Portable monitoring in sleep apnea

Penzel, Thomas; Blau, Alexander; García, Caridad Jacas; Schöbel, Christoph; Sebert, M.; Fietze, Ingo

doi:10.1007/s13665-012-0014-0

Cited by 14 publications

(7 citation statements)

References 48 publications

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“…For the diagnosis of OSA these are mostly focused on ambulatory and screening applications and use either nasal airflow or peripheral oxygen saturation (SpO 2 ) or a combination of both for the diagnosis of OSA. 8,9 However, these signals induce several problems and limitations. Mouth breathing or misplacement causes nasal airflow to frequently fail to measure breathing.…”

Section: Validation Of a New System Using Tracheal Body Sound And Movmentioning

confidence: 99%

“…27,28 In general, an application of those devices for the definite diagnosis of OSA is not recommended. 8 The commonly used type 3 monitors (at least 4 channels, usually including electrocardiography, airflow, effort, oximetry) provide positive results for the diagnosis of OSA compared to PSG. 28,29 The diagnostic performance of the presented monitor, however, is superior to type 4 monitors and comparable with type 3 monitors.…”

Section: Apnea-hypopnea Index Estimationmentioning

confidence: 99%

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Validation of a New System Using Tracheal Body Sound and Movement Data for Automated Apnea-Hypopnea Index Estimation

Kalkbrenner

Eichenlaub

Rüdiger

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: The current gold standard for assessment of obstructive sleep apnea is the in-laboratory polysomnography. This approach has high costs and inconveniences the patient, whereas alternative ambulatory systems are limited by reduced diagnostic abilities (type 4 monitors, 1 or 2 channels) or extensive setup (type 3 monitors, at least 4 channels). The current study therefore aims to validate a simplified automated type 4 monitoring system using tracheal body sound and movement data. Methods: Data from 60 subjects were recorded at the University Hospital Ulm. All subjects have been regular patients referred to the sleep center with suspicion of sleep-related breathing disorders. Four recordings were excluded because of faulty data. The study was of prospective design. Subjects underwent a full-night screening using diagnostic in-laboratory polysomnography and the new monitoring system concurrently. The apnea-hypopnea index (AHI) was scored blindly by a medical technician using in-laboratory polysomnography (AHIPSG). A unique algorithm was developed to estimate the apneahypopnea index (AHIest) using the new sleep monitor. Results: AHIest strongly correlates with AHIPSG (r 2 = .9871). A mean ± 1.96 standard deviation difference between AHIest and AHIPSG of 1.2 ± 5.14 was achieved. In terms of classifying subjects into groups of mild, moderate, and severe sleep apnea, the evaluated new sleep monitor shows a strong correlation with the results obtained by polysomnography (Cohen kappa > 0.81). These results outperform previously introduced similar approaches. Conclusions:The proposed sleep monitor accurately estimates AHI and diagnoses sleep apnea and its severity. This minimalistic approach may address the need for a simple yet reliable diagnosis of sleep apnea in an ambulatory setting. Clinical Trial Registration: Trial name: Validation of a new method for ambulant diagnosis of sleep related breathing disorders using body sound; URL: https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011195; Identifier: DRKS00011195 Keywords: monitoring, movement analysis, respiratory sounds, sleep apnea Citation: Kalkbrenner C, Eichenlaub M, Rüdiger S, Kropf-Sanchen C, Brucher R, Rottbauer W. Validation of a new system using tracheal body sound and movement data for automated apnea-hypopnea index estimation. J Clin Sleep Med. 2017;13(10):1123-1130. I NTRO DUCTI O NWith a prevalence of 4% in adult men and 2% in women, obstructive sleep apnea (OSA) is one of the most common sleeprelated breathing disorders.1 Additionally, more than 75% of people suffering from moderate OSA are either undiagnosed or untreated.2 OSA is characterized by multiple breathing cessations during the night due to different possible causes. If untreated, this disorder can lead to extensive daytime sleepiness 3 and an elevated risk for cardiovascular disease. [4][5][6] The main criteria used to indicate the severity of OSA is the apneahypopnea index (AHI), which describes the mean number of breathing pa...

