A single-center validation of the effectiveness in Obstructive Sleep Apnea screening with a photoplethysmography-based smart device

Abstract Background Obstructive sleep apnea (OSA), the most common upper-airway disease, is closely associated with cardiovascular risk. However, the early detection of OSA is challenging, relying on polysomnography (PSG) or portable monitor (PM) in hospitals. A novel technology, photoplethysmography (PPG), has been developed for OSA screening. But there has been limited validation of PPG-based smart devices compared to PSG or PM. Objective This study aimed to investigate the feasibility and verify the validity of PPG-based smart devices in the detection of OSA in real-world settings. Methods A total of 119 consecutive outpatients, were recruited from the Chinese PLA General Hospital from Sep 29 to Nov 10, 2019. Participants were simultaneously tested with a smart watch, and PSG or PM for a whole night sleep. Results In all, 102 patients (48.5±13.7 years old, female 23.5%) were into the final analysis after excluding 17 patients with poor quality of PPG signals. Among them, 83 patients (81.3%) were diagnosed with OSA. Compared to PM, the corresponding accuracy, sensitivity and specificity of PPG-based smart device in predicting moderate to severe OSA patients ( Apnea Hypopnea Index, AHI ≥15) were 87.9% (95% Confidential Interval, CI: 78.8%–94.1%), 89.7% (95% CI: 75.8%–97.1%) and 86.0% (95% CI: 72.1%–94.7%), respectively. Compared to PSG, the accuracy, sensitivity and specificity in predicting all the sleep apnea patients (AHI ≥5) were 81.1% (95% CI: 72.1%–88.2%), 76.5% (95% CI: 50.1%–93.2%) and 100% (95% CI: 29.2%–100%), respectively. Moreover, for moderate to severe OSA patients (AHI ≥15), the predictive ability of PPG-based smart device in OSA was of no significant difference compared to PM (P=0.75) or PSG (P=0.52). Conclusions The PPG-based smart device demonstrated good performance in detecting OSA. Nevertheless, it requires further validation in a large-scale population on screening OSA. Funding Acknowledgement Type of funding source: None

Download Full-text

A single-center validation of the effectiveness photoplethysmography-based smart device in screening obstructive sleep apnea (Preprint)

10.2196/preprints.18841 ◽

2020 ◽

Author(s):

Yibing Chen ◽

Weifang Wang ◽

Yutao Guo ◽

Hui Zhang ◽

Yundai Chen ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sensitivity And Specificity ◽

Large Scale ◽

World Health ◽

Smart Devices ◽

Smart Device ◽

Apnea Hypopnea Index ◽

Apnea Test ◽

Obstructive Sleep

BACKGROUND Obstructive sleep apnea (OSA), the most common upper-airway disease, is closely associated with cardiovascular risk. However, the early detection of OSA is challenging, relying on polysomnography (PSG) or home sleep apnea test (HSAT) in hospitals. A novel technology, PPG (Photoplethysmography), has been developed for OSA screening. However, the validation of PPG-based smart devices is limited as compared to that for PSG or HSAT. OBJECTIVE This study aimed to investigate the feasibility and validity of PPG-based smart devices in the detection of OSA. METHODS A total of 119 consecutive outpatients were recruited from the Chinese PLA General Hospital and assessed using a smart watch, PSG or HSAT for a whole night sleep. RESULTS 17/119 patients were excluded due to poor quality of PPG-signals. Among the rest, 83 patients were diagnosed with OSA. Compared to HSAT devices, the accuracy, sensitivity, and specificity of PPG-based smart device in predicting moderate to severe OSA patients (Apnea Hypopnea Index, AHI≥15) were 87.9%, 89.7%, and 86.0%, respectively. Compared to PSG, the accuracy, sensitivity, and specificity in predicting the sleep apnea in patients (AHI≥5) were 81.1%, 76.5%, and 100%, respectively. Moreover, for moderate to severe OSA patients (AHI≥15), the predictive ability of PPG-based smart device in OSA did no differ significantly as compared to HSAT (P=0.75) or PSG (P=0.52). CONCLUSIONS The PPG-based smart devices demonstrated good performance in detecting OSA; nevertheless, validation in a large-scale population is imperative. CLINICALTRIAL Chinese Clinical Trial Registry of the International Clinical Trials Registry Platform of the World Health Organization ChiCTR-OOC-17014138; http://www.chictr.org.cn/showprojen.aspx?proj=24191.

