scholarly journals 0491 Is a Single Night Sleep Study Sufficient for the Accurate Diagnosis of Sleep Apnea? An Exploration of Multi-Night Sleep Studies

SLEEP ◽  
2018 ◽  
Vol 41 (suppl_1) ◽  
pp. A185-A185
Author(s):  
J M Dzierzewski ◽  
N D Dautovich ◽  
B Rybarczyk ◽  
M Alattar ◽  
S A Taylor
Keyword(s):  
Sleep Apnea ◽  
Accurate Diagnosis ◽  
Night Sleep ◽  
Sleep Study ◽  
Sleep Studies ◽  
Single Night

CME/Answers: Obstructive Sleep Apnea: How to Deal with Night- To-Night Variability of Respiratory Events?

Praxis ◽  
2021 ◽  
Vol 110 (1) ◽  
pp. 16-18
Author(s):  
Maurice Roeder ◽  
Esther I. Schwarz ◽  
Thomas Gaisl ◽  
Malcolm Kohler
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Night Sleep ◽  
Sleep Study ◽  
Diagnostic Uncertainty ◽  
Sleep Studies ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Single Night

Abstract.According to current recommendations, the diagnosis of obstructive sleep apnea (OSA) is established by a single-night sleep study. However, recent reports suggest a remarkable night-to-night variability of OSA severity. We report on a 76-year-old man with suspected OSA who underwent six sleep studies within 13 months. Sleep studies demonstrated a remarkable variability of respiratory events based on an apnea-hypopnea index (AHI) varying between 1.1 and 43.1/h. There were no changes in body weight, alcohol intake, medication or comorbidities during the evaluation period. Due to diagnostic uncertainty and missing subjective benefit, the initially implemented CPAP therapy was stopped after one year of therapy. Considering night-to-night variability of OSA severity, single-night sleep studies might not be accurate enough in order to reliably diagnose or exclude OSA.

scholarly journals Snoring: a source of noise pollution and sleep apnea predictor

SLEEP ◽  
2019 ◽  
Vol 43 (6) ◽  
Author(s):  
Mudiaga Sowho ◽  
Francis Sgambati ◽  
Michelle Guzman ◽  
Hartmut Schneider ◽  
Alan Schwartz
Keyword(s):  
Sleep Apnea ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Noise Pollution ◽  
Apnea Hypopnea Index ◽  
Sleep Study ◽  
Sound Levels ◽  
Obstructive Sleep ◽  
Single Night ◽  
The Relationship

Abstract Snoring is a highly prevalent condition associated with obstructive sleep apnea (OSA) and sleep disturbance in bed partners. Objective measurements of snoring in the community, however, are limited. The present study was designed to measure sound levels produced by self-reported habitual snorers in a single night. Snorers were excluded if they reported nocturnal gasping or had severe obesity (BMI > 35 kg/m2). Sound was measured by a monitor mounted 65 cm over the head of the bed on an overnight sleep study. Snoring was defined as sound ≥40 dB(A) during flow limited inspirations. The apnea hypopnea index (AHI) and breath-by-breath peak decibel levels were measured. Snore breaths were tallied to determine the frequency and intensity of snoring. Regression models were used to determine the relationship between objective measures of snoring and OSA (AHI ≥ 5 events/h). The area under the curve (AUC) for the receiver operating characteristic (ROC) was used to predict OSA. Snoring intensity exceeded 45 dB(A) in 66% of the 162 participants studied, with 14% surpassing the 53 dB(A) threshold for noise pollution. Snoring intensity and frequency were independent predictors of OSA. AUCs for snoring intensity and frequency were 77% and 81%, respectively, and increased to 87% and 89%, respectively, with the addition of age and sex as predictors. Snoring represents a source of noise pollution in the bedroom and constitutes an important target for mitigating sound and its adverse effects on bed partners. Precise breath-by-breath identification and quantification of snoring also offers a way to risk stratify otherwise healthy snorers for OSA.

