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

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.

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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.

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.3473 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Chen ◽

W Wang ◽

Y Guo ◽

H Zhang ◽

Y Chen ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sensitivity And Specificity ◽

Large Scale ◽

Final Analysis ◽

Smart Devices ◽

Smart Device ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Significant Difference

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

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474 Phenotyping of patients with Moderate to Severe OSA on Polysomnography after Negative Home Sleep Apnea Testing

SLEEP ◽

10.1093/sleep/zsab072.473 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A187-A187

Author(s):

Sarah Sarfraz ◽

Lindsay McCullough ◽

Henry Arantes ◽

Alejandra Lastra

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Flow Time ◽

Apnea Hypopnea Index ◽

Apnea Test ◽

Recording Time ◽

Time Flow ◽

Obstructive Sleep ◽

Severe Sleep Apnea ◽

Apnea Testing

Abstract Introduction Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnea (OSA). Given cost, insurance restrictions and in some cases limited access to sleep center testing, the use of home based sleep apnea testing is becoming increasingly more common. A proportion of patients with technically adequate HSAT who are negative end up having significant disease on PSG. The characteristics of patients who are found to have moderate to severe sleep apnea on polysomnogram (PSG) after a negative home sleep apnea test (HSAT) are not known. We aim to phenotype these patients. Methods We conducted a retrospective chart review from March 2018 to February 2020. A total of 953 adult patients (18 years old and older) underwent HSAT, 248 tests resulted negative (apnea-hypopnea index <5/h). Out of the negative HSAT, 17 patients had moderate to severe obstructive sleep apnea on PSG. Those were included for analysis. Data on patient characteristics such as age, body mass index (BMI), gender, STOP-BANG, ESS and comorbidities was gathered. Respiratory disturbance index, recording time, flow time, oximetry time on HSAT was recorded. PSG recording time, baseline AHI, supine AHI and non-supine AHI were also noted. Technically inadequate HSAT were excluded from analysis. Results The percentage of patients with negative HSAT who were found to have moderate to severe sleep apnea on PSG and were included for analysis was 6.85% (n17). Mean age was 41 years. Mean BMI was 33 kg/m2. Common comorbidities were hypertension (29%), asthma (17.6 %), depression (17.6%), anxiety (11.7%) and reflux (5.9%). Average ESS was 11.7 and STOP-BANG was 3.8. The mean recording time was 477 minutes, flow time 391 minutes and oximetry time was 426 minutes on HSAT. Average PSG recording time was 433 minutes. Average AHI was 24 with supine being 33.2/h and non-supine 17.9/h. Conclusion A proportion of patients with negative HSAT have moderate to severe OSA on follow-up polysomnogram. These patients were young, with lower-class obesity, more positional OSA, and no associated complex comorbidities. Re-evaluation of current diagnostic algorithms and further research is needed to phenotype this at-risk group, as first-line PSG may be more cost-effective and efficient. Support (if any):

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0610 Prevalence of Positional Obstructive Sleep Apnea Based on 3% Vs 4% Oxygen Desaturation Using Home Sleep Apnea Testing

SLEEP ◽

10.1093/sleep/zsaa056.607 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A233-A234

Author(s):

M Mandal ◽

R Rengan ◽

S Rani ◽

J Ramzy ◽

M Vega Sanchez ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Oxygen Desaturation ◽

Apnea Hypopnea Index ◽

Apnea Test ◽

Positional Obstructive Sleep Apnea ◽

Obstructive Sleep ◽

Respiratory Event ◽

Home Sleep Apnea Testing ◽

Definition Of

Abstract Introduction Approximately 30% of patient with obstructive sleep apnea (OSA) have positional OSA [non-supine apnea-hypopnea index (AHI) < 5 events/hr]. However, the prevalence is based on variable definitions for hypopneas related to the degree of oxygen desaturation. In addition, use of a home sleep apnea test (HSAT) to identify positional OSA is limited. We hypothesized that in patients evaluated with an HSAT, using a definition for hypopneas based on 4% compared to 3% oxygen desaturation will significantly decrease the percentage diagnosed with positional OSA. Methods Fourteen patients with positional OSA based on a non-supine respiratory event index (REI) < 5 events/hr were included. The initial diagnosis was determined based on a hypopnea definition of ≥ 3% oxygen desaturation. The studies were reanalyzed using a hypopnea definition of ≥ 4% oxygen desaturation. Results Fourteen patients [9 (64%) males, 46±14 yrs, BMI 31±6 kg/m2, ESS 7±5, REI 9±3 events/hr, mean SaO2 94±2%, lowest SaO2 81±6%, %TST SaO2 < 90% 4±6%] were identified with positional OSA (supine REI 16±7 events/hr, non-supine REI 3±1 events/hr) using a hypopneas definition of ≥ 3% oxygen desaturation. When reanalyzed using a hypopnea ≥ 4% oxygen desaturation there was a significant decrease in the REI to 7±2 events/hr (p<0.001). Three patients (21%) no longer were considered to have OSA. These patients were younger (32±14 vs. 50±11yrs, p=0.03) and had less severe OSA (REI 6±1 vs. 9±3 events/hr (p=0.04), but there was no difference in BMI (32±11 vs. 31±5 kg/m2, p=0.9) or mean and lowest SaO2 (96±0.4 vs. 94±2%, p=0.13, and 82±8 vs. 81±6%, p=0.9, respectively). Conclusion In patients with mild positional OSA, using a hypopnea definition of at least 4% vs. 3% oxygen desaturation on a HSAT will have a significant effect on the overall REI and often exclude patients who would otherwise be treated for OSA. Support None.

