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Nasal pressure recordings to detect obstructive sleep apnea

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Abstract

Obstructive sleep apnea (OSA) is a common disease. Given the costs of in-laboratory polysomnography (PSG), alternative ambulatory methods for accurate diagnosis are desirable. The objective of this study was to evaluate the performance of a simple device (SleepCheck) to identify patients with sleep apnea. A total of 30 consecutive patients with suspected OSA syndrome referred to the sleep clinic were prospectively evaluated with standard PSG and SleepCheck simultaneously during an in-laboratory, supervised full-night diagnostic study. The PSG apnea and hypopnea index (AHI) was evaluated according to standard criteria, and SleepCheck assessed the respiratory disturbance index (RDI) based on nasal cannula pressure fluctuations. Compared to the full-night PSG, SleepCheck systematically overscored respiratory events (the mean difference between SleepCheck RDI and PSG AHI was 27.4±13.3 events per hour). This overscoring was in part related to normal physiologic decreases in flow during rapid eye movement sleep or after an arousal. However, there was reasonable correlation between AHI and RDI (r=0.805). Receiver operating characteristic curves with threshold values of AHI of 10 and 20/h demonstrated areas under the curves (AUCs) of 0.915 and 0.910, respectively. Optimum combinations of sensitivity and specificity for these thresholds were calculated as 86.4/75.0 and 88.9/81.0, respectively. Overall, the SleepCheck substantially overscored apneas and hypopneas in patients with suspected OSA. However, after correction of the bias, the SleepCheck had reasonable accuracy with an AUC, sensitivity, and specificity similar to other ambulatory type 4 devices currently available.

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Acknowledgements

The authors wish to thank Mrs. Ingrid Ellis for her editorial assistance in the final preparation of the manuscript. We are grateful for the statistical analysis provided by Ms. Mary Wong. The present study was supported by CNPq (Brazilian Government), who provided a scholarship to the first author (F.R.A.). One of the authors (N.T.A.) is supported by a Michael Smith Foundation for Health Research Scholar Award, a CIMR/BCLA new investigator award, and a departmental scholar award at UBC. In addition, SleepCheck was provided by IM Systems Inc., Baltimore.

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Authors and Affiliations

  1. Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada, V6T 1Z3

    Fernanda Ribeiro de Almeida, Hiroshi Ueda & Alan A. Lowe

  2. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada

    Najib T. Ayas

  3. Maxillofacial Orthognathics, Maxillofacial/Neck Reconstruction, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan

    Ryo Otsuka

  4. Sleep Laboratory, Vancouver General Hospital, Vancouver, Canada

    Peter Hamilton

  5. Department of Medicine, Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, Canada

    Frank C. Ryan

Authors
  1. Fernanda Ribeiro de Almeida
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  2. Najib T. Ayas
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  3. Ryo Otsuka
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  4. Hiroshi Ueda
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  5. Peter Hamilton
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  6. Frank C. Ryan
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  7. Alan A. Lowe
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Corresponding author

Correspondence to Fernanda Ribeiro de Almeida.

Additional information

This study was conducted at the Sleep Laboratory and Division of Orthodontics, The University of British Columbia, Canada

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de Almeida, F.R., Ayas, N.T., Otsuka, R. et al. Nasal pressure recordings to detect obstructive sleep apnea. Sleep Breath 10, 62–69 (2006). https://doi.org/10.1007/s11325-005-0042-x

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