Age and seasons influence on at-home pulse oximetry results in children evaluated for suspected obstructive sleep apnea

AbstractObstructive sleep apnea (OSA) is a disease characterized by a brief period of cessation or marked decline in ventilation. The standard treatment is continuous positive airway pressure (CPAP). To determine the indication, full-night polysomnography (PSG) is required; however, it is a stressful examination. We verified the usefulness of pulse-oximetry at home as a predictor for CPAP indication before PSG. Simultaneously, the clinical background and cephalometry were also verified. Among 376 subjects who received PSG at our hospital from February 2005 to April 2020, 138 subjects received pulse-oximetry at home before PSG were enrolled retrospectively and performed logistic regression analysis on those with CPAP indication. Concurrently, 262 of 376 subjects received cephalometry were enrolled, and logistic regression analysis were performed using clinical background and cephalometry. A 3% oxygen desaturation (3% ODI) on the pulse-oximeter was a predictor for CPAP indication. The positive predictive value of 3% ODI ≥ 28.5 events/h was 73.3% and the negative predictive value was 62.5%. Older age, higher body mass index (BMI), stronger lower jaw retraction (wider ∠ANB), and longer distance from the anterior superior tip of the hyoid bone to the mandibular plane (MP-H) on cephalometry were also independent predictors. The positive predictive value when both BMI ≥ 26.0 kg/m2 and MP-H ≥ 17.5 mm were present was 88.2% and the negative predictive value when both were absent was 71.3%. The combination of clinical background and cephalometry would be a useful screening tool as well as a pulse-oximetry at home for CPAP indication.

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At-home pulse oximetry in children undergoing adenotonsillectomy for obstructive sleep apnea

European Journal of Pediatrics ◽

10.1007/s00431-017-2868-1 ◽

2017 ◽

Vol 176 (4) ◽

pp. 493-499 ◽

Cited By ~ 7

Author(s):

Martino Pavone ◽

Nicola Ullmann ◽

Elisabetta Verrillo ◽

Giancarlo De Vincentiis ◽

Emanuela Sitzia ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Pulse Oximetry ◽

Obstructive Sleep ◽

At Home

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Feasibility of at-home continuous overnight pulse oximetry for obstructive sleep apnea screening in bariatric surgery candidates

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06660-5 ◽

2021 ◽

Author(s):

Sergio Navarro-Martínez ◽

Marina Carrasco-Llatas ◽

Silvia Matarredona-Quiles ◽

José Ángel Diez Ares ◽

Nuria Peris Tomás ◽

...

Keyword(s):

Bariatric Surgery ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Pulse Oximetry ◽

Obstructive Sleep ◽

At Home

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Initiation of therapy for obstructive sleep apnea syndrome: a randomized comparison of outcomes of telemetry-supported home-based vs. sleep lab-based therapy initiation

Sleep And Breathing ◽

10.1007/s11325-021-02371-7 ◽

2021 ◽

Author(s):

Ingo Fietze ◽

Sebastian Herberger ◽

Gina Wewer ◽

Holger Woehrle ◽

Katharina Lederer ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Control Group ◽

Sleep Laboratory ◽

Home Therapy ◽

Home Management ◽

Therapy Initiation ◽

Home Based ◽

Obstructive Sleep ◽

At Home

Abstract Purpose Diagnosis and treatment of obstructive sleep apnea are traditionally performed in sleep laboratories with polysomnography (PSG) and are associated with significant waiting times for patients and high cost. We investigated if initiation of auto-titrating CPAP (APAP) treatment at home in patients with obstructive sleep apnea (OSA) and subsequent telemonitoring by a homecare provider would be non-inferior to in-lab management with diagnostic PSG, subsequent in-lab APAP initiation, and standard follow-up regarding compliance and disease-specific quality of life. Methods This randomized, open-label, single-center study was conducted in Germany. Screening occurred between December 2013 and November 2015. Eligible patients with moderate-to-severe OSA documented by polygraphy (PG) were randomized to home management or standard care. All patients were managed by certified sleep physicians. The home management group received APAP therapy at home, followed by telemonitoring. The control group received a diagnostic PSG, followed by therapy initiation in the sleep laboratory. The primary endpoint was therapy compliance, measured as average APAP usage after 6 months. Results The intention-to-treat population (ITT) included 224 patients (110 home therapy, 114 controls); the per-protocol population (PP) included 182 patients with 6-month device usage data (89 home therapy, 93 controls). In the PP analysis, mean APAP usage at 6 months was not different in the home therapy and control groups (4.38 ± 2.04 vs. 4.32 ± 2.28, p = 0.845). The pre-specified non-inferiority margin (NIM) of 0.3 h/day was not achieved (p = 0.130); statistical significance was achieved in a post hoc analysis when NIM was set at 0.5 h/day (p < 0.05). Time to APAP initiation was significantly shorter in the home therapy group (7.6 ± 7.2 vs. 46.1 ± 23.8 days; p < 0.0001). Conclusion Use of a home-based telemonitoring strategy for initiation of APAP in selected patients with OSA managed by sleep physicians is feasible, appears to be non-inferior to standard sleep laboratory procedures, and facilitates faster access to therapy.

