Evaluation of a portable recording device (ApneaLink (TM)) for case selection of obstructive sleep apnea
Sleep And Breathing
(Impact Factor: 2.48).
08/2009; 13(3):213-219. DOI: 10.1007/s11325-008-0232-4
This study was designed to assess the sensitivity and specificity of a portable sleep apnea recording device (ApneaLink™) using standard polysomnography (PSG) as a reference and to evaluate the possibility of using the ApneaLink™ as a case selection technique for patients with suspected obstructive sleep apnea (OSA).
Materials and methods
Fifty patients (mean age 48.7 ± 12.6 years, 32 males) were recruited during a 4-week period. A simultaneous recording of both the standard in-laboratory PSG and an ambulatory level 4 sleep monitor (ApneaLink™) was performed during an overnight study for each patient. PSG sleep and respiratory events were scored manually according to standard criteria. ApneaLink™ data were analyzed either with the automated computerized algorithm provided by the manufacturer following the American Academy of Sleep Medicine standards (default setting DFAL) or The University of British Columbia Hospital sleep laboratory standards (alternative setting, ATAL). The ApneaLink respiratory disturbance indices (RDI), PSG apnea–hypopnea indices (AHI), and PSG oxygen desaturation index (ODI) were compared.
The mean PSG-AHI was 30.0 ± 25.8 events per hour. The means of DFAL-RDI and ATAL-RDI were 23.8 ± 21.9 events per hour and 29.5 ± 22.2 events per hour, respectively. Intraclass correlation coefficients were 0.958 between PSG-AHI and DFAL-RDI and 0.966 between PSG-AHI and ATAL-RDI. Receiver operator characteristic curves were constructed using a variety of PSG-AHI cutoff values (5, 10, 15, 20, and 30 events per hour). Optimal combinations of sensitivity and specificity for the various cutoffs were 97.7/66.7, 95.0/90.0, 87.5/88.9, 88.0/88.0, and 88.2/93.9, respectively for the default setting. The ApneaLink™ demonstrated the best agreement with laboratory PSG data at cutoffs of AHI ≥ 10. There were no significant differences among PSG-AHI, DFAL-RDI, and ATAL-RDI when all subjects were considered as one group. ODI at 2%, 3%, and 4% desaturation levels showed significant differences (p < 0.05) compared with PSG-AHI, DFAL-RDI, and ATAL-RDI for the entire group.
The ApneaLink™ is an ambulatory sleep monitor that can detect OSA and/or hypopnea with acceptable reliability. The screening and diagnostic capability needs to be verified by further evaluation and manual scoring of the ApneaLink™. It could be a better choice than traditional oximetry in terms of recording respiratory events, although severity may be under- or overestimated.
Available from: Bülent Güçyetmez
- "Yaggi et al. and Meoli et al. define apnea as an interruption of nasal airflow for at least 10 seconds, and hypopnea as a decrease in the airflow that is greater than 30% accompanied by a 4% decrease in the O2 saturation [2,3]. A polysomnography (PSG) may not always be performed in the ICU but simple, inexpensive, and easy to use devices such as ApneaLink™ can be used to determine AHI [4,5]. The detection of AHI among ICU patients can be beneficial in determining the diagnosis and treatment of the following cases. "
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ApneaLink™ (RESMED-Munich, Germany) is a simple and inexpensive device that determines the apnea-hypopnea index. The sensitivity and specificity of the apnea-hypopnea index are 100 and 87.5%, respectively. Our hypothesis can be used to create a treatment plan using the apnea-hypopnea index for intensive care unit patients.