scholarly journals A Convolutional Network for the Classification of Sleep Stages

Proceedings ◽  
2018 ◽  
Vol 2 (18) ◽  
pp. 1174 ◽  
Author(s):  
Isaac Fernández-Varela ◽  
Elena Hernández-Pereira ◽  
Vicente Moret-Bonillo
Keyword(s):  
Sleep Medicine ◽  
Sleep Stages ◽  
Kappa Index ◽  
Night Sleep ◽  
Convolutional Network ◽  
Sleep Study ◽  
Convolutional Networks ◽  
Sleep Studies ◽  
Automatic Methods

The classification of sleep stages is a crucial task in the context of sleep medicine. It involves the analysis of multiple signals thus being tedious and complex. Even for a trained physician scoring a whole night sleep study can take several hours. Most of the automatic methods trying to solve this problem use human engineered features biased for a specific dataset. In this work we use deep learning to avoid human bias. We propose an ensemble of 5 convolutional networks achieving a kappa index of 0.83 when classifying 500 sleep studies.

Velopharyngeal Dysfunction and Sleep Apnea-A Survey to Ascertain Surgical Practice Patterns

2017 ◽  
Vol 54 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Katelyn G. Bennett ◽  
Adina B. Robinson ◽  
Steven J. Kasten ◽  
Steven R. Buchman ◽  
Christian J. Vercler
Keyword(s):  
Sleep Apnea ◽  
Practice Patterns ◽  
Response Rate ◽  
Surgical Specialty ◽  
Sleep Study ◽  
Surgical Practice ◽  
Sleep Studies ◽  
Obstructive Sleep ◽  
E Mail ◽  
Question Survey

Objective To determine if all cleft surgeons uniformly and adequately evaluate patients with cleft for obstructive sleep apnea (OSA) and consider OSA in treatment of velopharyngeal dysfunction (VPD). Design A 22-question survey was administered via e-mail to 1117 surgeons who were members of the American Cleft Palate-Craniofacial Association. Logistic regression was used to determine if management was affected by years in practice, clinical volume, field of training, and region of practice. Main Outcome Measures We sought to determine if years in practice, clinical volume, region of practice, and surgical specialty affected surgeons’ evaluation of OSA and their approaches to VPD. Results A total of 231 surgeons responded (21% response rate), and 67% stated that they had trained in plastic surgery. With increasing years of practice, surgeons were less likely to refer patients for preoperative and postoperative sleep studies ( P = .00 and P = .001, respectively), screen patients for sleep apnea ( P = .008), or change their management based on a sleep study ( P = .001). There were no significant differences in screening or testing for OSA based upon clinical volume. Among those surveyed, otolaryngologists were more likely to refer patients for postoperative sleep studies ( P = .028). Surgeons in the Southeast were more likely to change their management based upon a sleep study ( P = .038). Conclusions Statistically significant trends in screening and testing for OSA in the setting of VPD were identified by this survey. Notably, older surgeons were less likely to investigate OSA in their patients, and not all specialties equally refer for postoperative sleep studies.

Sleep Study Measures on Postoperative Night 1 Following Implantation of the Hypoglossal Nerve Stimulator

2021 ◽  
pp. 019459982110234
Author(s):  
Phillip Huyett
Keyword(s):  
Sleep Apnea ◽  
Hypoglossal Nerve ◽  
Apnea Hypopnea Index ◽  
Nerve Stimulator ◽  
Sleep Study ◽  
Oxygen Desaturation Index ◽  
Obstructive Sleep ◽  
Same Day Discharge ◽  
Single Night ◽  
Mean Time

