Night-to-night reliability and agreement of obstructive sleep apnea pathophysiologic mechanisms estimated with phenotyping using polysomnography in cognitively normal elderly participants

Abstract

Study Objectives Phenotyping using polysomnography (PUP) is an algorithmic method to quantify physiologic mechanisms underlying obstructive sleep apnea (OSA): loop gain (LG1), arousal threshold (ArTH), and upper airway collapsibility (Vpassive) and muscular compensation (Vcomp). The consecutive-night test-retest reliability and agreement of PUP-derived estimates is unknown. From a cohort of elderly (age ≥55 years), largely non-sleepy, community-dwelling volunteers who underwent in-lab polysomnography (PSG) on 2 consecutive nights, we determined the test-retest reliability and agreement of PUP-estimated physiologic factors. Methods Subjects who had an apnea-hypopnea index (AHI3A) of at least 15 events per hour on the first night were included. PUP analyses were performed on each of 2 PSGs from each subject. Physiologic factor estimates were derived from NREM sleep and compared across nights using intraclass correlation coefficients (ICC) for reliability and smallest real differences (SRD) for agreement. Results Two PSGs from each of 43 subjects (86 total) were analyzed. A first-night effect was evident with increased sleep time and stability and decreased OSA severity on the second night. LG1, ArTH, and Vpassive demonstrated good reliability (ICC >0.80). Vcomp had modest reliability (ICC = 0.67). For all physiologic factors, SRD values were approximately 20% or more of the observed ranges, suggesting limited agreement of longitudinal measurements for a given individual. Conclusion For NREM sleep in cognitively normal elderly individuals with OSA, PUP-estimated LG1, ArTH, and Vpassive demonstrated consistent relative ranking of individuals (good reliability) on short-term repeat measurement. For all physiologic factors, longitudinal measurements demonstrated substantial intraindividual variability across nights (limited agreement).

Novel Technologies in the Diagnosis and Management of Sleep-disordered Breathing

“…The traits derived from PUP have been shown to have a moderate-to-good within-night repeatability, with correlations (Pearson correlation) ranging from 0.69 to 0.83 (Alex et al, 2022) for two independent measures taken from the same night. Night-to-night repeatability is similar, with correlations (intraclass correlation) ranging from 0.72 to 0.83 (Strassberger et al, 2023) in one study, and 0.67-0.91 in another (Tolbert et al, 2023). In general, intraclass correlations for collapsibility, loop gain, and arousal threshold have been >0.8 but lower for compensation.…”

Sleep apnea endotypes: from the physiological laboratory to scalable polysomnographic measures

“…The traits derived from PUP have been shown to have a moderate-to-good within-night repeatability, with correlations (Pearson correlation) ranging from 0.69 to 0.83 (Alex et al, 2022) for two independent measures taken from the same night. Night-to-night repeatability is similar, with correlations (intraclass correlation) ranging from 0.72 to 0.83 (Strassberger et al, 2023) in one study, and 0.67-0.91 in another (Tolbert et al, 2023). In general, intraclass correlations for collapsibility, loop gain, and arousal threshold have been >0.8 but lower for compensation.…”

Identifying the pathophysiological traits of obstructive sleep apnea during dexmedetomidine sedation

“…Fourth, we recognised the existing limitations of PUPBeta for deriving OSA traits (e.g., the assumption that the airway fully reopens between respiratory events, the handling of oral breathing) (Tolbert, Parekh et al, 2023; Younes & Schwab, 2023), and we anticipated further validation of our findings through gold‐standard measurements in the future. Though the OSA traits were derived from single polysomnography data, the night‐to‐night repeatability of OSA traits estimated from PUPBeta has been preliminarily validated as good (Strassberger et al, 2023; Tolbert, Schoenholz et al, 2023). Furthermore, all participants in this study were Chinese (Asian cohort), whose pathophysiological traits were similar to previously reported data (Finnsson et al, 2023), such as exhibiting higher collapsibility and a heightened arousal threshold compared with Caucasians (the arousal threshold values reported here were untransformed values).…”