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0567 Hypoxic Burden and Apnea-Hypopnea Duration in Patients with Positional Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsaa056.564 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A217-A218

Author(s):

J A Ramzy ◽

R Rengan ◽

M Mandal ◽

S Rani ◽

M E Vega Sanchez ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Total Sleep Time ◽

Sleep Time ◽

Apnea Hypopnea Index ◽

Apnea Test ◽

Positional Obstructive Sleep Apnea ◽

Obstructive Sleep ◽

Respiratory Event ◽

The Mean

Abstract Introduction Recently, the measurement of the hypoxic burden and apnea-hypopnea duration has been shown to correlate with mortality in patients with obstructive sleep apnea (OSA). We hypothesized that in patients with mild positional OSA (apnea-hypopnea index [AHI] < 5 events/hr in the non-supine position) the hypoxic burden would be increased and apnea-hypopnea duration shortened and similar to patients with non-positional OSA. Methods Fourteen patients with positional OSA and 24 patients non-positional OSA with similar severity of OSA based on the respiratory event index (REI) were included. All patients had a home sleep apnea test for suspected OSA. The hypoxic burden was calculated by the multiplication of REI and the mean area under the desaturation curves. Results Thirty-eight patients [12 (35%) males, 50±12 yrs, BMI 35±7 kg/m2, Epworth Sleepiness Scale (ESS) 11±8, REI 10±3 events/hr, apnea-hypopnea duration 19±4 sec, mean SaO2 94±2%, lowest SaO2 79±8%, % total sleep time (TST) SaO2 < 90% 11±16%, hypoxic burden 30±17 %min/hr] completed the study. Fourteen patients [9 (64%) males, 46±14 yrs, BMI 31±6 kg/m2, ESS 7±5, REI 9±3 events/hr, mean SaO2 94±2%, lowest SaO2 81±6%, %TST SaO2 < 90% 4±6%] had positional OSA (supine REI 16±7 events/hr, non-supine REI 3±1 events/hr) and 24 patients had non-positional OSA [3 (13%) males, 52±10 yrs, BMI 38±7 kg/m2, ESS 12±9, REI 10±3 events/hr, mean SaO2 94±2%, lowest SaO2 77±9%, %TST SaO2 < 90% 14±19%]. The hypoxic burden was elevated in both the positional and non-positional OSA patients with no difference between the groups (26±19 %min/hr and 32±15 %min/hr, respectively, p=0.13). The apnea-hypopnea duration was similar in positional and non-positional OSA patients (20±3 sec and 18±4 sec, respectively, p=0.08 sec). Conclusion In patients with mild positional OSA the hypoxic burden, which has been associated with cardiovascular mortality, is elevated and similar to patients with non-positional OSA. Support None

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Design and Evaluation of a Non-Contact Bed-Mounted Sensing Device for Automated In-Home Detection of Obstructive Sleep Apnea: A Pilot Study

Biosensors ◽

10.3390/bios9030090 ◽

2019 ◽

Vol 9 (3) ◽

pp. 90 ◽

Cited By ~ 2

Author(s):

Mosquera-Lopez ◽

Leitschuh ◽

Condon ◽

Hagen ◽

Rajhbeharrysingh ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Pilot Study ◽

Pressure Sensors ◽

Diagnostic System ◽

High Sensitivity ◽

Apnea Hypopnea Index ◽

P Value ◽

Apnea Test ◽

Obstructive Sleep

We conducted a pilot study to evaluate the accuracy of a custom built non-contactpressure-sensitive device in diagnosing obstructive sleep apnea (OSA) severity as an alternative toin-laboratory polysomnography (PSG) and a Type 3 in-home sleep apnea test (HSAT). Fourteenpatients completed PSG sleep studies for one night with simultaneous recording from ourload-cell-based sensing device in the bed. Subjects subsequently installed pressure sensors in theirbed at home and recorded signals for up to four nights. Machine learning models were optimized toclassify sleep apnea severity using a standardized American Academy of Sleep Medicine (AASM)scoring of the gold standard studies as reference. On a per-night basis, our model reached a correctOSA detection rate of 82.9% (sensitivity = 88.9%, specificity = 76.5%), and OSA severity classificationaccuracy of 74.3% (61.5% and 81.8% correctly classified in-clinic and in-home tests, respectively).There was no difference in Apnea Hypopnea Index (AHI) estimation when subjects wore HSATsensors versus load cells (LCs) only (p-value = 0.62). Our in-home diagnostic system providesan unobtrusive method for detecting OSA with high sensitivity and may potentially be used forlong-term monitoring of breathing during sleep. Further research is needed to address the lowerspecificity resulting from using the highest AHI from repeated samples.

