Laboratory versus portable sleep studies: a meta-analysis.
ABSTRACT The objective of this meta-analysis study was to compare the accuracy of home sleep studies with laboratory polysomnography in the diagnosis of obstructive sleep apnea (OSA).
Eligible studies included prospective cohort studies of portable and in-laboratory sleep studies performed on the same groups of patients. A comparison of respiratory disturbance index (RDI), mean low oxygen saturation levels, sleep time, rate of inadequate studies, and average cost per examination was made between portable and in-laboratory sleep studies. A total of 18 papers were identified in two independent Medline searches.
RDI values on portable sleep studies were 10% lower on average compared with laboratory studies (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.87-0.92). There was no significant difference in the mean low oxygen saturation on portable versus laboratory studies (OR, 1.0; 95% CI, 0.94-1.10). Recorded sleep time was significantly higher by 13% for laboratory compared with portable studies (OR, 0.87; 95% CI, 0.86-0.89), and portable studies were significantly more likely to give a poor recording when compared with laboratory examinations (P = .0001). The cost of home studies ranged from 35% to 88% lower than laboratory studies across a number of countries.
Home sleep studies provide similar diagnostic information to laboratory polysomnograms in the evaluation of sleep-disordered breathing but may underestimate sleep apnea severity. The lower cost of home sleep studies makes it a viable screening tool for patients with suspected OSA; however, these lower costs are partially offset by the higher rate of inadequate examinations.
SourceAvailable from: Tzu-Chieh Chou[Show abstract] [Hide abstract]
ABSTRACT: Sleep-disordered breathing (SDB) is associated with an increased risk of motor vehicle crashes. This study aimed to understand SDB progression and related factors among professional drivers. A total of 524 professional male drivers from a transportation company were included in this study. These drivers completed overnight in-home pulse oximetry studies both in 2006 and in 2009. Participants with abnormal results (oxygen desaturation index [ODI] ≥10 events/h) comprised the SDB group. Data included questionnaire information on demographics, medical history, SDB symptoms, and anthropometric measurements. A total of 318 male workers were recruited for further analysis. Fifty of these workers belonged to the SDB group. Workers with untreated SDB significantly progressed to a more severe state after three years. Baseline body mass index (BMI), baseline ODI, and change in BMI were all significant positive predictors of SDB progression (β = 0.823, 0.242, and 1.626; p = 0.047, 0.013, and 0.004, respectively). Compared with non-SDB drivers, SDB subjects showed a greater proportion of newly diagnosed cardiovascular disease (38.0%) at follow-up. Untreated SDB was a gradually progressive disorder in professional drivers over a three-year period. Subjects with high BMI and moderate to severe SDB should be closely monitored to allow for early detection of worsening SDB. Weight control should be highlighted in the management of SDB. Copyright © 2015 American Academy of Sleep Medicine. All rights reserved.Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2015; DOI:10.5664/jcsm.4596 · 2.83 Impact Factor
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ABSTRACT: To assess the frequency of obstructive sleep apnoea among women with and without hypertensive disorders of pregnancy.BJOG An International Journal of Obstetrics & Gynaecology 05/2014; 121(13). DOI:10.1111/1471-0528.12885 · 3.86 Impact Factor
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ABSTRACT: We hypothesized that a dual-channel portable monitor (PM) device could accurately identify patients who have a high pretest probability of obstructive sleep apnea (OSA), and we evaluated factors that may contribute to variability between PM and polysomnography (PSG) results. Consecutive clinic patients (N = 104) with possible OSA completed a home PM study, a PM study simultaneous with laboratory PSG, and a second home PM study. Uniform data analysis methods were applied to both PM and PSG data. Primary outcomes of interest were the positive likelihood ratio (LR+) and sensitivity of the PM device to "rule-in" OSA, defined as an apnea hypopnea index (AHI) ≥5 events/h on PSG. Effects of different test environment and study nights, and order of study and analysis methods (manual compared to automated) on PM diagnostic accuracy were assessed. The PM has adequate LR+ (4.8), sensitivity (80%), and specificity (83%) for detecting OSA in the unattended home setting when benchmarked against laboratory PSG, with better LR+ (>5) and specificity (100%) and unchanged sensitivity (80%) in the simultaneous laboratory comparison. There were no significant night-night (all p > 0.10) or study order effects (home or laboratory first, p = 0.08) on AHI measures. Manual PM data review improved case finding accuracy, although this was not statistically significant (all p > 0.07). Misclassification was more frequent where OSA was mild. Overall performance of the PM device is consistent with current recommended criteria for an "acceptable" device to confidently "rule-in" OSA (AHI ≥5 events/h) in a high pretest probability clinic population. Our data support the utility of simple two-channel diagnostic devices to confirm the diagnosis of OSA in the home environment. © 2014 American Academy of Sleep Medicine.Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2015; DOI:10.5664/jcsm.4600 · 2.83 Impact Factor