Agreement in the Scoring of Respiratory Events Among International Sleep Centers for Home Sleep Testing

Magalang, Ulysses J.; Arnardóttir, Erna Sif; Chen, Ning‐Hung; Cistulli, Peter A.; Gíslason, Þórarinn; Lim, Diane C.; Penzel, Thomas; Schwab, Richard J.; Tufik, Sérgio; Pack, Allan I.

doi:10.5664/jcsm.5398

Cited by 34 publications

(36 citation statements)

References 30 publications

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“…Subjects were recruited from SAGIC sleep centers. 13,16,17 Inclusion criteria were suspicion of OSA and undergoing a sleep study. The prospective study was approved by the IRB at the University of Pennsylvania (IRB protocol number 820563) and additional IRB approvals at each site.…”

Section: Prospective Samplementioning

confidence: 99%

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Defining Extreme Phenotypes of OSA Across International Sleep Centers

Rizzatti

Mazzotti

Mindel

et al. 2020

Chest

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BACKGROUND: Extreme phenotypes of OSA have not been systematically defined. RESEARCH QUESTION: This study developed objective definitions of extreme phenotypes of OSA by using a multivariate approach. The utility of these definitions for identifying characteristics that confer predisposition toward or protection against OSA is shown in a new prospective sample. STUDY DESIGN AND METHODS: In a large international sample, race-specific liability scores were calculated from a weighted logistic regression that included age, sex, and BMI. Extreme cases were defined as individuals with an apnea-hypopnea index (AHI) $ 30 events/hour but low likelihood of OSA based on age, sex, and BMI (liability scores > 90th percentile). Similarly, extreme controls were individuals with an AHI < 5 events/hour but high likelihood of OSA (liability scores < 10th percentile). Definitions were applied to a prospective sample from the Sleep Apnea Global Interdisciplinary Consortium, and differences in photographybased craniofacial and intraoral phenotypes were evaluated. RESULTS: This study included retrospective data from 81,338 individuals. A total of 4,168 extreme cases and 1,432 extreme controls were identified by using liability scores. Extreme cases were younger (43.1 AE 14.7 years), overweight (28.6 AE 6.8 kg/m 2), and predominantly female (71.1%). Extreme controls were older (53.8 AE 14.1 years), obese (34.0 AE 8.1 kg/m 2), and predominantly male (65.8%). These objective definitions identified 29 extreme cases and 87 extreme controls among 1,424 Sleep Apnea Global Interdisciplinary Consortium participants with photography-based phenotyping. Comparisons suggest that a greater cervicomental angle increases risk for OSA in the absence of clinical risk factors, and smaller facial widths are protective in the presence of clinical risk factors. INTERPRETATION: This objective definition can be applied in sleep centers throughout the world to consistently define OSA extreme phenotypes for future studies on genetic, anatomic, and physiologic pathways to OSA.

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Section: Prospective Samplementioning

confidence: 99%

“…software at each site. 16,17 Digital photographs were obtained by using standardized protocols. 8,9 Statistical Analysis Figure 1 illustrates the overall extreme phenotype design.…”

Section: Prospective Samplementioning

confidence: 99%

Defining Extreme Phenotypes of OSA Across International Sleep Centers

Rizzatti

Mazzotti

Mindel

et al. 2020

Chest

Self Cite

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“…Previous studies evaluated the reduction of inter‐scorer variability as the main success factor for teaching activities (Magalang, ; Penzel, ; Bosi et al, ). In our study we did not evaluate this particular question as we focused on the students’ experience.…”

Section: Discussionmentioning

confidence: 99%

“…However, it has been shown that inter‐scorer variability is significant (Younes et al,) and agreement is only close to 70% in a setting without systematic quality assurance. Indeed, several studies have shown that rigorous training and expert consensus scoring can improve the overall agreement in sleep and event scoring to levels of 85% and higher (Magalang et al, ; Penzel, ).…”

Section: Introductionmentioning

confidence: 99%

How to organise teaching activities for the scoring of cardiorespiratory polygraphies? Experiences from three Swedish Sleep Society teaching courses