This treatment plan has been created by determining the apnea-hypopnea index of eight Caucasian patients with a variety of diagnoses. Case 1 is that of a 70-year-old man diagnosed with rectum cancer and scheduled for elective surgery. Case 2 is that of a 65-year-old man diagnosed with rectum cancer and scheduled for elective surgery. Case 3 is that of a 78-year-old woman diagnosed with chronic obstructive pulmonary disease-pneumonia. Case 4 is that of a 26-year-old man diagnosed with head trauma. Case 5 is that of an 80-year-old man diagnosed with cerebrovascular disease. Case 6 is that of a 79-year-old man diagnosed with cerebrovascular disease. Case 7 is that of an 8-year-old girl diagnosed with ventricular septal defect-epidural hemorragia. Case 8 is that of a 42-year-old man diagnosed with subarachnoid hemorrage.
The apnea-hypopnea index can be informative regarding prognosis and outcomes, and helps to take precautions and develop new treatment strategies among critical patients in intensive care. The integration of developments in sleep medicine to intensive care unit practices means that we can be more informed about critical patients.
Available from: Carlos Alberto Nigro
- "It has good potential as a simple screening device, particularly because it allows the manual review and scoring of the raw data. There are several reports which have evaluated the performance of the automatic analysis of nasal pressure from the ApneaLink device against polysomnography to diagnosis sleep apnea    . Furthermore, we have recently demonstrated that the manual analysis of data using an AHI (ApneaLink) and an RDI (PSG) ≥5 as "
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To evaluate the accuracy and reliability of the medical decision based on the results of the hand scoring from a two-channel recording device (ApneaLink) plus clinical data for the prescription of a CPAP assay in patients with suspected OSA.
39 subjects were assessed in the sleep laboratory with polysomnography and ApneaLink. The patients completed the Epworth sleepiness scale and a clinical history. Two blinded independent observers decided to prescribe CPAP according to the results of the PSG (gold standard, observer A), ApneaLink (alternative method, observer B), and the clinical parameters. Sensitivity and specificity of observer B on the indication of CPAP were calculated. The interobserver agreement for the indication of CPAP was assessed using kappa statistics.
38 subjects were included (26 men, mean age 47.5, mean RDI 28.7, mean BMI 31.4 kg/m
). The prevalence of OSA was 84%. The sensitivity and specificity of observer B to initiate a CPAP trial were 90.6% and 100%, respectively. The interrater agreement for the prescription of CPAP was good (kappa: 0.75).
This study has shown that the use of ApneaLink plus clinical data has made it possible to indicate CPAP reliably in most patients with high-clinical pretest for OSA.
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ABSTRACT: Kardiologische Patienten zeigen eine hohe Prävalenz an schlafbezogenen Atemstörungen (SBAS). Während obstruktive Schlafapnoesyndrome gehäuft bei Patienten mit Vorhofflimmern, Bluthochdruck und kardialen Ischämien vorkommen, leiden Herzinsuffizienzpatienten zu einem signifikanten Anteil an zentralen Schlafapnoesyndromen (CSA). Goldstandard der Diagnostik einer SBAS ist die Polysomnographie (PSG). Viele Patienten mit SBAS werden jedoch aufgrund der nicht flächendeckend verfügbaren, personal- und kostenaufwendigen Diagnostik bislang nicht diagnostiziert. Daher ist die Etablierung von einfachen Screeningverfahren in der kardiologischen Routine wichtig. Einfache Screeningverfahren sind z. B. standardisierte Fragebögen, die gute Ergebnisse bei Kollektiven mit OSA, nicht aber bei Patienten mit CSA gezeigt haben. Darüber hinaus werden tragbare Screeninggeräte, die Oxymetrie und/oder Atemflüsse messen, erfolgreich im ambulanten Screening angewendet. Vielversprechend sind neuere Algorithmen, die aus Herzfrequenzvariabilität und/oder QRS-Morphologie aus Standard-Langzeit-Elektrokardiogrammen (LZ-EKG) Apnoe-Hypopnoe-Indices (AHI) ermitteln können. Die Etablierung von SBAS-Screening mittels LZ-EKG könnte in Zukunft ein umfassendes Screening kardiovaskulärer Patienten sicherstellen.
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