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Journal of Clinical Sleep Medicine :... Apr 2022The objective of this meta-analysis was to analyze agreement in apnea-hypopnea index (AHI) determination between peripheral arterial tonometry (PAT) and polysomnography... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVES
The objective of this meta-analysis was to analyze agreement in apnea-hypopnea index (AHI) determination between peripheral arterial tonometry (PAT) and polysomnography (PSG) studies.
METHODS
Mean AHI bias and standard deviation extracted from Bland-Altman plots reported in studies were pooled in a meta-analysis, which was then used to calculate percentage errors of limit agreement in AHI determination by PAT using PSG AHI as the reference. Individual participant data (where reported in studies) were used to compute Cohen's kappa to assess agreement between PSG and PAT on sleep apnea severity and for computing the sensitivity and specificity of PAT at different AHI thresholds using PSG AHI as the reference.
RESULTS
From 17 studies and 1,318 participants (all underwent simultaneous PSG and use of the WatchPAT device), a pooled mean AHI bias of 0.30 (standard error [SE], 0.74) and a WatchPAT AHI percentage error of 230% was calculated. The meta-analysis of Cohen's kappa for agreement between PSG and WatchPAT studies for classifying patients with no sleep apnea, mild, moderate, or severe sleep apnea severity was 0.45 (SE, 0.06), 0.29 (SE, 0.05), 0.25 (SE, 0.07), and 0.64 (SE, 0.05), respectively. At AHI thresholds of 5, 15 and 30 events/h, WatchPAT studies showed pooled sensitivities and specificities of 94.11% and 43.47%, 92.21% and 72.39%, and 74.11% and 87.10%, respectively. Likelihood ratios were not significant at any AHI threshold.
CONCLUSIONS
The results of this meta-analysis suggest clinically significant discordance between WatchPAT and PSG measurements of AHI, significant sleep apnea severity misclassification by PAT studies, and poor diagnostic test performance.
CITATION
Iftikhar IH, Finch CE, Shah AS, Augunstein CA, Ioachimescu OC. A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies. 2022;18(4):1093-1102.
Topics: Diagnostic Tests, Routine; Humans; Manometry; Polysomnography; Sensitivity and Specificity; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34879903
DOI: 10.5664/jcsm.9808 -
Current Gastroenterology Reports Aug 2020In the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the... (Review)
Review
PURPOSE OF REVIEW
In the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the cause of symptoms, identify pathology and guide effective management. One of the most notable recent advances in the field of oesophageal function has been high-resolution manometry (HRM). This review explores how innovation in HRM has progressed and has far from reached a plateau.
RECENT FINDINGS
HRM technology, methodology and utility continue to evolve; simple additions to the swallow protocol (e.g. eating and drinking), shifting position, targeting symptoms and adding impedance sensors to the HRM catheter have led to improved diagnoses, therapeutic decision-making and outcomes. Progress in HRM persists and shows little sign of abating. The next iteration of the Chicago Classification of motor disorders will highlight these advances and will also identify opportunities for further research and innovation.
Topics: Deglutition; Electric Impedance; Esophageal Motility Disorders; Humans; Manometry; Patient Positioning
PubMed: 32767186
DOI: 10.1007/s11894-020-00787-x -
Medical Engineering & Physics May 2023Non-invasive surface recording devices used for detecting swallowing events include electromyography (EMG), sound, and bioimpedance. However, to our knowledge there are...
OBJECTIVES
Non-invasive surface recording devices used for detecting swallowing events include electromyography (EMG), sound, and bioimpedance. However, to our knowledge there are no comparative studies in which these waveforms were recorded simultaneously. We assessed the accuracy and efficiency of high-resolution manometry (HRM) topography, EMG, sound, and bioimpedance waveforms, for identifying swallowing events.
METHODS
Six participants randomly performed saliva swallow or vocalization of "ah" 62 times. Pharyngeal pressure data were obtained using an HRM catheter. EMG, sound, and bioimpedance data were recorded using surface devices on the neck. Six examiners independently judged whether the four measurement tools indicated a saliva swallow or vocalization. Statistical analyses included the Cochrane's Q test with Bonferroni correction and the Fleiss' kappa coefficient.