Grote

2018

Journal of Sleep Research

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Education in the scoring of sleep‐disordered breathing is organised differently and data on the evaluation of teaching strategies based on student ratings are sparse. The aim of the study was to analyse the gain in theoretical and practical knowledge achieved during different course settings offered by a national sleep society. The course contained 1 hr of theoretical teaching (scoring rules and recording methodology) and 2.5 hr of practical scoring (physiological breathing, obstructive/central sleep apnea and hypoventilation). Three different settings were provided: a large scoring group including participants with mixed experiences (1), a small scoring group with inexperienced scorers (2), and guided scoring for experienced scorers (3). Evaluation was performed at the end of the course. Data from 67 out of 82 participants (79%) were analysed (42 nurses/technicians and 25 physicians/dentists). Previous scoring experience was limited, moderate and extended in 25, 26, and 15 students, respectively. Gain of practical knowledge and overall course rating were significantly higher in settings 2 and 3 compared with 1 (p = 0.005 and p = 0.018 respectively). Guided scoring was the preferred practical teaching setting in experienced scorers, whereas scoring in large groups together with an experienced student was preferred in newcomers. Profession did not influence gain of knowledge, course satisfaction or preferred course design. From the student's perspective, consensus scoring in groups or guided scoring for all students may have advantages compared with single/small‐group scoring settings. Technical teaching knowledge of faculty members is of significant importance.

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“…The accepted method to analyze RIP is manual scoring, according to rules, which represent the consensus of experts [14,15]. Manual scoring suffers from intra-and inter-scorer variability [16][17][18] and is time consuming, limiting research on POA to small studies of 20 to 60 infants [5,6,11,13].…”

Section: Introductionmentioning

confidence: 99%

Automatic unsupervised respiratory analysis of infant respiratory inductance plethysmography signals

et al. 2020

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Infants are at risk for potentially life-threatening postoperative apnea (POA). We developed an Automated Unsupervised Respiratory Event Analysis (AUREA) to classify breathing patterns obtained with dual belt respiratory inductance plethysmography and a reference using Expectation Maximization (EM). This work describes AUREA and evaluates its performance. AUREA computes six metrics and inputs them into a series of four binary k-means classifiers. Breathing patterns were characterized by normalized variance, nonperiodic power, instantaneous frequency and phase. Signals were classified sample by sample into one of 5 patterns: pause (PAU), movement (MVT), synchronous (SYB) and asynchronous (ASB) breathing, and unknown (UNK). MVT and UNK were combined as UNKNOWN. Twenty-one preprocessed records obtained from infants at risk for POA were analyzed. Performance was evaluated with a confusion matrix, overall accuracy, and pattern specific precision, recall, and F-score. Segments of identical patterns were evaluated for fragmentation and pattern matching with the EM reference. PAU exhibited very low normalized variance. MVT had high normalized nonperiodic power and low frequency. SYB and ASB had a median frequency of respectively, 0.76Hz and 0.71Hz, and a mode for phase of 4 o and 100 o. Overall accuracy was 0.80. AUREA confused patterns most often with UNKNOWN (25.5%). The pattern specific F-score was highest for SYB (0.88) and lowest for PAU (0.60). PAU had high precision (0.78) and low recall (0.49). Fragmentation was evident in pattern events <2s. In 75% of the EM pattern events >2s, 50% of the samples classified by AUREA had identical patterns. Frequency and phase for SYB and ASB were consistent with published values for synchronous and asynchronous breathing in infants. The low normalized variance in PAU, was consistent with published scoring rules for pediatric apnea. These findings support the use of AUREA to classify breathing patterns and warrant a future evaluation of clinically relevant respiratory events.

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Agreement in the Scoring of Respiratory Events Among International Sleep Centers for Home Sleep Testing

Cited by 34 publications

References 30 publications

Defining Extreme Phenotypes of OSA Across International Sleep Centers

Defining Extreme Phenotypes of OSA Across International Sleep Centers

How to organise teaching activities for the scoring of cardiorespiratory polygraphies? Experiences from three Swedish Sleep Society teaching courses

Automatic unsupervised respiratory analysis of infant respiratory inductance plethysmography signals

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