Validation of a portable recording device (ApneaLink) for identifying patients with suspected obstructive sleep apnoea syndrome

Background: Polysomnography (PSG) is currently the standard diagnostic procedure for sleep apnoea. This study evaluates the diagnostic accuracy of a portable recording device, ApneaLink (AL; ResMed, Poway, CA, USA) for detection of sleep apnoea in comparisons against PSG.
Methods: The AL device is a three-channel screening tool that measures airflow through a nasal pressure transducer, oximetry and pulse, providing an apnoea–hypopnoea index (AHI) based on recording time. Nocturnal PSG (Alice 4; Healthdyne, Atlanta, GA, USA), with airflow measured by a nasal pressure transducer (ProTech PTAF2; ProTech, Woodinville, WA, USA) and AL recordings were carried out simultaneously in consecutive patients with suspected obstructive sleep apnoea syndrome (OSAS). The PSG recordings were analysed manually by a blinded investigator. The oxygen desaturation index of AL was also compared against the AHI based on PSG.
Results: Fifty consecutive subjects with symptoms of OSAS were recruited with mean age of 50 years and body mass index of 27.9 kg/m². The AHI obtained by the AL device correlated closely to that obtained by PSG (Pearson correlation, r = 0.978, P < 0.001), whereas the correlation between PSG AHI and oxygen desaturation index by AL was also strong ( r = 0.895, P < 0.001). Comparison of AHI based on the AL against the PSG demonstrated high sensitivity and specificity at AHI ≥10/h (sensitivity 0.977 and specificity 1.0) and at AHI ≥20/h (sensitivity 0.969 and specificity 1.0).
Conclusion: The AL portable monitoring device is highly sensitive and specific in quantifying the apnoea–hypopnoea index when compared against hospital based polysomnography in patients with suspected OSAS. The simple device may be useful for screening and diagnostic purpose when access to PSG is limited.     

Validation of Embletta portable diagnostic system for identifying patients with suspected obstructive sleep apnoea syndrome (OSAS)

Background and objectives: This study aimed to evaluate the diagnostic accuracy of Embletta portable diagnostic system (PDS, Medcare, Reykjavik, Iceland) for the screening of sleep apnoea in clinical practice. Methods: The Embletta PDS is a digital three‐channel recording device that measures airflow through a nasal cannula connected to a pressure transducer, oxygen saturation plus both respiratory and abdominal movements via built‐in effort and body position sensors. An AHI is determined based on recording time. Nocturnal polysomnography (Alice 4, Healthdyne, Atlanta, USA), with airflow measured by a nasal pressure transducer (PTAF2, Pro‐Tech, Woodinville, WA, USA)) and Embletta PDS recordings, was performed simultaneously in consecutive patients with suspected OSA syndrome. The PSG recordings were analysed manually by a blinded investigator. Results: Ninety subjects were recruited and 10 failed Embletta PDS studies due to measurement failure. Among the remaining 80 subjects, 63 were males. The mean age (SD) was 51.4 (11.9) years old, BMI 27.1(4.2) kg/m², neck circumference 38.6 (3.6) cm and Epworth Sleepiness Score 9.7 (5.3). The AHI obtained by the Embletta PDS correlated closely with that obtained by PSG (Pearson correlation, r = 0.979, P < 0.001). Comparison of AHI based on the Embletta PDS against the PSG demonstrated high sensitivity at AHI ≥ 5/h (sensitivity 0.924 and specificity 0.857) and high specificity at AHI ≥ 20/h (sensitivity 0.853 and specificity 0.957). Conclusions: The Embletta PDS is a highly sensitive and specific screening device in quantifying AHI when compared against PSG in patients with suspected OSA syndrome.     

