Validation of British Thoracic Society guidelines for the diagnosis of the sleep apnoea/hypopnoea syndrome: can polysomnography be avoided?

Ryan, Pablo; Hilton, Michael F.; Boldy, D.A.R.; Evans, Adrian; Bradbury, Sarah; Sapiano, S.; Prowse, K; Cayton, R.M.

doi:10.1136/thx.50.9.972

Cited by 92 publications

(50 citation statements)

References 16 publications

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“…With an ODI cut-off at o15, three patients (17%) would have been missed by the MESAM-IV device and one patient (6%) would have been wrongly classified as being positive (sensitivity: 57%, specificity: 91%), which is in agreement with the findings of RYAN et al [9]. A low ODI threshold augments sensitivity at the expense of specificity.…”

Section: Comparison Studysupporting

confidence: 82%

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Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome

Fietze

Dingli²,

Diefenbach³

et al. 2004

European Respiratory Journal

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The current study investigated the night-to-night variability and diagnostic accuracy of the oxygen desaturation index (ODI), as measured by ambulatory monitoring, in the diagnosis of mild and moderate obstructive sleep apnoea-hypopnoea syndrome.To assess the variability of the ODI, 35 patients were monitored at home during 7 consecutive nights by means of a portable recording device, the MESAM-IV1. The ODI variability factor and the influence of age, body mass index (BMI), alcohol, and body position were assessed. Furthermore, the diagnostic accuracy of the MESAM-IV was measured by comparison with polysomnographical outcomes in 18 patients.During home recording, the median ODI was 10.9 (interquartile range: 5.8-16.1) across the patients. Although the reliability of the ODI was adequate, the probability of placing the patient in the wrong severity category (ODI f15 or ODI w15) when only one single recording was taken is 14.4%. ODI variability was not significantly influenced by age, BMI, time spent in a supine position, or mild dosages of alcohol. A good correlation was found between the apnoea-hypopnoea index and the ODI.In conclusion, the findings suggest that the diagnostic accuracy of the MESAM-IV is strong, since the oxygen desaturation index is correlated with the apnoea-hypopnoea index. In most obstructive sleep apnoea-hypopnoea syndrome patients, oxygen desaturation index variability is rather small, and screening could be reliably based on single 1-night recordings. Eur Respir J 2004; 24: 987-993.

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Section: Comparison Studysupporting

confidence: 82%

“…o15 desaturations of 4% per hour in bed. An apnoea-hypopnoea index (AHI) w15?h -1 , which was slept on PSG, was used as the objective measure of disease [9]. These authors found that the BTS criteria are highly specific when positive (100% specificity), but may miss sleep apnoeics with no significant desaturations (31% sensitivity).…”

mentioning

confidence: 98%

Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome

Fietze

Dingli²,

Diefenbach³

et al. 2004

European Respiratory Journal

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“…In the first place, not all studies are based on the same definition of AHI. For example, some previous studies conservatively employ values of AHI ≥ 15 events/hour (Ryan et al 1995, Lévy et al 1996, Lacassagne et al 1997, Sano et al 1998, Olson et al 1999, Magalang et al 2003, whereas others use AHI ≥ 5 events/hour to diagnose mild OSA (Chaudhary et al 1998, Littner 2000, Fernández et al 2004. We used a threshold of AHI ≥ 10 events/hour.…”

Section: Discussionmentioning

confidence: 99%

Nonlinear characteristics of blood oxygen saturation from nocturnal oximetry for obstructive sleep apnoea detection

Álvarez¹,

Hornero²,

Abásolo³

et al. 2006

Physiol. Meas.

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Nocturnal oximetry is an attractive option for the diagnosis of obstructive sleep apnoea (OSA) syndrome because of its simplicity and low cost compared to polysomnography (PSG). The present study assesses non-linear analysis of blood oxygen saturation (SaO 2 ) from nocturnal oximetry as a diagnostic test to discriminate between OSA positive and OSA negative patients. A sample of 187 referred outpatients, clinically suspected of having OSA, were studied using nocturnal oximetry performed simultaneously with complete PSG. A positive OSA diagnosis was found for 111 cases, while the remaining 76 cases were classified as OSA negative. The following oximetric indexes were obtained: cumulative time spent below a saturation of 90% (CT90), oxygen desaturation indexes of 4% (ODI4), 3% (ODI3) and 2% (ODI2), and the delta index (∆ index). SaO 2 records were subsequently processed applying two non-linear methods: central tendency measure (CTM) and Lempel-Ziv (LZ) complexity. Significant differences (p < 0.01) were found between OSA positive and OSA negative patients. Using CTM we obtained a sensitivity of 90.1% and a specificity of 82.9%, while with LZ the sensitivity was 86.5% and the specificity was 77.6%. CTM and LZ accuracy was higher than that provided by ODI4, ODI3, ODI2 and CT90. The results suggest that non-linear analysis of SaO 2 signals from nocturnal oximetry could yield useful information in OSA diagnosis.

