Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnoea

Vázquez, Juan-Carlos

doi:10.1136/thorax.55.4.302

Cited by 232 publications

(195 citation statements)

References 18 publications

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“…However, there is good evidence that equivalence exists between the two measures of OSAS severity [49], and indeed ODI is at least as reproducible as the AHI between repeated nights [50]. Furthermore, oscillations in oxygen levels may be more pertinent to the vascular effects of OSA than apnoeic events [51] and therefore the current authors believe that the use of an ODI rather than an AHI does not limit the interpretation of their data.…”

Section: Study Limitationsmentioning

confidence: 86%

CPAP and measures of cardiovascular risk in males with OSAS

Kohler¹,

Pepperell²,

Casadei³

et al. 2008

European Respiratory Journal

175

115

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Obstructive sleep apnoea syndrome (OSAS) has been associated with hypertension, stroke and myocardial ischaemia in epidemiological and observational studies. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS, but the impact of this intervention on established risk factors for cardiovascular disease remains incompletely understood.A total of 102 males with moderate-to-severe OSAS were randomised to therapeutic (n551) or subtherapeutic (n551) CPAP treatment for 4 weeks to investigate the effects of active treatment on 24-h urinary catecholamine excretion, baroreflex sensitivity (BRS), arterial stiffness (augmentation index) and 24-h ambulatory blood pressure (ABP).After 4 weeks of therapeutic CPAP, significant reductions were seen in urine normetanephrine excretion (from mean¡SD 179.7¡80.1 to 132.7¡46.5 mmol?mol -1 creatinine) and augmentation index (from 14.5¡11.3 to 9.1¡13.8%) compared with the subtherapeutic control group. Furthermore, therapeutic CPAP significantly improved BRS (from 7.1¡3.3 to 8.8¡4.2 ms?mmHg) and reduced mean arterial ABP by 2.6¡5.4 mmHg.In conclusion, treatment of obstructive sleep apnoea with continuous positive airway pressure may lower cardiovascular risk by reducing sympathetic nerve activity, ambulatory blood pressure and arterial stiffness and by increasing sensitivity of the arterial baroreflex.

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Section: Study Limitationsmentioning

confidence: 86%

CPAP and measures of cardiovascular risk in males with OSAS

Kohler¹,

Pepperell²,

Casadei³

et al. 2008

European Respiratory Journal

175

115

View full text Add to dashboard Cite

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“…This large number of tests dictated that we use automatic scoring in the interest of efficiency and reliability. The Snore Sat Recorder used in this study has been shown to correlate well with a polysomnogram-determined respiratory disturbance index (r 2 = 0.97) 47 suggesting that the recorder provides a reliable index of the full-night frequency of respiratory disturbances. Furthermore, the oxygen component used in the scoring of ODI is less prone to uncontrolled variability and noise than the ventilatory component used in the scoring of AHI.…”

Section: Ppv 97% Npv 72%mentioning

confidence: 93%

“…Specifically, all participants underwent a 2-night feedback-controlled mandibular positioning (FCMP) study, and all received a custom treatment appliance. All participants underwent outcome testing with the treatment appliance in the mouth for 2 nights in the home using a validated monitor 47 that automatically calculates a 4% ODI. Therapeutic success or failure was defined as a mean ODI value from the 2 outcome studies of less or greater than 10 events/h, respectively.…”

Section: Generalmentioning

confidence: 99%

A Feedback-Controlled Mandibular Positioner Identifies Individuals With Sleep Apnea Who Will Respond to Oral Appliance Therapy