RESULTS
Classification accuracy was significantly different between the four measurement methods (P < 0.001). The highest classification accuracy was for HRM topography (>99%), followed by sound and bioimpedance waveforms (98%), then EMG waveform (97%). The Fleiss' kappa value was highest for HRM topography, followed by bioimpedance, sound, and then EMG waveforms. Classification accuracy of the EMG waveform showed the greatest difference between certified otorhinolaryngologists (experienced examiners) and non-physicians (naive examiners).
CONCLUSION
HRM, EMG, sound, and bioimpedance have fairly reliable discrimination capabilities for swallowing and non-swallowing events. User experience with EMG may increase identification and interrater reliability. Non-invasive sound, bioimpedance, and EMG are potential methods for counting swallowing events in screening for dysphagia, although further study is needed.
Topics: Humans; Electromyography; Reproducibility of Results; Deglutition; Manometry; Deglutition Disorders
PubMed: 37120175
DOI: 10.1016/j.medengphy.2023.103980 -
Critical Care (London, England) Jan 2021
Topics: Esophagus; Humans; Manometry; Positive-Pressure Respiration; Respiration, Artificial
PubMed: 33402179
DOI: 10.1186/s13054-020-03453-w -
PloS One 2020There is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system... (Comparative Study)
Comparative Study Observational Study
There is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed "digital manometry") and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were -7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, -37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and -20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.
Topics: Adult; Aged; Aged, 80 and over; Anal Canal; Constipation; Cross-Sectional Studies; Electromyography; Fecal Incontinence; Female; Healthy Volunteers; Humans; Male; Manometry; Middle Aged; Pelvic Floor; Pressure; Rectum; Wearable Electronic Devices
PubMed: 32991595
DOI: 10.1371/journal.pone.0228761 -
Neurogastroenterology and Motility Nov 2022The functional lumen imaging probe (Endoflip™) is increasingly used for evaluation of patients with esophageal symptoms. To improve the interpretation of Endoflip™... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The functional lumen imaging probe (Endoflip™) is increasingly used for evaluation of patients with esophageal symptoms. To improve the interpretation of Endoflip™ in clinical practice, normative values with appropriate cut-off values are required.
METHODS
Original clinical studies describing Endoflip™ use for measurements of esophageal motility in healthy adults were considered. Meta-analysis was performed based on published values.
RESULTS
A total of 17 articles were included in the systematic review, 15 of which were included in the meta-analysis, representing 154 unique subjects. At 40 ml distention, the 5th-95th and 10th-90th percentiles for esophagogastric junction distensibility index (EGJ-DI) were 1.96-10.95 mm /mmHg and 2.36-8.95 mm /mmHg, respectively. An EGJ-DI below 2 mm /mmHg was found in 5.4%, and below 3 mm /mmHg in 20.1% of healthy subjects. At 50 ml distention, the 5th-95th and 10th-90th percentiles for EGJ-DI are 2.86-10.66 mm /mmHg and 3.28-9.12 mm /mmHg, respectively (below 2 mm /mmHg: 0.6%, 3 mm /mmHg: 6.3%). The 5th-95th and 10th-90th percentiles for EGJ-DI at 60 ml distention were 3.06-8.14 mm /mmHg and 3.33-7.18 mm /mmHg, respectively (below 2 mm /mmHg: 0.0%, 3 mm /mmHg: 7%). A clear cut-off for lower values was identified while a large spread in values was observed for upper limits of normal for EGJ-DI for all filling volumes.
CONCLUSIONS
Given these observations, we recommend using a cut-off of 2 mm /mmHg for clinical practice, values below can be considered abnormal. Given that 5.4% of the healthy subjects will have an EGJ-DI below 2 mm /mmHg at 40 ml, we recommend using the 50 and 60 ml distention volumes. The clinical use of an upper limit for normality of EGJ-DI seems questionable.