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Section: Validation Of a New System Using Tracheal Body Sound And Movmentioning

confidence: 99%

Section: Apnea-hypopnea Index Estimationmentioning

confidence: 99%

Validation of a New System Using Tracheal Body Sound and Movement Data for Automated Apnea-Hypopnea Index Estimation

Kalkbrenner

Eichenlaub

Rüdiger

et al. 2017

Journal of Clinical Sleep Medicine

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“…The gold standard of sleep-disordered breathing diagnostics is PSG performed in a sleep laboratory [12]. In this study we used polygraphy instead.…”

Section: Study Design and Measurementsmentioning

confidence: 99%

Predictors of obstructive sleep apnea

2016

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Obstructive sleep apnea (OSA) is a disorder with a high prevalence not only in western societies. OSA is defined as an apnea-hypopnea index(AHI)> 5/hsleep, whereas OSA syndrome (OSAS) includes the symptoms associated with OSA. The current prevalence of OSA approximately amounts to 26 % (AHI ≥ 5) of the population in the US aged 30-70 years [13]. Worse sleep-disordered breathing (AHI ≥ 15) has a prevalence of 10 %. The prevalence varies depending on age, body mass index (BMI), and gender: Among 30-49-year-old men, the number of patients affected (AHI ≥ 15) is much higher (10 %) than among women of the same age (3 %). Reaching older ages (50-70 years), the numbers are higher, with prevalences of 17 % of men and 9 % of women with an AHI ≥ 15 [13]. These epidemiological estimations represent the increase of OSA over the last two decades, which is likely a result of the progressing obesity epidemic in the US [13].This gives an impression of how huge the number of people with OSAS really is. In many cases it is never diagnosed, due to a lack of symptoms such as daytime sleepiness or neurocognitive disorders. The situation is equivalent in European countries, where many cases of OSAS remain undetected. A recent populationbased study in Lausanne collected data of 2121 participants and found a prevalence of 83.8 % among men and 60.8 % among women with an AHI ≥ 5, whereas 49.7 % of the male and 23.4 % of the female participants actually had an AHI ≥ 15 [7].It has to be taken into consideration that only some affected persons have symptoms of OSAS that would help to detect it.The gold standard of OSAS diagnostics is polysomnography (PSG), but this is also very complex and expensive. Capacity is mostly limited and waiting periods extend to 6 months and longer. There is a discussion on the guidelines' recommendation to use polygraphy instead, in order to prescreen patients with suspected OSAS [14]. In the recent past, researchers took the initiative to simplify the diagnostic process, considering the fact that approximately 80 % of the people with OSA remain undiagnosed [5]. A recent pilot study analyzed the inability to fit hands around the neck as a predictor of OSA. This screening procedure has a positive predictive power of 100 %, but a negative predictive power of only 31.6 % for an AHI ≥ 5/h [5].Consequences of OSAS include worsening of cardiovascular disease with a negative impact on the general health condition of the patient, neurocognitive disorders, and a much higher risk for car accidents because of daytime sleepiness and inattentiveness [10,16]. Besides the effort to reduce the number of undiagnosed cases of OSA, it is of general interest among surgeons and anesthesiologists to estimate the postoperative outcome ofpatients with OSA [2]. Therefore, scientists developed a clinical screening in a sleep center, in a population with a high incidence of OSA. The test ought to define the severity of OSA and contains Mallampati Index, the distance between thyroid and chin (cm), neck circumference (cm), BMI (kg/m 2 ), and...

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“…This had been addressed in reviews when trying to identify the best and the most feasible methods for sleep studies. 4,5 There is a consensus that the reference for oronasal airfl ow is a mask with a pneumotachograph. Because this is not practically applicable in clinical sleep studies, other sensors are used.…”

Section: Equipment Related Issuesmentioning

confidence: 99%