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Reliability of Holter Oximetry for Home Sleep Apnea Testing

Otolaryngology ◽

10.1016/j.otohns.2008.05.269 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P83-P84 ◽

Cited By ~ 1

Author(s):

Jordan C Stern ◽

Conor Heneghan ◽

Redmond Shouldice

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Apnea Hypopnea Index ◽

Patients Âgés ◽

Home Testing ◽

Obstructive Sleep ◽

Adults And Children ◽

Home Sleep Apnea Testing ◽

A Prospective Study ◽

At Home

Objective To test the reliability of the Holter Oximeter for home testing of obstructive sleep apnea. Previous reports have shown a 96% correlation with simultaneous polysomnography and Holter Oximetry in the sleep laboratory. This study was designed to measure reliability of data obtained at home, as well as to obtain information from patients regarding comfort of the device. Methods A prospective study of 120 consecutive patients (ages 5 to 85) presenting to an otolaryngology practice during a 4-month period with complaints of snoring or sleep apnea symptoms. Device: The Holter Oximeter produces an apnea hypopnea index (AHI) based on an automated processing method of a continuous electrocardiogram and pulse oximeter. The reliability of the test was determined by the number of tests completed without interruption due to patient discomfort, electrode or device failure. Results There was 97% data recovery from the home testing device. Data failure was due to faulty memory cards in the device or surface electrode failure. All patients tolerated wearing the device at home, and there were no voluntary interruptions of the tests by patients. On a discomfort scale of 0 to 10 (0: no discomfort and 10: maximal discomfort), the average discomfort score was 2. Conclusions Holter Oximetry represents a new, easy to use, and reliable device for the home diagnosis of obstructive sleep apnea. It can also be used to measure outcomes for the surgical and non-surgical treatment of obstructive sleep apnea in adults and children.

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Cardiorespiratory Polygraphy for Detection of Obstructive Sleep Apnea in Patients With Atrial Fibrillation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.758548 ◽

2021 ◽

Vol 8 ◽

Author(s):

Michiel Delesie ◽

Lieselotte Knaepen ◽

Johan Verbraecken ◽

Karolien Weytjens ◽

Paul Dendale ◽

...

Keyword(s):

Atrial Fibrillation ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Screening Tool ◽

Area Under The Curve ◽

Screening Tools ◽

Apnea Hypopnea Index ◽

Automated Algorithm ◽

Obstructive Sleep ◽

At Home

Background: Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients due to absence of good OSA screening pathways. Polysomnography (PSG) is the gold standard for diagnosing OSA but too resource-intensive as a screening tool. We explored whether cardiorespiratory polygraphy (PG) devices using an automated algorithm for Apnea-Hypopnea Index (AHI) determination can meet the requirements of a good screening tool in AF patients.Methods: This prospective study validated the performance of three PGs [ApneaLink Air (ALA), SOMNOtouch RESP (STR) and SpiderSAS (SpS)] in consecutive AF patients who were referred for PSG evaluation. Patients wore one of the three PGs simultaneously with PSG, and a different PG during each of three consecutive nights at home. Severity of OSA was classified according to the AHI during PSG (<5 = no OSA, 5–14 = mild, 15–30 = moderate, >30 = severe).Results: Of the 100 included AF patients, PSG diagnosed at least moderate in 69% and severe OSA in 33%. Successful PG execution at home was obtained in 79.1, 80.2 and 86.8% of patients with the ALA, STR and SpS, respectively. For the detection of clinically relevant OSA (AHI ≥ 15), an area under the curve of 0.802, 0.772 and 0.803 was calculated for the ALA, STR and SpS, respectively.Conclusions: This study indicates that home-worn PGs with an automated AHI algorithm can be used as OSA screening tools in AF patients. Based on an appropriate AHI cut-off value for each PG, the device can guide referral for definite PSG diagnosis.

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