Download Full-text

A single-center validation of the effectiveness of photoplethysmography-based smart device for screening obstructive sleep apnea

10.22541/au.162063890.07969621/v1 ◽

2021 ◽

Author(s):

Chen Yibing ◽

Weifang Wang ◽

Hui Zhang ◽

Yutao Guo ◽

Lixin Xie ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sensitivity And Specificity ◽

Large Scale ◽

Smart Devices ◽

Smart Device ◽

Apnea Hypopnea Index ◽

Early Screening ◽

Apnea Test ◽

Obstructive Sleep

Background: Obstructive sleep apnea (OSA), the most common upper-airway disease, is closely associated with cardiovascular risk. However, the early screening of OSA is challenging, relying on polysomnography (PSG) or home sleep apnea test (HSAT) in hospitals. Photoplethysmography (PPG) has been developed as a novel technology for OSA screening, but the validation of PPG-based smart devices is limited as compared to that for PSG or HSAT. Objective: This study aimed to investigate the feasibility and validity of PPG-based smart devices in the screening of OSA. Methods: A total of 119 consecutive outpatients were recruited from the Chinese PLA General Hospital and assessed for a whole-night sleep using a smartwatch, PSG, or HSAT. Results: 17/119 patients were excluded from the study due to the poor quality of PPG signals. Among the remaining, 83 patients were diagnosed with OSA. Compared to HSAT devices, the accuracy, sensitivity, and specificity of PPG-based smart devices in predicting moderate-to-severe OSA patients (apnea-hypopnea index, AHI≥15) were 87.9%, 89.7%, and 86.0%, respectively. Compared to PSG, the accuracy, sensitivity, and specificity in predicting sleep apnea in patients (AHI≥5) were 81.1%, 76.5%, and 100%, respectively. Moreover, for moderate-to-severe OSA patients (AHI≥15), the predictive ability of PPG-based smart devices in OSA did no differ significantly as compared to HSAT (P=0.75) or PSG (P=0.52). Conclusions: The PPG-based smart devices performed adequately in detecting OSA; nevertheless, validation in a large-scale population is imperative.

Download Full-text

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽

10.1159/000516243 ◽

2021 ◽

pp. 1-8

Author(s):

Lifeng Li ◽

Demin Han ◽

Hongrui Zang ◽

Nyall R. London

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Nasal Surgery ◽

Subjective Sleep Quality ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

Objective: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. Methods: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. Results: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). Conclusion: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

Download Full-text

Clinical and Polysomnographic Characteristics of Patients with Extreme Obstructive Sleep Apnea, AHI > 100: A Case-Control Study

Shiraz E-Medical Journal ◽

10.5812/semj.109587 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Forogh Soltaninejad ◽

Negarsadat Neshat ◽

Mehrzad Salmasi ◽

Babak Amra

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Study Results ◽

Significant Difference ◽

Severe Manifestation ◽

The Mean ◽

Nocturnal Polysomnography ◽

Control Study

Background: Severe obstructive sleep apnea (OSA), defined by apnea-hypopnea index (AHI) as more than 30 events per hour, was previously related to more comorbidity. However, limited studies separated the patients with AHI > 100 from those with a less severe manifestation of the disease. Objectives: The current study aimed at describing the characteristics of this subgroup and comparing them with less severe conditions. Methods: A retrospective analysis was conducted on 114 patients with OSA. Nocturnal polysomnography was used to diagnose severe OSA. Patients were categorized into two groups: (1) 60 < AHI < 100 (very severe OSA), (2) AHI ≥ 100 (extreme OSA). Demographic, medical history, and polysomnographic variables were evaluated and compared between the two groups. Results: Extreme OSA was diagnosed in 19 patients, the mean body mass index (BMI) was significantly higher in this group (39.26 ± 5.93 vs. 35.68 ± 6.45 kg/m2, P = 0.025). They also had lower minimal O2 saturation (65.68 ± 10.16 vs. 74.10 ± 8.74, P = 0.003) and more time with < 90% O2 saturation (T < 90%) (81.78 ± 22.57 vs. 58.87 ± 33.14, P = 0.01). OHS prevalence was significantly higher in the group with extreme OSA (P = 0.04). The most frequent comorbidity was hypertension, with an incidence of 60.5%, for the extreme group, although there was no significant difference between the two groups in terms of clinical associations. Conclusions: The current study results suggested that greater BMI and lower minimal O2 saturation, as well as increased T < 90%, were associated with extreme OSA, although no differences were observed in the associated diseases between the compared groups.

