Portable Sleep Monitoring for Diagnosing Sleep Apnea in Hospitalized Patients With Heart Failure

Aurora, R. Nisha; Patil, Susheel P.; Punjabi, Naresh M.

doi:10.1016/j.chest.2018.04.008

Cited by 42 publications

(24 citation statements)

References 41 publications

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“…There are a limited number of studies evaluating portable sleep monitor testing to diagnose OSA in patients with cardiorespiratory disorders. Recently, Aurora et al 22 examined portable sleep monitoring to diagnose sleep apnea in patients hospitalized for heart failure and concluded that sleep apnea can be accurately and efficiently identified by PM testing. Oliveira et al 2 evaluated the use of HSAT to diagnose OSA in 72 adults with COPD using the same study design as in our study, but with a different type 3 PM.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Nox-T3 Portable Monitor for Diagnosis of Obstructive Sleep Apnea in Patients With Chronic Obstructive Pulmonary Disease

Chang

Han

et al. 2019

Journal of Clinical Sleep Medicine

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Study Objectives: Clinical practice guidelines recommend polysomnography (PSG) for diagnosis of obstructive sleep apnea (OSA) in patients with major comorbidities. We evaluated home sleep apnea testing (HSAT) using a type 3 portable monitor (PM, Nox-T3, Nox Medical, Reykjavik, Iceland) to diagnose OSA in adults with chronic obstructive pulmonary disease (COPD). Methods: Ninety adults with COPD (89.0% males, mean ± standard deviation age 66.5 ± 7.8 years, body mass index 27.5 ± 5.8 kg/m 2 , forced expiratory volume in the first second/forced vital capacity [FEV1/ FVC] 53.5 ± 12.4%, FEV1 54.0 ± 18.4% predicted) underwent unattended HSAT followed by an in-laboratory PSG with simultaneous PM recording. Results: Scoring hypopneas with a ≥ 4% oxygen desaturation, the apnea-hypopnea index (AHI) was 16.7 ± 20.6 events/h on HSAT, 20.0 ± 23.3 events/h on in-laboratory PM, and 21.2 ± 26.2 events/h on PSG (P < .0001). Bland-Altman analysis of AHI on HSAT versus PSG showed a mean difference (95% confidence interval) of −5.08 (−7.73, −2.42) events/h (P = .0003) and limits of agreement (± 2 standard deviations) of −30.00 to 19.85 events/h; HSAT underestimated AHI to a greater extent for more severe values (rho = −.529, P < .0001). Using an AHI ≥ 5 events/h to diagnose OSA, HSAT had 95% sensitivity, 78% specificity, 88% positive predictive value, and 89% negative predictive value compared to PSG. Mean oxygen saturation was 93.2 ± 3.7% on PSG, 91.0 ± 3.3% on in-laboratory PM, and 90.8 ± 4.0% on HSAT (P < .0001). Percentage time oxygen saturation ≤ 88% was 17.9 ± 26.4% on HSAT, 17.4 ± 25.5% on in-laboratory PM, and 10.0 ± 21.1% on PSG (P < .0001). Conclusions:The Nox-T3 PM can be used to diagnose OSA in patients with COPD but, most likely due to differences among pulse oximeters, a greater number of patients with COPD and without OSA qualified for nocturnal oxygen treatment using this PM than PSG.

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Section: Discussionmentioning

confidence: 99%

Validation of the Nox-T3 Portable Monitor for Diagnosis of Obstructive Sleep Apnea in Patients With Chronic Obstructive Pulmonary Disease

Chang

Han

et al. 2019

Journal of Clinical Sleep Medicine

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“…17 In general, type III devices seem to have an acceptable reliability to identify OSA in patients with heart failure both in acute settings (in hospital) and in stable conditions (at home). 11,18,19 In our study, patients in the IHD group had preserved ejection fraction without clinical heart failure. OSA was the predominant component in patients with IHD.…”

Section: Effects Of Different Comorbiditiesmentioning

confidence: 60%

“…The AHI equivalent of other type III devices has been shown to be closer to PSG AHI if the total sleep time of PSG was used to calculate the AHI instead of the total recording time. 11 1). This can be another factor contributing to the difference between the total sleep time of PSG and the estimated total sleep time in NOX-T3 (Table 2).…”

Section: Concordance Of Nox-t3 and Psgmentioning

confidence: 99%

Using a portable monitoring device for diagnosing obstructive sleep apnea in patients with multiple coexisting medical illnesses

