A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies

Iftikhar, Imran H.; Finch, Christina; Shah, Amit; Augunstein, Cheryl A.; Ioachimescu, Octavian C.

doi:10.5664/jcsm.9808

Cited by 15 publications

(5 citation statements)

References 36 publications

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“…Although previous studies have shown a high correlation between the respective AHI values derived from PAT and PSG, clinicians should be careful while interpreting these results because a high correlation is not necessarily equivalent to diagnostic utility (Yalamanchali et al, 2013). The results of the present study were consistent with those of an earlier systematic review (Iftikhar et al, 2021). Our own research builds on previous research, which adds to the body of evidence on this subject.…”

Section: Discussionsupporting

confidence: 94%

“…The results of the present study were consistent with those of an earlier systematic review (Iftikhar et al, 2021). Our own research builds on previous research, which adds to the body of evidence on this subject.…”

Section: Discussionsupporting

confidence: 92%

“…Two systematic reviews evaluated the diagnostic performance of PAT for SAS in comparison to PSG (Iftikhar et al, 2021; Yalamanchali et al, 2013); however, the diagnostic accuracy of PAT was not the main objective of either review, and the review by Yalamanchali et al only examined the correlation between the apnea–hypopnea index (AHI) of PSG and the AHI of HSAT, rather than sensitivity or specificity. Although the AASM guidelines recommend the use of HSAT as the initial testing option in certain situations (Kapur et al, 2017), there is a lack of comprehensive evidence to determine whether HSAT using PAT can replace PSG.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of home sleep apnea testing using peripheral arterial tonometry for sleep apnea: A systematic review and meta‐analysis

Ichikawa

Akiyama

Tsujimoto

et al. 2022

Journal of Sleep Research

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Summary This study aimed to evaluate the diagnostic accuracy of home sleep apnea testing using peripheral arterial tonometry for sleep apnea as an alternative to polysomnography. We conducted a systematic review and meta‐analysis of observational studies, randomized controlled trials, and diagnostic case–control studies examining the diagnostic accuracy of peripheral arterial tonometry by searching the CENTRAL, MEDLINE, EMBASE, ICTRP and http://clinicaltrials.gov databases on 5 October 2021. We assessed the risk of bias of the included studies using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. A bivariate random‐effects model was generated to derive the summary point estimates of sensitivity and specificity with 95% confidence intervals at different apnea–hypopnea index cutoffs. This meta‐analysis included 13 studies (1227 participants, median prevalence of sleep apnea with apnea–hypopnea index ≥ 5 events per hr: 85%). The risk of bias in the included studies was low to moderate. The pooled sensitivity and specificity estimates were 96% (95% confidence interval: 93%–97%) and 44% (95% confidence interval: 32%–56%) at apnea–hypopnea index ≥ 5 events per hr, 88% (85%–91%) and 74% (63%–83%) at apnea–hypopnea index ≧ 15 events per hr, and 80% (66%–89%) and 90% (83%–95%) at apnea–hypopnea index ≧ 30 events per hr, respectively. Peripheral arterial tonometry resulted in a significant number of false negatives and false positives at any apnea–hypopnea index cutoff when applied to the median prevalence setting of the included studies. The inadequate sensitivity and specificity of peripheral arterial tonometry render it an unsuitable alternative to polysomnography for detecting sleep apnea for apnea–hypopnea index ≧ 5, 15 and 30 events per hr.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of home sleep apnea testing using peripheral arterial tonometry for sleep apnea: A systematic review and meta‐analysis

Ichikawa

Akiyama

Tsujimoto

et al. 2022

Journal of Sleep Research

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“…Nevertheless, concordance with PSG in diagnosing sleep apnoea was good and increased to 86% for diagnosis of sleep apnoea in patients with a PAT AHI score of ≥ 15/h. Limited accuracy of classifying sleep apnoea severity was recently reported [ 24 , 31 , 32 ]. This is also reflected in our data (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The results of the existing studies and their interpretation are divergent. On one hand, a good correlation between PAT AHI and PSG AHI is shown [ 19 – 22 ], on the other hand, misclassification of severity and presence of OSA by PAT was described [ 23 , 24 ]. In addition, severity of OSA, age and certain comorbid conditions such as arterial stiffness, may affect the diagnostic accuracy of PAT [ 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Peripheral arterial tonometry versus polysomnography in suspected obstructive sleep apnoea