Download Full-text

Severity of obstructive sleep apnea (OSA) in 382 Han and Uyghur patients with sleep disorders

Traditional Medicine and Modern Medicine ◽

10.1142/s2575900018500106 ◽

2018 ◽

Vol 01 (02) ◽

pp. 163-169

Author(s):

Aman Gul ◽

Nassirhadjy Memtily ◽

Aikeranmu Aihemaiti ◽

Amir Abdukadir ◽

Palidan Wushuer

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Race And Ethnicity ◽

Impact Factors ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Significant Difference ◽

Adults And Children ◽

Respiratory Disturbance ◽

Distinctive Difference

Objective: Race and ethnicity may impact the prevalence and severity of Obstructive Sleep Apnea (OSA) in adults and children. In this study, we aim to investigate the ethnologic influence on OSA severity between Han and Uyghur OSA patients in Xinjiang, China.Methods: We enrolled total of 382 (205 Han and 177 Uyghur) patients diagnosed with OSA with apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) [Formula: see text] 5. During admission, the severity of OSA was evaluated by polysomnography (PSG).Results: From demographic characteristics of enrolled patients, we found that there was no significant difference in sex, age, BMI, and neck circumference between two study populations. Uyghur OSA patients had longer sleep latency, longer REM sleep and N3 stage, but shorter N1 phase than Han OSA patients. AHI and apnea RDI level, but not hypopnea RDI, were evidently higher in Han patients compared with Uyghur patients. There was no distinctive difference between two ethnic populations in average and minimum peripheral capillary oxygen saturation (SaO2) level.Conclusion: Better understanding of impact factors encompassing ethnicity may help improve OSA diagnosis accuracy, management and treatment for patients in Xinjiang.

Download Full-text

Do the turbinates play an important role in obstructive sleep apnea syndrome? – Our experience

Romanian Journal of Rhinology ◽

10.1515/rjr-2016-0011 ◽

2016 ◽

Vol 6 (22) ◽

pp. 93-98

Author(s):

Nicoleta Dumitrescu ◽

Raluca Enache ◽

Codrut Sarafoleanu

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Apnea Hypopnea Index ◽

Nasal Airflow ◽

Nasal Surgery ◽

Obstructive Sleep ◽

Significant Difference ◽

Apnea Syndrome

Abstract BACKGROUND. Nasal obstruction may trigger obstructive sleep apnea syndrome (OSAS) and it is considered to be a cofactor in its pathophysiology. However, the relation between cause and effect still remains a matter of debate. MATERIAL AND METHODS. 18 patients diagnosed with chronic hypertrophic rhinitis and obstructive sleep apnea syndrome were included in the present study. All patients underwent nasal surgery as the single treatment for their sleep breathing disorders. Rhinomanometric (total nasal airflow, logReff, logVR) and polygraphic parameters (apnea-hypopnea index - AHI, snore flags index – SFI) were evaluated pre- and 2 months postoperatively. RESULTS. There was a statistically significant difference between the values of the preoperative and postoperative total nasal airflow (p-value<0.0001). In case of AHI, there was a decrease in its value from 31.56 preoperatively to 30.03 postoperatively, but the difference was not statistically significant (p=0.937). The SFI, on the other hand, presented a significant decrease (p=0.05), from a mean value of 93.15 preoperatively to 56.02 after the surgery. The correlation of the total nasal airflow with AHI and SFI, revealed that nasal surgery had an important impact upon snoring characteristics (r=0.24) and less upon OSAS severity (r=0.21). CONCLUSION. The nasal cavity obstruction contributes less to OSAS, but still represents a disorder that needs to be corrected in case of such patients. Turbinates reduction surgery may be applied in the treatment of OSAS and combined with palate and/or tongue surgery.