Sleep disorders: a potential role in New Zealand motor vehicle accidents

Background: The potential role of sleep disorders in New Zealand motor vehicle accidents (MVA) has not been systematically studied. Aims: To trial a recruitment method and document the frequency of sleep disorders in drivers attending an emergency department with injury following MVA. Methods: Injured drivers admitted to Wellington Hospital Emergency Department were prospectively recruited by letter and follow‐up telephone call. Data from a traffic accident, health and sleep questionnaire and polysomnography were collected and analysed using the SPSS statistical package. Results: Of 120 eligible drivers, 40 (33%) completed the study protocol. The mean age of participants was 44 ± 17 years. Non‐participants were younger (mean age 33 ± 14 years, P < 0.01) and more often of Asian or Pacific Island ethnicity (P < 0.01). Twenty‐seven (67%) felt unrefreshed on waking and 10 (25%) had an elevated Epworth Sleepiness Score (> 10/24). Six (15%) felt drowsy or fell asleep prior to the accident. Sleep disorders were common (40%): obstructive sleep apnoea 14 (35.9%), periodic limb movements of sleep three (7.7%), sleep restriction (< 6 h sleep on a regular basis) five (12.5%), and insomnia one (2.5%). Conclusions: Daytime somnolence and sleep disorders were commonly found in drivers attending the Emergency Department after accidents resulting in injury. Driver fatigue and sleep disorders should be considered as a potential contributing factor in New Zealand MVAs. Recruitment of drivers following a MVA via the Emergency Department is challenging. Strategies to improve recruitment are discussed. (Intern Med J 2002; 32: 297?304)     

Validation of a portable monitoring device for the diagnosis of obstructive sleep apnea: electrocardiogram-based cardiopulmonary coupling

Sleep and Breathing - We aimed to evaluate the validity of the cardiopulmonary coupling (CPC) device, a limited-channel portable monitoring device for obstructive sleep apnea (OSA) screening in one...     

Remote daily real-time monitoring in patients with COPD – A feasibility study using a novel device

New technologies have allowed remote real-time electronic recording of symptoms and spirometry. The feasibility of utilising this technology in COPD patients has not been investigated.This is a feasibility study. The primary objective is to determine whether the use of an electronic diary with a portable spirometer can be performed by COPD patients with a moderate to severe disease. Secondary objectives are to investigate the value of this method in early detection of acute exacerbations of COPD (AECOPD).In this 6-month study, 18 patients recorded daily their symptom score and spirometry. Data was sent on real time. AECOPD which was defined according to pre-set criteria were noted. Spirometry values and scores for health-related quality of life were compared between the start and the end of the study. Hospitalisation rate due to AECOPD was compared with a parallel period in the previous year.On average, patients were able to record 77% of their total study days. The system detected 73% of AECOPD. In further 27% of AECOPD patients sought treatment although the change in symptoms did not meet AECOPD definition. The number of COPD-related hospitalisations significantly reduced compared to the previous year. There was a significant increase in FEV₁ and FVC from the start to the end of the study.The remote monitoring device used in this study can be used in COPD patients. AECOPD was detected early in the majority of cases. Hospitalisation rate due to AECOPD was reduced and FEV₁ and FVC values increased during the study.     

Implementation of a split-night protocol to improve efficiency in assessment and treatment of obstructive sleep apnoea

In Australia, unmet demand for sleep study services is resulting in protracted waiting lists and treatment delays for those in need. This present study gauged efficiency gains that could be achieved by implementing a split-night protocol within the laboratory. Results demonstrate improved technical efficiency by at least 15%, reducing time to treatment for the most severe cases and increasing patient throughput within the clinic. With over 56,000 sleep studies carried out annually, this technique has significant utility in evidence-based practice.     

动态心电图和动态血压同步监测在缺血性脑卒中患者诊断中的临床价值

目的探讨动态心电图和动态血压同步监测在缺血性脑卒中(ischemic stroke,IS)患者诊断中的临床价值。方法选择2016年12月至2018年11月酒泉市金塔县人民医院接诊的46例IS患者进行研究,设定为IS组,并选取同期在我院进行检查的原发性高血压(高血压)患者32例,设定为无IS组(non-ischemic stroke,NIS)组。对所有患者进行动态心电图(dynamic electrocardiogram,DCG)和动态血压(ambulatory blood pressure,ABP)同步监测。比较两组患者昼夜血压变化、异常心电图比例和心率变异性相关指标,对相关参数进行Logistic多因素回归分析。结果与NIS组相比,IS组患者昼夜平均收缩压和血压昼夜节律消失比例均显著升高,日间平均舒张压显著降低,差异有统计学意义(P<0.05)。IS组DCG监测到房性期前收缩、房性心动过速、短阵心房颤动、室性期前收缩和ST段改变的比例明显高于NIS组,差异有统计学意义(P<0.05)。IS组在窦性R-R间期标准差(standard deviation of normal R-R intervals,SDNN)、窦性R-R间期差值的平方根(root mean square of the successive normal sinus R-R interval difference,rMSSD)和每5 min时段窦性R-R间期平均值标准差(standard deviation of the averaged normal sinus R-R intervals for all 5-minute segments over 24 hours,SDANN)等心率变异性指标上明显低于NIS组,差异有统计学意义(P<0.05)。Logistic多因素回归分析显示昼夜平均收缩压、血压昼夜节律消失、心房颤动与IS呈正相关,日间平均舒张压、SDNN、rMSSD、SDANN与IS呈负相关。结论血压昼夜节律消失、心律失常、心率变异与IS发生关系密切,同步监测高血压患者DCG和ABP对预诊断IS具有较高的临床价值。     