Chan

Chan³

et al. 2021

Clinical Respiratory J

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Introduction: The existing guidelines recommend type III devices should be used in patients without significant comorbidities. Objectives: This study explored the reliability of using a type III device in patients with significant medical conditions to diagnose sleep apnea. Methods:Patients had an overnight sleep study conducted simultaneously with both polysomnography (PSG) and a type III (NOX-T3) monitoring device.All patients had stable multiple coexisting medical illnesses without any changes in medications and conditions within 1 month of sleep study.Results: Between July 2019 and March 2020, there were altogether 74 patients recruited with analyzable data. Five major disease groups were identified in the cohort: psychiatric illnesses, stroke, ischemic heart diseases (IHDs), chronic kidney diseases (CKDs), and others. Psychiatric patients with medications were found to have the lowest apnea hypopnea index (AHI) (23.7 per hour) and arousal index (46.6 per hour). The CKD group had the highest mean arousal index (71.4 per hour) and obstructive apnea count (110.2). NOX-T3 respiratory event index (REI) was significantly lower than the PSG AHI (mean REI 31.4 vs. mean AHI: 42.2). The number of patients with no/mild/moderate/ severe obstructive sleep apnea (OSA) diagnosed by NOX-T3 and PSG was 7/17/19/31 and 5/11/20/38, respectively. Conclusion: NOX-T3 device can reliably diagnose OSA in patients with different stable coexisting medical conditions. There is a tendency for underestimation of the severity of the OSA with NOX-T3 in patients with coexisting medical conditions especially with sedative medications. A positive NOX-T3 reliably diagnoses OSA whereas a negative NOX-T3 result needs to be interpreted with caution.

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“…The results showed that a portable ApneaLink device could be used to identify patients with heart failure with sleep apnea (AHI≥15 and <5 events/h), which contained both obstructive and central apneas ( 58 ). In another study, researchers distinguished the central and obstructive AHI values in another study, and also found a strong correlation coefficient between HSAT and polysomnography, which indicated a possible diagnosis ( 59 ). However, HSAT does not appear to have reduced the cost, as it is only 10% lower than the cost of polysomnography for the provider ( 60 ).…”

Section: Update On Diagnosismentioning

confidence: 95%

An Update on Obstructive Sleep Apnea for Atherosclerosis: Mechanism, Diagnosis, and Treatment

Chen

Lin

Zeng

2021

Front. Cardiovasc. Med.

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The occurrence and development of atherosclerosis could be influenced by intermittent hypoxia. Obstructive sleep apnea (OSA), characterized by intermittent hypoxia, is world-wide prevalence with increasing morbidity and mortality rates. Researches remain focused on the study of its mechanism and improvement of diagnosis and treatment. However, the underlying mechanism is complex, and the best practice for OSA diagnosis and treatment considering atherosclerosis and related cardiovascular diseases is still debatable. In this review, we provided an update on research in OSA in the last 5 years with regard to atherosclerosis. The processes of inflammation, oxidative stress, autonomic nervous system activation, vascular dysfunction, platelet activation, metabolite dysfunction, small molecule RNA regulation, and the cardioprotective occurrence was discussed. Additionally, improved diagnosis such as, the utilized of portable device, and treatment especially with inconsistent results in continuous positive airway pressure and mandibular advancement devices were illustrated in detail. Therefore, further fundamental and clinical research should be carried out for a better understanding the deep interaction between OSA and atherosclerosis, as well as the suggestion of newer diagnostic and treatment options.

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Portable Sleep Monitoring for Diagnosing Sleep Apnea in Hospitalized Patients With Heart Failure

Abstract: Portable sleep monitoring can accurately diagnose sleep apnea in hospitalized patients with heart failure and may promote early initiation of treatment.

Cited by 42 publications

References 41 publications

Validation of the Nox-T3 Portable Monitor for Diagnosis of Obstructive Sleep Apnea in Patients With Chronic Obstructive Pulmonary Disease

Validation of the Nox-T3 Portable Monitor for Diagnosis of Obstructive Sleep Apnea in Patients With Chronic Obstructive Pulmonary Disease

Using a portable monitoring device for diagnosing obstructive sleep apnea in patients with multiple coexisting medical illnesses

An Update on Obstructive Sleep Apnea for Atherosclerosis: Mechanism, Diagnosis, and Treatment

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