et al. 2023

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Background Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnoea (OSA). Home sleep apnoea testing with peripheral arterial tonometry (PAT) is a recommended diagnostic alternative for patients with an increased risk for OSA. In a large clinical cohort, we investigated concordance and predictors for discordance in diagnosing OSA using PAT and PSG, and three-year cardiovascular risk in patients with discordant OSA diagnosis. Methods Retrospective monocentric cohort study. Patients with a PAT AHI ≥ 5/h followed by an in-hospital PSG within three months were included. All patients with a PAT AHI ≥ 5/h but a PSG AHI < 5/h were classified as discordant. Patients with PAT and PSG AHI ≥ 5/h were classified as concordant. To ascertain cardiovascular risk, major adverse cardiovascular events (MACE) were analyzed in discordant patients and sex, age, body mass index (BMI) and cardiovascular disease-matched concordant patients over a follow-up time of 3.1 ± 0.06 years. Results A total of 940 patients, 66% male with an average age of 55 ± 0.4 years and BMI of 31 ± 0.2 kg/m2 were included. Agreement in OSA diagnosis was observed in 80% of patients (55% in mild and 86% in moderate and severe OSA). Factors significantly associated with a discordant diagnosis were female sex, younger age and lower BMI, but not comorbidities. There was no significant difference in MACE (p = 0.920) between discordant patients (n = 155) and matched concordant patients (n = 274) with or without therapy. Conclusions Concordance between PAT and PSG diagnosis of sleep apnoea is good, particularly in moderate and severe OSA. Predictors for discordant results between PAT and PSG were age, sex and BMI. MACE risk is similar in those with OSA diagnosed by PAT or PSG.

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Comparison of Home Sleep Devices and Sleep Study Testing in Hypoglossal Nerve Stimulation Patients

Huyett,

Yu,

Kent

et al. 2024

The Laryngoscope

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ObjectiveHypoglossal nerve stimulation (HGNS) is an implantable therapy for obstructive sleep apnea (OSA). Therapy efficacy is currently confirmed by a formal sleep study after empiric adjustment by the patient at home based on their subjective experience with the device. Home‐based longitudinal apnea hypopnea index (AHI) measurements have the potential to refine HGNS therapeutic amplitude selection with objective data. Our objective was to compare AHI derived from routine sleep studies and two different home sleep devices in new HGNS recipients.MethodsProspectively enrolled patients receiving HGNS therapy were provided a Sleep Tracking Mat (Withings, Issy‐les‐Moulineaux, France) and NightOwl peripheral arterial tonometry (PAT) sensor (Ectosense, Leuven, Belgium) for longitudinal, home AHI monitoring from 1 to 6 months post‐implant. Therapy efficacy was assessed at 3 and 6 months post‐implant using in‐lab polysomnography (PSG) or home sleep apnea test (HSAT). The sleep mat and PAT sensor AHI were compared against PSG and HSAT for accuracy of OSA severity identification.ResultsSixty patients were enrolled across 5 centers and followed for 6 months. The sleep mat had sensitivity and specificity for identifying AHI <15 of 61% and 82% and AHI <30 of 77% and 100%. The PAT device had sensitivity and specificity for identifying AHI <15 of 57% and 77% and AHI <30 of 81% and 80%.ConclusionsThe sleep mat and PAT sensor demonstrated high sensitivity and specificity for detection of mild and moderate OSA in patients with HGNS therapy and may enable longitudinal objective monitoring of HGNS efficacy in the home setting.Level of Evidence3 Laryngoscope, 2024

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A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies

Cited by 15 publications

References 36 publications

Diagnostic accuracy of home sleep apnea testing using peripheral arterial tonometry for sleep apnea: A systematic review and meta‐analysis

Diagnostic accuracy of home sleep apnea testing using peripheral arterial tonometry for sleep apnea: A systematic review and meta‐analysis

Peripheral arterial tonometry versus polysomnography in suspected obstructive sleep apnoea

Comparison of Home Sleep Devices and Sleep Study Testing in Hypoglossal Nerve Stimulation Patients

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