Download Full-text

Robotic Modification of Epiglottis Trimming in the Treatment of Obstructive Sleep Apnea

Otolaryngology ◽

10.1177/01945998211064610 ◽

2021 ◽

pp. 019459982110646

Author(s):

Mehmet Ali Babademez ◽

Fatih Gul ◽

Kadir Sinasi Bulut ◽

Mecit Sancak ◽

Saliha Kusoglu Atalay

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Tertiary Hospital ◽

Apnea Hypopnea Index ◽

Complete Relief ◽

Sleep Endoscopy ◽

Drug Induced ◽

Drug Induced Sleep Endoscopy ◽

Obstructive Sleep ◽

Significant Difference

Objective With the widespread use of drug-induced sleep endoscopy, it has been suggested that epiglottis pathologies are present at high rates in patients with sleep apnea. The aim of our study was to evaluate the efficacy of trimming the curled-inward epiglottis as an updated surgical technique in patients with omega epiglottis. Study Design Retrospective study. Setting Tertiary hospital. Methods Among the 283 patients with epiglottis pathology, 21 with isolated omega-shaped epiglottis (age, 33-53 years) fulfilled the inclusion criteria between May 2016 and April 2019. Drug-induced sleep endoscopy was used to detect epiglottic collapse compressed by the lateral parts during inspiration. An epiglottoplasty technique was applied as single-level sleep surgery in patients with an isolated omega-shaped epiglottis. The medical data were also reviewed. Results The mean pre- and postoperative total apnea-hypopnea index (AHI) scores were 27.89 and 10.58, respectively, and this difference was statistically significant ( P < .001). There was a statistically significant difference between the pre- and postoperative supine AHI scores (27.02 vs 10.48, P < .001). Surgical success, defined as AHI <20 and a decrease in AHI by 50%, was documented in 85.71% of patients (18/21), and 12 patients found complete relief from obstructive sleep apnea symptoms (AHI <5); the cure rate was 38.09% (8/21). Conclusion Trimming the curled-inward epiglottis may represent an excellent option for epiglottis surgery in patients with obstructive sleep apnea by being less invasive than techniques currently in use.

Download Full-text

557 Nasal cavity narrowing in pediatric obstructive sleep apnea

SLEEP ◽

10.1093/sleep/zsab072.555 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A220-A220

Author(s):

Christopher Cielo ◽

Shubha Vasisht ◽

Darko Stefanovski ◽

Rachel Whelan ◽

Joseph McDonough ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Cavity ◽

Small Sample ◽

Acoustic Rhinometry ◽

Invasive Technique ◽

Apnea Hypopnea Index ◽

Adenotonsillar Hypertrophy ◽

Obstructive Sleep ◽

Significant Difference

Abstract Introduction The contribution of nasal cavity narrowing to obstructive sleep apnea (OSA) in children has not been well-defined. Acoustic rhinometry is a non-invasive technique that uses acoustic pulses to measure nasal cavity cross-sectional area (CSA) at defined distances from the tip of the naris. This study evaluated the relationship between nasal cavity CSA and OSA in children. We hypothesized that OSA severity would correlate with reduced nasal CSA. Methods Children 5–12 years of age with OSA underwent polysomnography and acoustic rhinometry at baseline and after 3 months and 12 months of growth as part of a randomized controlled trial. Statistical analysis of the nasal cavity CSA up to 6 cm from the tip of the naris was performed using mixed-effects linear regression model with visit month, age at visit, trial number, OSA severity, and side (left or right naris), and statistical interaction between OAHI category and distance from the tip of the nose as a fixed effect and the random effects set on the level of individual subject. Least significant differences were used to account for multiple comparisons. An unbiased approach using latent class analysis was used to determine OSA severity categories based on obstructive apnea hypopnea index (OAHI). Post-hoc analysis was used assess the model adjusted (marginal) means and pairwise effects. Results 112 participants completed testing (50% male, aged 7.9±2.1 years). Median (IQR) OAHI for subjects with mild OSA (n=69) was 4.4/hr (3.2), moderate OSA (n=35) was 9.7/hr (7.1), and severe OSA (n=8) was 21.3/hr (17.2). There was a significant difference in linear trend for nasal cavity narrowing of the CSA between patients with mild vs. moderate OSA, p=0.023. There was no difference in nasal cavity narrowing between the severe group and other groups, likely due to the small sample size of this group. Conclusion There is a difference in the anterior nasal cavity narrowing between children with mild OSA and moderate OSA. In addition to structural narrowing from adenotonsillar hypertrophy, this may be another contributor to pediatric OSA. Support (if any) R01 HL120909 K23 HL135346 K01 HL130719

Download Full-text

Relevance of obstructive sleep apnea and smoking: Obstructive sleep apnea and smoking

Family Practice ◽

10.1093/fampra/cmaa112 ◽

2020 ◽

Author(s):

Ayse Didem Esen ◽

Meltem Akpinar

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Rem Sleep ◽

Demographic Data ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Study Results ◽