Remmers

Topor

Grosse³

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Mandibular protruding oral appliances represent a potentially important therapy for obstructive sleep apnea (OSA). However, their clinical utility is limited by a less-than-ideal efficacy rate and uncertainty regarding an efficacious mandibular position, pointing to the need for a tool to assist in delivery of the therapy. The current study assesses the ability to prospectively identify therapeutic responders and determine an efficacious mandibular position. Methods: Individuals (n = 202) with OSA participated in a blinded, 2-part investigation. A system for identifying therapeutic responders was developed in part 1 (n = 149); the predictive accuracy of this system was prospectively evaluated on a new population in part 2 (n = 53). Each participant underwent a 2-night, in-home feedback-controlled mandibular positioner (FCMP) test, followed by treatment with a custom oral appliance and an outcome study with the oral appliance in place. A machine learning classification system was trained to predict therapeutic outcome on data obtained from FCMP studies on part 1 participants. The accuracy of this trained system was then evaluated on part 2 participants by examining the agreement between prospectively predicted outcome and observed outcome. A predicted efficacious mandibular position was derived from each FCMP study. Results: Predictive accuracy was as follows: sensitivity 85%; specificity 93%; positive predictive value 97%; and negative predictive value 72%. Of participants correctly predicted to respond to therapy, the predicted mandibular protrusive position proved efficacious in 86% of cases. Conclusions: An unattended, in-home FCMP test prospectively identifies individuals with OSA who will respond to oral appliance therapy and provides an efficacious mandibular position. Clinical Trial Registration: The trial that this study reports on is registered on www.clinicaltrials.gov, ID NCT03011762, study name: Feasibility and Predictive Accuracy of an In-Home Computer Controlled Mandibular Positioner in Identifying Favourable Candidates for Oral Appliance Therapy Keywords: home sleep test, obstructive sleep apnea, oral appliance therapy, predictive accuracy, sleep-disordered breathing Citation: Remmers JE, Topor Z, Grosse J, Vranjes N, Mosca EV, Brant R, Bruehlmann S, Charkhandeh S, Jahromi SA. A feedback-controlled mandibular positioner identifies individuals with sleep apnea who will respond to oral appliance therapy. J Clin Sleep Med. 2017;13(7):871-880. I NTRO DUCTI O NObstructive sleep apnea (OSA) is a chronic disease caused by repeated narrowing or closure of the pharynx during sleep. The disease compromises quality of life, 1,2 increases risk of accidents, [3][4][5] and is associated with an increased risk of cardiovascular events 6 and reduced survival rate. 7,8 Continuous positive airway pressure (CPAP), the standard therapy for this disease, is efficacious and benign. However, long-term compliance with CPAP is low, 9,10 and this may contribute to its ineffectiveness in preventing adverse...

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“…We proposed using the alternative of "selective" polysomnography in the highest-risk group of commercial drivers(1) by first identifying drivers most likely to have apnea with questionnaire and oximetry (15). The questionnaire we used, the multivariable apnea prediction (16,17), predicts likelihood of apnea by combining three symptom-frequency questions with body mass index (BMI), age and gender.…”

Section: Diagnosing Apneamentioning

confidence: 99%

Estimated cost of crashes in commercial drivers supports screening and treatment of obstructive sleep apnea

Gurubhagavatula

Nkwuo

Maislin

et al. 2008

Accident Analysis & Prevention

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Sleep apnea among commercial drivers may increase the risk of fall-asleep crashes, which incur large expenses. Drivers of passenger cars whose apnea is treated experience lower crash risk. Among community-based holders of commercial driver's licenses, we considered three methods for identifying sleep apnea syndrome: 1) in-lab polysomnography; 2) selective in-lab polysomnography for high-risk drivers, where high risk is first identified by body mass index, age and gender, followed by oximetry in a subset of drivers; and 3) not screening. The costs for each of these three programs equaled the sum of the costs of testing, treatment of identified cases, and crashes. Assuming that treatment prevents apnea-related crashes, polysomnography is not costeffective, because it was more expensive than the cost of crashes when no screening is done. Screening with BMI, age and gender, however, with confirmatory in-lab polysomnography only on high-risk drivers was cost-effective, as long as a high proportion (73.8%) of screened drivers accepts treatment. These findings indicate that strategies that reduce reliance on in-laboratory polysomnography may be more cost-effective than not screening, and that treatment acceptance may need to be a condition of employment for affected drivers.

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Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnoea

Cited by 232 publications

References 18 publications

CPAP and measures of cardiovascular risk in males with OSAS

CPAP and measures of cardiovascular risk in males with OSAS

A Feedback-Controlled Mandibular Positioner Identifies Individuals With Sleep Apnea Who Will Respond to Oral Appliance Therapy

Estimated cost of crashes in commercial drivers supports screening and treatment of obstructive sleep apnea

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