Obstructive sleep apnea (OSA) is a common but largely underdiagnosed condition. This study aimed to test the hypothesis that the oxygen desaturation index (ODI) obtained using a wireless high-resolution oximeter with a built-in accelerometer linked to a smartphone with automated cloud analysis, Overnight Digital Monitoring (ODM), is a reliable method for the diagnosis of OSA. METHODS: Consecutive patients referred to the sleep laboratory with suspected OSA underwent in-laboratory polysomnography (PSG) and simultaneous ODM. The PSG apnea-hypopnea index (AHI) was analyzed using the criteria recommended and accepted by the American Academy of Sleep Medicine (AASM) for the definition of hypopnea: arousal or X3% O 2 desaturation (PSG-AHI 3%) and X4% O 2 desaturation (PSG-AHI 4%), respectively. The results of PSG and ODM were compared by drawing parallels between the PSG-AHI 3% and PSG-AHI 4% with ODM-ODI 3% and ODM-ODI 4% , respectively. Bland-Altman plots, intraclass correlation, receiver operating characteristics (ROC) and area under the curve (AUC) analyses were conducted for statistical evaluation. ClinicalTrial.gov: NCT03526133. RESULTS: This study included 304 participants (men: 55%; age: 55±14 years; body mass index: 30.9±5.7 kg/m 2 ; PSG-AHI 3% : 35.3±30.1/h, ODM-ODI 3% : 30.3±25.9/h). The variability in the AASM scoring bias (PSG-AHI 3% vs PSG-AHI 4%) was significantly higher than that for PSG-AHI 3% vs ODM-ODI 3% (3%) and PSG-AHI 4% vs ODM-ODI 4% (4%) (9.7, 5.0, and 2.9/h, respectively; po0.001). The limits of agreement (2 ± SD, derived from the Bland-Altman plot) of AASM scoring variability were also within the same range for (PSG vs ODM) 3% and 4% variability: 18.9, 21.6, and 16.5/h, respectively. The intraclass correlation/AUC for AASM scoring variability and PSG vs ODM 3% or 4% variability were also within the same range (0.944/0.977 and 0.953/0.955 or 0.971/0.964, respectively). CONCLUSION: Our results showed that ODM is a simple and accurate method for the diagnosis of OSA.

Purpose: To compare the outcomes and costs of stress urinary incontinence (SUI) surgery using a hand-made sling (Marlex®) versus a commerciallyavailable suburethral polypropylene sling (Advantage®). Materials and Methods: Thirty-nine women with SUI due to bladder neck hypermobility and/or sphincter incompetence diagnosed by clinical examination and urodynamic studies were divided into two groups: group 1 (n = 19) consisted of patients from an academic center (Department of Urology, University Hospital of Federal University of Maranhao, and group 2 (n = 20) patients from private practice. The hand-made polypropylene suburethral sling was used in group 1 and the commercial sling in group 2. The patients were evaluated 30, 60 and 90 days after surgery. Results: The mean duration of surgery was 43 min. in group 1 and 51 min. in group 2. No postoperative voiding difficulties were observed in group 1 (100%), as well as, in 94.7% of patients of group 2. A bladder catheter was not required in any of the patients of the two groups at the end of the study. The level of satisfaction was 100% in group 1, whereas, one patient of group 2 considered the surgery to be unsuccessful. Urodynamic studies showed low amplitude uninhibited contraction in 11.1% of patients of group 1 and 10.5% of group 2. No complications were observed in either group. Conclusion: The hand-made polypropylene mesh (Marlex®) can be used for sling procedures, saving costs and yielding results similar to that obtained with commercial sling systems.

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Obstructive sleep apnea (OSA) is extremely common and has several consequences. However, most cases remain undiagnosed. One limitation is the lack of simple and validated methods for OSA diagnosis at home. The aim of this study was to validate a wireless high-resolution oximeter with a built-in accelerometer linked to a smartphone with automated cloud analysis (Biologix) that was compared with a home sleep test (HST, Apnea Link Air) performed on the same night. We recruited 670 patients out of a task force of 1013 patients with suspected OSA who were referred to our center for diagnosis. The final sample consisted of 478 patients (mean age: 56.7 ± 13.1 years, mean body mass index: 31.9 ± 6.3 kg/m2). To estimate the night-to-night OSA severity variability, 62 patients underwent HST for two consecutive nights. The HST-apnea–hypopnea index (AHI) and the Biologix-oxygen desaturation index (ODI) was 25.0 ± 25.0 events/h and 24.9 ± 26.5 events/h, respectively. The area under the curve—sensibility/specificity to detect at least mild (HST-AHI > 5), moderate-to-severe (HST-AHI > 15), and severe OSA (HST-AHI > 30) were (0.983)—94.7/92.8, (0.986)—94.8/93.9, and (0.990)—95.8/94.3, respectively. The limits of agreement originating from the Bland–Altman plot and the correlation between HST-AHI and Biologix-ODI were lower than the night-to-night HST-AHI variability (25.5 and 34.5 events/h, respectively, p = 0.001). We conclude that Biologix is a simple and reliable technique for OSA diagnosis at home.