Significant Difference ◽

Study Population ◽

The Impact

Abstract Background The data concerning the association of smoking and obstructive sleep apnea (OSA) are limited. The effects of cigarette smoking on OSA still remain obscure. Objectives To reveal the impact of smoking on obstructive sleep apnea. Methods About 384 patients with the diagnosis of OSA through full night polysomnographic (PSG) examination were included to the study. The demographic data (age, sex and BMI), complaints and medical history, status of smoking as non-smokers and smokers, smoking frequency (cigarettes/day), polysomnograhic data comprising apnea hypopnea index (AHI), non-REM sleep AHI (NREM AHI), REM sleep AHI (REM AHI), minimum oxygen saturation (min SaO2) were recorded for all the subjects. Non-smokers and smokers were compared in terms of severity of OSA. Results The study population consisted of 384 subjects, 253 males and 131 females. Smoking frequency was not found correlated with OSA severity. Among smokers, males had higher severe OSA rate (P = 0.002, P < 0.05). In subjects with BMI < 30, severe OSA rate was higher in smokers (34.44% versus 21%) (P = 0.027, P < 0.05). Conclusions Our study detected higher rate of severe OSA in male smokers and smokers with BMI < 30. PSG data did not yield statistically significant difference in non-smokers and smokers. OSA severity was not found correlated with smoking frequency. Along with the study results, the impact of smoking on OSA is still controversial. Prospective studies with larger sample size may be contributive to further evaluation of the association of OSA with smoking.

Download Full-text

0170 Association of HIF-1 Alpha and Beta Subunits with Clock and BMAL1 Proteins in Obstructive Sleep Apnea Patients

SLEEP ◽

10.1093/sleep/zsaa056.168 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A67-A67

Author(s):

A Gabryelska ◽

M Sochal ◽

S Turkiewicz ◽

P Bialasiewicz

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Circadian Clock ◽

Hypoxia Inducible Factor ◽

Study Groups ◽

Oxygen Metabolism ◽

Apnea Hypopnea Index ◽

Protein Levels ◽

Obstructive Sleep ◽

Significant Difference

Abstract Introduction Obstructive sleep apnea (OSA) is a chronic condition that is characterized by intermittent hypoxia. Key regulator of oxygen metabolism is hypoxia inducible factor (HIF), which consists of oxygen sensitive subunit and continuously produced subunit. Circadian clock is composed of set of genes, which function as activators - CLOCK and BMAL 1, who similarly to HIF are basic helix-loop-helix-PER-ARNT-SIM transcription factors. Therefore, the aim of the study was to assess the relationship between HIF-1alpha, HIF-1beta, CLOCK, BMAL1 and polysomnography (PSG) variables in healthy individuals and severe OSA patients. Methods The study included 20 individuals, who underwent PSG and based on apnea-hypopnea index (AHI) were divided into severe OSA group (n=10; AHI30; 90% male) and healthy control (n=10; AHI<5; 70% male). All participants had their peripheral blood collected in the evening (9:00-10:00 pm) before and in the morning (6:00-7:00 am) after the PSG. HIF-1alpha, HIF-1beta, CLOCK and BMAL1 protein concertation measurements were performed using ELISA. Results Significant difference was observed in the following protein measurements between study groups: evening and morning HIF-1 (p=0.020 and p=0.043, respectively), evening HIF-1alpha (p=0.047), evening and morning CLOCK (p=0.037 and p=0.019, respectively) and morning BMAL1 (p=0.016). No differences were observed between morning and evening protein levels in both groups. Evening HIF-1beta corraleted with evening CLOCK and morning BMAL1 (R=0.511, p=0.21 and R=0.594, p=0.006, respectively), while morning HIF-1 with evening BMAL1 (R=474, p=0.35). Furthermore, evening and morning HIF-1 correlated with evening BMAL1 (R=564, p=0.010 and R=0.689, p=0.001, respectively). Additionally, morning CLOCK and BMAL1 correlated with AHI (R=0.510, p=0.022 and R=0.560, p=0.010, respectively) and desaturation index (R=0.487, p=0.209 and R=0.570, p=0.009, respectively). Conclusion There is significant correlation between both subunits of HIF-1 protein and circadian clock proteins: CLOCK and BMAL1, which further correlate with increased disease severity. This suggests OSA patients are in risk of circadian clock disruption due to present hypoxia. Support The study was financed by Polish National Centre Grant no. 2018/31/N/NZ5/03931.

Download Full-text