Home-based Diagnosis of Obstructive Sleep Apnea in an Urban Population

Abstract

understand patient preferences with respect to setting of testing; home vs. in-laboratory. METHODS ParticipantsAdult African Americans, age ≥ 18 years at a single tertiary care center, with high risk for OSA (defi ned by the Berlin Questionnaire, n = 75) were recruited. The Berlin Questionnaire asks about snoring, daytime symptoms, high blood pressure, and body mass index (BMI).9 A positive response in 2 of 3 categories of questions is indicative of high risk for OSA and determined eligibility for enrollment. Participants were recruited from primary care and sleep medicine clinics. Exclusion BRIEF SUMMARY Current Knowledge/Study Rationale: This study was done to examine the feasibility and accuracy of home-based diagnostic testing in urban populations at risk for sleep apnea.

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

“…When two studies evaluated the home-based PAT device against in-laboratory PSG at an AHI cutoff of ≥ 15, specificity ranged from 0.77 to 1.00 and sensitivity ranged from 0.92 to 0.96. 105,106 A single study evaluated the PAT device at an AHI cutoff of ≥ 30, and reported a specificity of 0.82 (95% CI: 0.57 to 0.96) and sensitivity of 0.92 (95% CI: 0.62 to 1.00) 105 (see supplemental material, Table S55 through Table S57). …”

“…104 Two cross-over studies randomized patients to home-based PAT, and in-laboratory simultaneous PSG and PAT. 105,106 For comparison to in-laboratory PSG, only the home-based PAT data were used for this recommendation. A single study that evaluated the performance of the PAT device in the home against in-laboratory PSG using a cutoff of AHI ≥ 5, 106 reported a specificity of 0.43 (95% CI: 0.22 to 0.66).…”

Revise Respiratory Event Criteria or Revise Severity Thresholds for Sleep Apnea Definition?

“…A heart rate-based apnea/hypopnea evaluation, a respiratory sound-based apnea/hypopnea evaluation, or a pulse attenuation evaluation for apnea/hypopnea events are surrogates. 6 Surrogates may serve very well against the reference standard and may do their job well in clinical practice. 6 For summing up these surrogates the term "respiratory disturbance index (RDI)" was coined, being different from AHI.…”

“…6 Surrogates may serve very well against the reference standard and may do their job well in clinical practice. 6 For summing up these surrogates the term "respiratory disturbance index (RDI)" was coined, being different from AHI. This opens our eyes to the problem that nasal prongs or thermal sensors provide surrogates for airfl ow as well.…”

Home Sleep Tests for Obstructive Sleep Apnea (OSA)

“…32 This device is validated for the diagnosis of OSA. 22,[33][34][35][36] The PAT signal is a measure of sympathetic activity and is augmented, along with an increase in the heart rate and a decrease in oxygen saturation, at the termination of a respiratory event. 32,34 Using the above measurements, this device can indirectly detect respiratory events.…”