Objective To examine the changes in measures of sleep apnea severity and hypoxemia on the first postoperative night following implantation of the hypoglossal nerve stimulator. Study Design This was a single-arm prospective cohort study. Setting A single academic sleep surgical practice. Methods Subjects with moderate to severe obstructive sleep apnea underwent implantation of the hypoglossal nerve stimulator (HGNS) and were discharged to home the same day as surgery. A single-night WatchPAT study was performed on the night immediately following surgery (PON 1) and was compared to baseline sleep testing. Results Twenty subjects who were an average of 58.6 ± 2.5 years old, were 25% female, and had a mean body mass index of 28.1 ± 0.9 kg/m2 completed the study. Mean O2 nadir at baseline was 79.6% ± 1.1% compared to 82.7% ± 0.9% ( P = .013) on PON 1. One patient demonstrated a >10% worsening in O2 nadir. Only 2 additional patients demonstrated a worsening in O2 nadir on PON 1, each by only 1 percentage point. Neither mean time spent below SpO2 88% nor oxygen desaturation index (ODI) worsened postoperatively (mean time spent below oxygen saturation of 88%, 27.8 ± 7.85 vs 11.2 ± 5.2, P = .03; mean ODI, 29.6 ± 5.2/h vs 21.0 ± 5.4/h, P = .10). Mean obstructive apnea hypopnea index (AHI) was no worse (40.6 ± 4.7/h to 28.7 ± 4.2/h, P = .02), with only 2 patients experiencing an obstructive AHI >20% more severe than baseline. Only 1 patient demonstrated a clinically meaningful increase in central AHI on PON 1. Conclusions Overall, AHI and measures of nocturnal hypoxemia are stable, if not improved, on PON 1 following HGNS implantation. These findings support the safety of same-day discharge following implantation of the hypoglossal nerve stimulator.

scholarly journals Revisiting level II sleep studies in the era of COVID-19: a theoretical economic decision model in patients with suspected obstructive sleep apnea

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Najib T. Ayas ◽  
Rachel Jen ◽  
Brett Baumann
Keyword(s):  
British Columbia ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Decision Model ◽  
Sleep Study ◽  
Diagnostic Algorithms ◽  
Sleep Studies ◽  
Level Ii ◽  
Obstructive Sleep ◽  
Home Sleep Study

Abstract Background The recent pandemic has made it more challenging to assess patients with suspected obstructive sleep apnea (OSA) with in laboratory polysomnography (PSG) due to concerns of patient and staff safety. The purpose of this study was to assess how Level II sleep studies (LII, full PSG in the home) might be utilized in diagnostic algorithms of suspected OSA using a theoretical decision model. Methods We examined four diagnostic algorithms for suspected OSA: an initial PSG approach, an initial LII approach, an initial Level III approach (LIII, limited channel home sleep study) followed by PSG if needed, and an initial LIII approach followed by LII if needed. Costs per patient assessed was calculated as a function of pretest OSA probability and a variety of other variables (e.g. costs of tests, failure rate of LIII/LII, sensitivity/specificity of LIII). The situation in British Columbia was used as a case study. Results The variation in cost per test was calculated for each algorithm as a function of the above variables. For British Columbia, initial LII was the least costly across a broad range of pretest OSA probabilities (< 0.80) while initial LIII followed by LII as needed was least costly at very high pretest probability (> 0.8). In patients with a pretest OSA probability of 0.5, costs per patient for initial PSG, initial LII, initial LIII followed by PSG, and initial LIII followed by LII were: $588, $417, $607, and $481 respectively. Conclusions Using a theoretical decision model, we developed a preliminary cost framework to assess the potential role of LII studies in OSA assessment. Across a broad range of patient pretest probabilities, initial LII studies may provide substantial cost advantages. LII studies might be especially useful during pandemics as they combine the extensive physiologic information characteristic of PSG with the ability to avoid in-laboratory stays. More empiric studies need to be done to test these different algorithms.

scholarly journals Screening Sleep Abnormalities in Children with Prader–Willi Syndrome: Challenges in the Indian Scenario

2021 ◽  
Vol 1 ◽  
pp. 20-25
Author(s):  
Akanksha Chirag Parikh ◽  
Santhosh Sathyanarayana Olety
Keyword(s):  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Case Vignette ◽  
Prader Willi Syndrome ◽  
Older Children ◽  
Indian Children ◽  
Recombinant Growth Hormone ◽  
Sleep Related Breathing Disorders ◽  
Sleep Study ◽  
Sleep Studies