Sensitivity and specificity of the mini-mental state examination for identifying dementia in the oldest-old: the 90+ study

OBJECTIVES: To evaluate the sensitivity and specificity of the Mini-Mental State Examination (MMSE) in identifying dementia in the oldest-old when stratified by age and education. DESIGN: Cross-sectional. SETTING: Research clinic and in-home visits. PARTICIPANTS: Population-based sample of adults aged 90 and older (n=435) who are enrolled in the 90+ Study, a longitudinal, population-based study. MEASUREMENTS: Neurological examination to determine dementia diagnosis, MMSE, and demographic data. RESULTS: Receiver operating characteristic (ROC) analyses indicated that the MMSE had high diagnostic accuracy for identifying dementia in subjects aged 90 and older across different age and education groups (area under the ROC curve values ranged from 0.82 to 0.98). A range of possible cutoff values and corresponding sensitivity and specificity are provided for the following age groups: 90-93, 94-96, and >or=97. Age groups were subdivided by educational attainment (相似文献   

无创性 CPAP 治疗在 OSAHS 合并缺血性心脏病中的临床应用简

目的 探讨长期无创性持续气道内正压通气（CPAP）治疗阻塞型睡眠呼吸暂停低通气综合征（OSAHS）合并缺血性心脏病（IHD）患者的临床疗效.方法 将64例确诊患者随机分为两组.治疗组在传统的内科治疗基础上加用整夜的CPAP治疗,对照组仅采用传统的内科治疗手段.监测两组治疗前后的PSG参数、ECG变化和临床症状改善.结果 治疗组的AHI、MinSpO2、SpO2〈90%占睡眠时间的改善率显著,ST段下降和T波改变明显改善、临床症状亦明显缓解（P〈0.01）.结论 在内科药物治疗基础上采用持续CPAP治疗OSAHS合并IHD效果显著,值得临床推广应用.     

Canadian Sleep Society/Canadian Thoracic Society position paper on the use of portable monitoring for the diagnosis of obstructive sleep apnea/hypopnea in adults

The present position paper on the use of portable monitoring (PM) as a diagnostic tool for obstructive sleep apnea/hypopnea (OSAH) in adults was based on consensus and expert opinion regarding best practice standards from stakeholders across Canada. These recommendations were prepared to guide appropriate clinical use of this new technology and to ensure that quality assurance standards are adhered to. Clinical guidelines for the use of PM for the diagnosis and management of OSAH as an alternative to in-laboratory polysomnography published by the American Academy of Sleep Medicine Portable Monitoring Task Force were used to tailor our recommendations to address the following: indications; methodology including physician involvement, physician and technical staff qualifications, and follow-up requirements; technical considerations; quality assurance; and conflict of interest guidelines. When used appropriately under the supervision of a physician with training in sleep medicine, and in conjunction with a comprehensive sleep evaluation, PM may expedite treatment when there is a high clinical suspicion of OSAH.     

便携式睡眠监测仪在睡眠呼吸暂停低通气综合征诊断中的应用及前景展望

便携式睡眠监测仪是一种简化监测电极后用于家中或无人监管情况下的睡眠疾患诊断设备,与多导睡眠图相比,可以大大提高诊断能力.本文综述了便携式监测仪在睡眠呼吸暂停低通气综合征诊断中的应用现状及前景.     