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“…91 The use of home-based nocturnal oximetry alone as a screening tool for OSA has a sensitivity of only 31% and can lead to an underestimation of OSA severity. 92 Combinations of the above factors modestly raise the predictive abilities of various models to levels of 60 to 70%. More recent clinical prediction models that integrate specific clinical examination findings and/or home-based oximetry appear to have improved predictive capabilities and hold promise for risk stratification; however, further validation is required.…”

Section: Diagnosis Risk Stratification For Appropriate Referral For Pmentioning

confidence: 99%

Adult Obstructive Sleep Apnea

Patil

Schneider

Schwartz

et al. 2007

Chest

430

169

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Obstructive sleep apnea (OSA) is a highly prevalent disease characterized by recurrent episodes of upper airway obstruction that result in recurrent arousals and episodic oxyhemoglobin desaturations during sleep. Significant clinical consequences of the disorder cover a wide spectrum, including daytime hypersomnolence, neurocognitive dysfunction, cardiovascular disease, metabolic dysfunction, and cor pulmonale. The major risk factors for the disorder include obesity, male gender, and age. Current understanding of the pathophysiologic basis of the disorder suggests that a balance of anatomically imposed mechanical loads and compensatory neuromuscular responses are important in maintaining upper airway patency during sleep. OSA develops in the presence of both elevated mechanical loads on the upper airway and defects in compensatory neuromuscular responses. A sleep history and physical examination is important in identification of patients and appropriate referral for polysomnography. Understanding nuances in the spectrum of presenting complaints and polysomnography correlates are important for diagnostic and therapeutic approaches. Knowledge of common patterns of OSA may help to identify patients and guide therapy.Keywords critical pressure; diagnosis; obstructive sleep apnea; pathophysiology Obstructive sleep apnea (OSA) is a highly prevalent disease, affecting 4% of men and 2% of women, 1 and strongly linked to the current obesity epidemic. The disorder is characterized by recurrent episodes of upper airway obstruction, and is associated with reductions in ventilation, resulting in recurrent arousals and episodic oxyhemoglobin desaturations during sleep.2 Significant clinical consequences of the disorder cover a wide spectrum including daytime hypersomnolence,3 , 4 neurocognitive dysfunction, 5 cardiovascular disease (hypertension, stroke, myocardial infarction, heart failure), 6, 7 metabolic dysfunction,8 -10 respiratory failure, and cor pulmonale. 11 The major risk factors for the disorder include obesity, male gender, postmeno-pausal status, and age, and are discussed in detail elsewhere. [12][13][14] The rising prevalence of obesity in the United States suggests that OSA will represent an escalating public health burden. 15 Therefore, knowledge and understanding of the pathogenic basis, clinical presentation, and diagnosis of OSA are essential for the development of preventive, screening, and therapeutic strategies to reduce the public health burden of the disorder. In this review, we * The manuscript was supported by grants HL50381, HL37379, and HL77137 from the National Heart, Lung, Blood Institute, National NIH Public Access Author ManuscriptChest. Author manuscript; available in PMC 2010 January 29. Published in final edited form as:Chest. Pathophysiology of Upper Airway Obstruction in OSAThe pharynx is a complex structure that serves several purposes including speech, swallowing, and respiration. The human pharynx is composed of > 20 muscles and divided into four sections that include the nas...

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Validation of British Thoracic Society guidelines for the diagnosis of the sleep apnoea/hypopnoea syndrome: can polysomnography be avoided?

Abstract: Background-The British Thoracic Society report on the diagnosis and treatment of the sleep apnoea/hypopnoea syndrome (SAHS) suggests that, ifthe pulse oximetry baseline oxygen saturation is above 90%,

Cited by 92 publications

References 16 publications

Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome

Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome

Nonlinear characteristics of blood oxygen saturation from nocturnal oximetry for obstructive sleep apnoea detection

Adult Obstructive Sleep Apnea

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