There is a high prevalence of sleep-related breathing disorders in the form of obstructive and central sleep apnea as well as spontaneous oxygen desaturation in children with Prader–Willi syndrome (PWS). Most cases are asymptomatic and if untreated go on to develop unfavorable neurodevelopmental, cardiovascular, and cerebrovascular outcomes. Hence, sleep study or polysomnography (PSG) is recommended in all children at the time of diagnosis as well as with the development of certain risk factors including symptoms of sleep apnea, before and after initiation of recombinant growth hormone (rGH) therapy. The use of rGH in children with PWS has been shown to improve central sleep apnea but also shown to be associated with worsening of OSA. PSG is ideally performed in a sleep laboratory. Various types of PSG devices are available depending on the biological parameters that are desired to be monitored. Sleep disorders in children are distinct from those seen in adults and have different diagnostic scoring criteria necessitating a trained pediatric sleep specialist to analyze the PSG recording. Through the clinical case vignette of a 14-year-old girl with PWS, severe obesity, and sleep disordered breathing, this review aims to highlight the need, timing, types, analysis, and interpretation of sleep studies in infants and older children with PWS, particularly in relation to rGH therapy. There is a paucity of literature on sleep studies in children with PWS in the local setting. Thus this review also suggests the need for adapting the existing Western guidelines for PSG in Indian children with PWS.

569 Correlation between age and initial findings of sleep disordered breathing in children with achondroplasia

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A224-A225
Author(s):  
Fayruz Araji ◽  
Cephas Mujuruki ◽  
Brian Ku ◽  
Elisa Basora-Rovira ◽  
Anna Wani
Keyword(s):  
Sleep Apnea ◽  
Primary Care Physicians ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Sleep Study ◽  
Surgical Interventions ◽  
Screening Guidelines ◽  
Obstructive Sleep ◽  
Children’S Sleep ◽  
Disordered Breathing

Abstract Introduction Achondroplasia (ACH) occurs approximately 1 in 20,000–30,000 live births. They are prone to sleep disordered breathing specifically due to the upper airway stenosis, enlarged head circumference, combined with hypotonia and limited chest wall size associated with scoliosis at times. The co-occurrence of sleep apnea is well established and can aide in the decision for surgical intervention, however it is unclear at what age children should be evaluated for sleep apnea. Screening is often delayed as during the daytime there is no obvious gas exchange abnormalities. Due to the rareness of this disease, large studies are not available, limiting the data for discussion and analysis to develop guidelines on ideal screening age for sleep disordered breathing in children with ACH. Methods The primary aim of this study is to ascertain the presence of sleep disorder breathing and demographics of children with ACH at time of first polysomnogram (PSG) completed at one of the largest pediatric sleep lab in the country. The secondary aim of the study is to identify whether subsequent polysomnograms were completed if surgical interventions occurred and how the studies differed over time with and without intervention. Retrospective review of the PSGs from patients with ACH, completed from 2017–2019 at the Children’s Sleep Disorders Center in Dallas, TX. Clinical data, demographics, PSG findings and occurrence of interventions were collected. Results Twenty-seven patients with the diagnosis of ACH met criteria. The average age at the time of their first diagnostic PSG was at 31.6 months of age (2.7 years), of those patients 85% had obstructive sleep apnea (OSA),51% had hypoxemia and 18% had hypercapnia by their first diagnostic sleep study. Of those with OSA, 50% were severe. Majority were females, 55%. Most of our patients were Hispanic (14%), Caucasian (9%), Asian (2%), Other (2%), Black (0%). Each patient had an average of 1.9 PSGs completed. Conclusion Our findings can help create a foundation for discussion of screening guidelines. These guidelines will serve to guide primary care physicians to direct these patients to an early diagnosis and treatment of sleep disordered breathing. Support (if any):

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