高血压合并阻塞性睡眠呼吸暂停综合征患者昼夜血压的变化

目的研究轻中度高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者昼夜血压变化的特点。方法入选心功能(NHYA)Ⅰ级的轻中度高血压患者177例,经多导睡眠呼吸监测后,按睡眠呼吸暂停指数分为4组,单纯高血压组(A组)42例,高血压合并轻度OSAS组(B组)66例,高血压合并中度OSAS组(C组)25例和高血压合并重度OSAS组(D组)44例,进行24 h动态血压监测。结果 D组患者昼间和夜间血压水平明显高于A组(P<0.05,P<0.01),与A组比较,B、C和D组夜间舒张压显著升高(P<0.05,P<0.01)。夜间低血氧水平与醒时、醒后舒张压、昼间、夜间收缩压和舒张压呈负相关(P<0.05)。结论轻中度高血压合并OSAS患者的夜间舒张压更高,合并重度OSAS的高血压患者全天血压水平均明显高于单纯高血压患者,血压升高幅度与夜间低氧血症程度呈负相关。     

Prevalence of snoring and sleep-disordered breathing in a group of commercial bus drivers in Hong Kong

Objectives: To assess the prevalence of sleep‐­disordered breathing (SDB) and its associated symptoms in a group of commercial bus drivers in Hong Kong. Methods: Two hundred and sixteen of 410 bus drivers from three different shifts were interviewed with the Sleep & Health Questionnaire (SHQ) and the Epworth sleepiness scale (ESS) at a Hong Kong bus depot. Seventeen subjects from each shift were then randomly selected for at‐home sleep study using the Mesam IV device (Madaus Medizin?Elektronik, Freiburg, Germany). Results: There were 207 men and nine women (mean age 42.4 ± 7.5 years; body mass index (BMI) 25.4 ± 4.5 kg/m²; ESS 5.3 ± 4.2). From the SHQ it was discovered that: (i) daytime sleepiness was reported by 87 subjects (40%), (ii) snoring ≥ 3 times per week was reported by 80 subjects (37%), (iii) witnessed apnoea was reported by 17 subjects (7.9%) and (iv) 29 subjects (13.4%) reported having fallen asleep during driving. Among the 51 subjects who underwent the at‐home sleep study: (i) 31 subjects (61%) had respiratory disturbance index (RDI) ≥ 5 per hour of sleep, (ii) 21 subjects (41%) had RDI ≥ 10 per hour of sleep, (iii) 12 subjects (24%) had RDI ≥ 15 per hour of sleep and (iv) 35 subjects (68.6%) snored objectively ≥ 10% of the night. Ten subjects (20%) had RDI ≥ 5 and sleepiness at work, while five subjects (9.8%) had RDI ≥ 5 and ESS > 10. No significant differences were noted in the SHQ responses, ESS, objective snoring or RDI among the three groups. Multiple regression analysis showed that BMI and witnessed apnoea were the only positive independent predictors of RDI. Conclusions: This study showed a high prevalence of objective snoring and SDB in a group of commercial bus drivers. Neither self‐reported sleepiness nor the ESS could identify subjects with SDB. (Intern Med J 2002; 32: 149?157)     

Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study.

AIM: The aim of this long-term prospective study was to evaluate the effect of treating obstructive sleep apnoea (OSA) on the rate of cardiovascular events in coronary artery disease (CAD). METHODS AND RESULTS: We prospectively studied 54 patients (mean age 57.3 +/- 10.1 years) with both CAD (> or = 70% coronary artery stenosis) and OSA (apnoea-hypopnoea index > or = 15). In 25 patients, OSA was treated with continuous positive airway pressure (n=21) or upper airway surgery (n=4); the remaining 29 patients declined treatment for their OSA. The median follow-up was 86.5 +/- 39 months. The two groups were similar at baseline in age, body mass index, smoking history, hypertension, hypercholesterolaemia, diabetes mellitus, number of diseased vessels, left ventricular ejection fraction, and CAD therapy. Treatment of risk factors other than OSA was similar in the two groups. The endpoint (a composite of cardiovascular death, acute coronary syndrome, hospitalisation for heart failure, or need for coronary revascularisation) was reached in 6 (6/25, 24%) and 17 (17/29, 58%) patients with and without OSA treatment, respectively (P<0.01). OSA treatment significantly reduced the risk of occurrence of the composite endpoint (hazard ratio 0.24; 95% confidence interval, 0.09-0.62; p<0.01) and of each of its components. CONCLUSIONS: Our data indicate that the treatment of OSA in CAD patients is associated with a decrease in the occurrence of new cardiovascular events, and an increase in the time to such events.