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

Abstract

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.

Peripheral arterial tonometry versus polysomnography in suspected obstructive sleep apnoea

“…Comparable data for negative PAT were found in the PATER study [ 31 ]. Previous studies have shown that PAT has a good sensitivity for an AHI ≥ 5/h (pooled sensitivity of 96%; CI 93–97%) [ 52 ]. The focus of our study was to determine how a positive PAT result (≥ 5 /h) in a representative clinical cohort of different pre-test probabilities, could be integrated into medical decision-making and showed a good PPV of 0.8 for a PAT AHI ≥ 5/h or 0.86 for an AHI ≥ 15/h.…”

Home Sleep Apnea Testing for the Diagnosis of Obstructive Sleep Apnea

“…A meta-analysis of 20 studies reported a diagnostic accuracy of 61% in classification of OSA severity category (normal, mild, moderate, and severe) comparing home sleep apnea testing vs polysomnography. A meta-analysis of PAT-based home sleep apnea testing that included 13 trials reported a sensitivity of 96% and a specificity of 44% for patients with an AHI of 5 or more events per hour, and it reported a sensitivity of 80% and a specificity of 90% for patients with an AHI of 30 or more events per hour. A comparison of concurrent polysomnography and PAT-based home sleep apnea testing device recordings of 500 patients suspected to have OSA found diagnostic concordance in 42% for mild, 41% for moderate, and 83% for severe OSA .…”

Clinical prediction models for the early diagnosis of obstructive sleep apnea in stroke patients: a systematic review

“…The polysomnography (PSG), conducted in a sleep laboratory by a trained physician, is widely recognized as the gold standard for OSA diagnosis [ 11 ]. Patients experiencing an average of at least 15 apnea events per hour are typically diagnosed with OSA [ 12 ].…”