Sao Paulo – UNIFESP, Rua Napoleao de Barros, 925, Sao Paulo, SP, 04024-002, Brazil

    Márcia G. Oliveira, Sérgio Tufik, Lia Bittencourt & Sonia M. Togeiro

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  1. Márcia G. Oliveira
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  2. Erika C. Treptow
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  3. Cesar Fukuda
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Correspondence to Márcia G. Oliveira.

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Oliveira, M.G., Treptow, E.C., Fukuda, C. et al. Diagnostic Accuracy of Home-Based Monitoring System in Morbidly Obese Patients with High Risk for Sleep Apnea. OBES SURG 25, 845–851 (2015). https://doi.org/10.1007/s11695-014-1469-6

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