Monitorização portátil no diagnóstico da apneia obstrutiva do sono: situação atual, vantagens e limitações

Polese, Jéssica Fábia; Santos-Silva, Rogério; Kobayashi, Rafael Freire; Pinto, Indira Nunes de Paula; Tufik, Sérgio; Bittencourt, Lia

doi:10.1590/s1806-37132010000400017

Cited by 13 publications

(5 citation statements)

References 46 publications

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“…Portable PSG is effective and may be used as an alternative to in-laboratory PSG, especially in patients with a high clinical probability of OSA. 36 37 38 Fourth, we did not exclude subjects with white-coat hypertension. Lastly, as we utilized hospital-based registry data, the results from the study cannot be generalized to the general population.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Obstructive Sleep Apnea That Determine Its High Prevalence in Resistant Hypertension

et al. 2015

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PurposeResistant hypertension (HTN) occurs in 15-20% of treated hypertensive patients, and 70-80% of resistant hypertensive patients have obstructive sleep apnea (OSA). The characteristics of resistant HTN that predispose patients to OSA have not been reported. Therefore, we aimed to determine the clinical, laboratory, and polysomnographic features of resistant HTN that are significantly associated with OSA.Materials and MethodsHypertensive patients (n=475) who underwent portable polysomnography were enrolled. The patients were categorized into controlled (n=410) and resistant HTN (n=65) groups. The risk factors for the occurrence of OSA in controlled and resistant hypertensive patients were compared, and independent risk factors that are associated with OSA were analyzed.ResultsOut of 475 patients, 359 (75.6%) were diagnosed with OSA. The prevalence of OSA in resistant HTN was 87.7%, which was significantly higher than that in controlled HTN (73.7%). Age, body mass index, neck circumference, waist circumference, and hip circumference were significantly higher in OSA. However, stepwise multivariate analyses revealed that resistant HTN was not an independent risk factor of OSA.ConclusionThe higher prevalence and severity of OSA in resistant HTN may be due to the association of risk factors that are common to both conditions.

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Section: Discussionmentioning

confidence: 99%

Clinical Features of Obstructive Sleep Apnea That Determine Its High Prevalence in Resistant Hypertension

et al. 2015

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“…In this scenario, portable sleep monitors, also called polygraphy (PG) have gained growing interest to be used as an attractive alternative to surpass the main above limitations. PGs have been extensively validated against polysomnography in patients with high clinical probability of OSA [12][13][14][15] . However, whether PGs can be used for diagnosing OSA in non-referred populations is unclear.…”

Section: Introductionmentioning

confidence: 99%

Pragmatic Validation of Home Portable Sleep Monitor for diagnosing Obstructive Sleep Apnea in a non-referred population: The ELSA-Brasil study

Aielo¹,

Santos²,

Silva³

et al. 2019

Sleep Sci

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ObjectivePolygraphy (PG) is an attractive alternative for diagnosing obstructive sleep apnea (OSA) in patients with high pre-test probability. However, several patients may not present typical symptoms. In this scenario, it is unclear the performance of PG for diagnosing OSA in non-referred populations to sleep laboratories.MethodsData from participants of the ELSA-Brasil cohort were used for this analysis. We performed an overnight home PG (Embletta GoldTM) synchronized with a wrist actigraphy (Actiwatch model 2TM). The validation strategy comprised three scorings from each participant: 1) Original scoring (PG): Routine scoring using data from the exclamation button mark to define “analysis start” and “analysis stop”; 2) Scoring using actigraphy data (PG+actigraphy): total sleep time defined by the actigraphy data; 3) Scoring using diaries (PG+diary): “analysis start” and “analysis stop” based on the diaries. Bland-Altman plots were generated to assess the agreements (Kappa) between each scoring strategy.ResultsA total of 300 participants were included in the final analysis (45% males, mean age: 48±8 years). The frequency of OSA using the PG score was 27.3%. Despite small differences in the OSA severity index, we obtained a high concordance of AHI comparing the PG vs. PG+actigraphy (Kappa: 0.95) as well as PG+diary vs. PG+actigraphy (Kappa: 0.96). No significant changes in the OSA classification (mild, moderate and severe) were observed in the 3 protocols.ConclusionUsing a pragmatic approach to address OSA at home, our results suggest that PG is a useful tool for OSA diagnosis even in subjects not referred to sleep studies.

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“…Studies demonstrate that portable devices have proven to be able to provide a diagnosis equivalent to that provided by in-laboratory polysomnography, at least in patients with a high likelihood of OSA. 37 , 38 …”

Section: Discussionmentioning

confidence: 99%

Sleep-disordered breathing in patients with COPD and mild hypoxemia: prevalence and predictive variables

et al. 2017

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Objective:To infer the prevalence and variables predictive of isolated nocturnal hypoxemia and obstructive sleep apnea (OSA) in patients with COPD and mild hypoxemia.Methods:This was a cross-sectional study involving clinically stable COPD outpatients with mild hypoxemia (oxygen saturation = 90-94%) at a clinical center specializing in respiratory diseases, located in the city of Goiânia, Brazil. The patients underwent clinical evaluation, spirometry, polysomnography, echocardiography, arterial blood gas analysis, six-minute walk test assessment, and chest X-ray.Results:The sample included 64 patients with COPD and mild hypoxemia; 39 (61%) were diagnosed with sleep-disordered breathing (OSA, in 14; and isolated nocturnal hypoxemia, in 25). Correlation analysis showed that PaO2 correlated moderately with mean sleep oxygen saturation (r = 0.45; p = 0.0002), mean rapid eye movement (REM) sleep oxygen saturation (r = 0.43; p = 0.001), and mean non-REM sleep oxygen saturation (r = 0.42; p = 0.001). A cut-off point of PaO2 ≤ 70 mmHg in the arterial blood gas analysis was significantly associated with sleep-disordered breathing (OR = 4.59; 95% CI: 1.54-13.67; p = 0.01). The model showed that, for identifying sleep-disordered breathing, the cut-off point had a specificity of 73.9% (95% CI: 51.6-89.8%), a sensitivity of 63.4% (95% CI: 46.9-77.9%), a positive predictive value of 81.3% (95% CI: 67.7-90.0%), and a negative predictive value of 53.1% (95% CI: 41.4-64.4%), with an area under the ROC curve of 0.69 (95% CI: 0.57-0.80), correctly classifying the observations in 67.2% of the cases. Conclusions:In our sample of patients with COPD and mild hypoxemia, the prevalence of sleep-disordered breathing was high (61%), suggesting that such patients would benefit from sleep studies.

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Monitorização portátil no diagnóstico da apneia obstrutiva do sono: situação atual, vantagens e limitações

Cited by 13 publications

References 46 publications

Clinical Features of Obstructive Sleep Apnea That Determine Its High Prevalence in Resistant Hypertension

Clinical Features of Obstructive Sleep Apnea That Determine Its High Prevalence in Resistant Hypertension

Pragmatic Validation of Home Portable Sleep Monitor for diagnosing Obstructive Sleep Apnea in a non-referred population: The ELSA-Brasil study

Sleep-disordered breathing in patients with COPD and mild hypoxemia: prevalence and predictive variables

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