Diagnosis of sleep apnea without sensors on the patient ’ s face

Abstract

Study Objectives: Thermistors, nasal cannulas, and respiratory inductance plethysmography (RIP) are the recommended reference sensors of the American Academy of Sleep Medicine (AASM) for the detection and characterization of apneas and hypopneas; however, these sensors are not well tolerated by patients and have poor scorability. We evaluated the performance of an alternative method using a combination of tracheal sounds (TSs) and RIP signals. Methods: Consecutive recordings of 70 adult patients from the Pays de la Loire Sleep Cohort were manually scored in random order using the AASM standard signals and the combination TS and RIP signals, without respiratory sensors placed on the patient's face. The TS-RIP scoring used the TS and RIP-flow signals for detection of apneas and hypopneas, respectively, and the suprasternal pressure and RIP belt signals for the characterization of apneas.Results: Sensitivity and specificity of the TS-RIP combination were 96.21% and 91.34% for apnea detection and 89.94% and 93.25% for detecting hypopneas, respectively, with a kappa coefficient of 0.87. For the characterization of apneas, sensitivity and specificity were 98.67% and 96.17% for obstructive apneas, 92.66% and 99.36% for mixed apneas, and 96.14% and 98.89% for central apneas, respectively, with a kappa coefficient of 0.94. The TS-RIP scoring revealed a high agreement for classifying obstructive sleep apnea into severity classes (none, mild, moderate, and severe obstructive sleep apnea) with a Cohen's kappa coefficient of 0.96. Conclusions: Compared with the AASM reference sensors, the TS-RIP combination allows reliable noninvasive detection and characterization of respiratory events with a high degree of sensitivity and specificity. TS-RIP combination could be used for diagnosis of obstructive sleep apnea in adults, either as an alternative to the AASM sensors or in combination with the recommended AASM sensors.

Sleep laboratories reopening and COVID-19: a European perspective

“…Although respiratory inductive plethysmography (RIP) may help to diagnose respiratory events without using sensors on the patient's face, it is unlikely to replace traditional sensors for airflow, due to relative instability of signals over time, and lack of sensitivity especially in mild cases. Some solutions have been proposed, such as viral filters inserted in the nasal cannula circuit [ 37 ], or combination of RIP and tracheal sounds [ 38 ]. Finally, many smartphone apps may turn out to be useful for SDB diagnosis, but they are not validated yet.…”

Artificial Intelligence-Based Algorithms and Healthcare Applications of Respiratory Inductance Plethysmography: A Systematic Review

“…The studies were conducted for various applications, including measurement of respiratory volumes [9,27,34,35,37,[44][45][46][47][48][49][50], monitoring of respiratory activity in infants [11,40,50,51], sleep studies in adults [12,13,[52][53][54][55][56], and tracking of selected human activities [36] and smoking [57,58]. The studies [37,38,48] exclusively focused on the calibration of RIP devices, and the studies [11,23,55] analyzed the performance of RIP exclusively in children.…”

“…Continuous positive airway pressure (CPAP), a prevalent treatment for obstructive sleep apnea, is depicted in Figure 5a, while Figure 5b depicts the airway obstruction caused by apnea. The authors of [12] proposed that the combination of tracheal sounds and RIP could be used as a reliable method for detecting and characterizing respiratory events without the need to place sensors on patients' faces and that it could be used as an alternative to or in addition to the recommended AASM sensors. RIP can monitor breathing asynchrony between the thorax and abdomen occurring in OSA and can aid in diagnosis of OSA, though asynchronous breathing is not exclusive to OSA [79].…”

“…RIP can be used in both stationary and ambulatory subjects and is generally suitable for continuous long-term monitoring, which offers an advantage over traditional spirometry in some specific cases [9][10][11]. Moreover, analysis of breathing patterns from RIP data can be used in diagnostic procedures in some illnesses associated with respiratory functioning [12,13]. With the advancement in computation and signal processing techniques, RIP has huge potential to be used as an alternative alongside some other established methods in clinical practices.…”

Sleep medicine and coronavirus disease 2019

“…This drastic interruption to services comes at a time when the prevalence and economic costs of OSA are increasing as levels of obesity increase globally [8], so there is a clear need to maintain access to appropriate diagnostic services for individuals with suspected OSA. Measures to enhance the safety of in-laboratory testing, including nasal circuit viral filters for nasal cannulae and the combination of RIP with measurement of tracheal sounds rather than airflow are under investigation [9,10]. Utilization of telemedicine and home sleep apnoea testing are likely to rise to avoid unnecessary infection risks to patients and to continue to provide optimal care [11 ▪ ].…”