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Effect of arterial blood bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea

10.21203/rs.3.rs-770372/v1 ◽

2021 ◽

Author(s):

Chong Pei ◽

Shuyu Gui

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sensitivity And Specificity ◽

Statistical Significance ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Arterial Blood ◽

Obstructive Sleep

Abstract Background To evaluate the effect of arterial bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire (SBQ) screening for obstructive sleep apnea (OSA). Methods A total of 144 patients with suspected OSA were included. Polysomnograms (PSG) and blood gas analysis were performed, and the Epworth Sleepiness Scale (ESS), STOP-Bang questionnaire, and Berlin questionnaire were completed. The correlation between the arterial HCO3− concentration, apnea hypopnea index (AHI), and other related indicators was analyzed. The scoring results of the ESS, SBQ, and Berlin questionnaire were compared with the PSG results, and the sensitivity and specificity were calculated in the form of a four-cell table. The changes in the sensitivity and specificity of OSA screening after SBQ alone and combined with HCO3− concentration were compared, and ROC curves were drawn. Results Arterial HCO3− concentration was positively correlated with AHI (r = 0.537, P < 0.001). The ratio of HCO3− concentration ≥ 24.6 mmol/L in the non-OSA group was significantly lower than that in the OSA group (25.0% VS 80.8%, P < 0.001). The sensitivity of the SBQ was higher than that of the ESS (97.5% VS 81.7%, P < 0.001) and the Berlin questionnaire (97.5% VS 79.2%, P < 0.001). There was no statistical significance in the specificity of the three scales (25%, 37.5%, 37.5%). A combined SBQ score ≥ 3 and HCO3− concentration ≥ 24.6 mmol/L showed increased specificity and decreased sensitivity compared with an SBQ score ≥ 3 alone, with a corresponding AUC of 0.771 (P < 0.01) and 0.613 (P > 0.05), respectively. Conclusion The sensitivity of the SBQ was better than that of the Berlin questionnaire and ESS. After combining arterial blood HCO3− concentration, the SBQ questionnaire increased the specificity of OSA prediction and decreased the sensitivity, which improved the accuracy of screening.

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Are Sleep Questionnaires Valid in All Adult Age Groups as Screening Tools for Obstructive Sleep Apnea?

Journal of Rhinology ◽

10.18787/jr.2018.00278 ◽

2020 ◽

Vol 27 (2) ◽

pp. 90-94

Author(s):

Ho Min Lee ◽

Jae Ki Kim ◽

Jung Gwon Nam ◽

Tae-Hoon Lee

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sensitivity And Specificity ◽

Age Groups ◽

Area Under The Curve ◽

Screening Tools ◽

Apnea Hypopnea Index ◽

Adult Age ◽

Age Related ◽

Obstructive Sleep

Background and Objectives: Evaluation of Epworth Sleepiness Scale (ESS), Berlin, STOP, and STOP-Bang questionnaire validities for obstructive sleep apnea (OSA) screening among various adult age groups.Materials and Method: Results for each of those questionnaires were compared with diagnostic overnight polysomnography (PSG) data obtained for 396 patients suffering either insomnia, sleep apnea, excessive daytime sleepiness, or chronic snoring who had been divided into three age groups (20-39, 40-59, or ≥60 years). For each questionnaire, the sensitivity, specificity, accuracy, and area under the curve (AUC) were calculated.Results: Among the OSA group [apnea hypopnea index (AHI) cutoff ＞5], Berlin and STOP questionnaire sensitivity and specificity were significantly different among the age groups. Among the moderate-to-severe OSA sub-group (AHI cutoff ＞15), the specificity of Berlin, STOP, and STOP-Bang questionnaire was significantly different among age groups.Conclusion: The Berlin and STOP questionnaires differed with patient age in OSA screening. The ESS questionnaire, by contrast, did not show any age-related differences of sensitivity and specificity in OSA screening or moderate-to-severe OSA screening.

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Effect of arterial blood bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01720-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chong Pei ◽

Shuyu Gui

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sensitivity And Specificity ◽

Statistical Significance ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Arterial Blood ◽

Obstructive Sleep

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Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.08.10650 ◽

2020 ◽

Vol 103 (8) ◽

pp. 725-728

Keyword(s):

Bariatric Surgery ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Lifestyle Modification ◽

Apnea Hypopnea Index ◽

Morbidly Obese ◽

Obese Patients ◽

Obstructive Sleep ◽

Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

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