Short-Term Variability in Apnea-Hypopnea Index during Extended Home Portable Monitoring

Prasad, Bharati; Usmani, Sarah; Steffen, Alana; Dongen, Hans P A Van; Pack, Frances M.; Strakovsky, Inna; Staley, Bethany; Dinges, David F.; Maislin, Greg; Pack, Allan I.; Weaver, Terri E.

doi:10.5664/jcsm.5886

Cited by 39 publications

(34 citation statements)

References 42 publications

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“…Our data didn’t show an association between internight variability in AHI and sex, age, sleepiness, or BMI, which agrees with the findings of Prasad et al. 21 .…”

Section: Discussionsupporting

confidence: 91%

Reproducibility and predictors of the apnea hypopnea index across multiple nights

Alshaer¹,

Ryan²,

Bradley³

2018

Sleep Sci

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BackgroundAttended polysomnography (PSG) is the standard diagnostic test for sleep apnea (SA). However, due to internight variability in SA, a single night PSG may not accurately reflect the true severity of SA. Although internight variability is a well-known phenomenon, its root causes have not been fully elucidated. The objective of this study was to determine factors associated with internight variability in the apnea-hypopnea index (AHI) and its magnitude in the home environment.MethodsEach participant had a full overnight PSG simultaneous with a validated portable sleep apnea monitoring device (BresoDx®) followed by two overnight home tests using the portable monitor only. Patients were stratified into those with variable AHI and consistent AHI (AHI difference ≥10 or <10 between any 2 nights, respectively). Demographics, sleepiness, sleep test variable, and supine-predominant SA (supine-SA) were examined for any association with variable AHI.ResultsForty patients completed the protocol. The correlation between PSG and simultaneous BresoDx derived AHIs was 93.4%. Inter-class correlation between the three nights’ AHIs was 89.2%. Over two-thirds (67.5%) of patients had consistent AHIs across the three nights while 32.5% had variable AHI. AHI variability was significantly associated with supine-SA (p=0.0014) and correlated with first night’s AHI (r=0.664, p<0.001). None of the other variable, including BMI, sleepiness, gender, or test duration were associated with internight variability.ConclusionAlthough portable monitoring was highly reproducible over three nights in the majority of participants, one third had a variable AHI. Supine-SA and high AHI on the first night were predictors of high internight variability.

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“…Our data didn’t show an association between internight variability in AHI and sex, age, sleepiness, or BMI, which agrees with the findings of Prasad et al. 21 .…”

Section: Discussionsupporting

confidence: 91%

Reproducibility and predictors of the apnea hypopnea index across multiple nights

Alshaer¹,

Ryan²,

Bradley³

2018

Sleep Sci

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“…The quest for a quantified index of respiratory events as a meas- Sixth, how many consecutive nights must be monitored to yield a reliable AHI (Crinion et al, 2020;Le Bon et al, 2000;Prasad et al, 2016;Stoberl et al, 2017)? And, finally, should the procedure be performed in the sleep laboratory or at home ( Apnea A cessation of airflow at the nose and mouth lasting at least 10 s.…”

Section: Methodological Issuesmentioning

confidence: 99%

On the rise and fall of the apnea−hypopnea index: A historical review and critical appraisal

Pevernagie

Gnidovec-Stražišar

Grote

et al. 2020

Journal of Sleep Research

195

134

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The publication of "The Sleep Apnea Syndromes" by Guilleminault et al. in the 1970s hallmarked the discovery of a new disease entity involving serious health consequences. Obstructive sleep apnea was shown to be the most important disorder among the sleep apnea syndromes (SAS). In the course of time, it was found that the prevalence of obstructive sleep apnea reached the proportions of a global epidemic, with a major impact on public health, safety and the economy. Early on, a metric was introduced to gauge the seriousness of obstructive sleep apnea, based on the objective measurement of respiratory events during nocturnal sleep. The apnea index and later on the apnea−hypopnea index, being the total count of overnight respiratory events divided by the total sleep time in hours, were embraced as principle measures to establish the diagnosis of obstructive sleep apnea and to rate its severity. The current review summarises the historical evolution of the apnea−hypopnea index, which has been subject to many changes, and has been criticised for not capturing relevant clinical features of obstructive sleep apnea. In fact, the application of

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“…The APAP titration is also monitored for improvement of the patient's OSA with an APAP machine for a longer period than with in-lab titration. Therefore, it is advantageous as reflecting changes in daily sleep and OSA status and is a more comfortable titration method for patients [27]. One study has reported that one week of APAP titration seems sufficient to find an effective and stable PAP level [4].…”

Section: Discussionmentioning

confidence: 99%

Clinical Parameters Related to the Duration of Automatic Positive Airway Pressure Titration

et al. 2020

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Background and ObjectiveaaAutomatic positive airway pressure (APAP) therapy is a treatment and titration method for obstructive sleep apnea (OSA). However, little is known about the optimal duration of APAP titration for identifying effective pressure. 1) To evaluate the response of patients with OSA to low-span APAP titration for up to 3 months; 2) to find the optimal duration of APAP titration necessary to achieve the lowest treatment pressure; and 3) to identify variables that affect the APAP titration. MethodsaaThis retrospective study was done in a single tertiary-care academic medical center. It included 50 patients with low-span APAP treatment from January 2016 to December 2018. The patients were divided into low-variation and high-variation groups depending on the median value (18%) of change in the apnea-hypopnea index (AHI) from 1 week to 1 month. ResultsaaThe AHI estimated by the APAP machine showed different features over time in each group and changed significantly even after a month. The change in AHI was greater in patients with a larger forced vital capacity (FVC) (> 92.5% predicted value) of a pulmonary function test, and was lesser in older (> 52 years) patients. This change was also compared with body composition between the two groups. ConclusionsaaFinal titration pressure may be established at approximately 1 month after APAP titration. In particular, for patients with larger FVCs, it may be necessary to further adjust the treatment pressure to a minimum to improve compliance.

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Short-Term Variability in Apnea-Hypopnea Index during Extended Home Portable Monitoring

Cited by 39 publications

References 42 publications

Reproducibility and predictors of the apnea hypopnea index across multiple nights

Reproducibility and predictors of the apnea hypopnea index across multiple nights

On the rise and fall of the apnea−hypopnea index: A historical review and critical appraisal

Clinical Parameters Related to the Duration of Automatic Positive Airway Pressure Titration

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