Topics: Adult; Diagnostic Imaging; Esophageal Achalasia; Esophagogastric Junction; Healthy Volunteers; Humans; Manometry
PubMed: 35665566
DOI: 10.1111/nmo.14419 -
Annals of the Academy of Medicine,... Aug 2021We aimed to provide a practical and evidence-based guide on the indications, performance and reporting of high-resolution oesophageal manometry (HRM) and ambulatory pH...
INTRODUCTION
We aimed to provide a practical and evidence-based guide on the indications, performance and reporting of high-resolution oesophageal manometry (HRM) and ambulatory pH monitoring (PHM) in adult patients in Singapore.
METHODS
The guideline committee comprised local gastroenterologists from public and private sectors with particular expertise in aspects of HRM and PHM, and it was tasked to produce evidence-based statements on the indications, performance and reporting of these tests. Each committee member performed literature searches to retrieve relevant articles within the context of domains to which they were assigned.
RESULTS
Twelve recommendation statements were created and summarised.
CONCLUSION
Standardising key aspects of HRM and PHM is imperative to ensure the delivery of high-quality care. We reported the development of recommendations for the performance and interpretation of HRM and ambulatory reflux monitoring in Singapore.
Topics: Adult; Esophageal pH Monitoring; Esophagus; Humans; Hydrogen-Ion Concentration; Manometry; Singapore
PubMed: 34472558
DOI: 10.47102/annals-acadmedsg.2020623 -
Clinical and Translational... May 2022Biofeedback therapy (BFT) is a well-known treatment for functional anorectal disorders. The effect of BFT was monitored in fecal incontinence (FI) patients with the...
INTRODUCTION
Biofeedback therapy (BFT) is a well-known treatment for functional anorectal disorders. The effect of BFT was monitored in fecal incontinence (FI) patients with the Fecobionics test and with the conventional technologies, anorectal manometry (ARM) and balloon expulsion test (BET).
METHODS
Studies were performed in 12 patients before and after 8 weeks of biofeedback training. The Fecal Incontinence Severity Index (FISI) score was obtained. Anal resting and squeeze pressures were measured before the bag was distended in the rectum until urge to defecate. Pressure recordings were made during Fecobionics evacuation.
RESULTS
BFT resulted in 24% reduction in FISI scores (P < 0.01). Seven patients were characterized as responders. Anal pressures, the urge-to-defecate volume, and defecatory parameters did not change significantly during BFT. For ARM-BET, the maximum anal squeeze pressure, the urge-to-defecate volume, and the expulsion time were lower after BFT compared with those before BFT (P < 0.05). For Fecobionics, the change in urge volume (r = 0.74, P < 0.05) and the change in defecation index (r = 0.79, P < 0.01) were associated with the change in FISI score. None of the ARM-BET parameters were associated with the change in FISI score. It was studied whether any pre-BFT data could predict treatment success. The Fecobionics expulsion duration and the defecation index predicted the outcome (P < 0.05). The defecation index had a sensitivity of 100% and a specificity of 72%. None of the ARM-BET parameters predicted the outcome (all P > 0.2).
DISCUSSION
Fecobionics was used as a tool to monitor the effect of BFT and proved better than conventional technologies for monitoring and predicting the outcome in the FISI score.
Topics: Biofeedback, Psychology; Defecation; Fecal Incontinence; Humans; Manometry; Severity of Illness Index
PubMed: 35363631
DOI: 10.14309/ctg.0000000000000491 -
Neurogastroenterology and Motility Jun 2021The equipment and methods for performing anorectal manometry and biofeedback therapy are different and not standardized. Normal values are influenced by age and sex. Our...
BACKGROUND
The equipment and methods for performing anorectal manometry and biofeedback therapy are different and not standardized. Normal values are influenced by age and sex. Our aims were to generate reference values, examine effects of gender and age, and compare anorectal pressures measured with diagnostic and biofeedback catheters and a portable manometry system.
METHODS
In this multicenter study, anorectal pressures at rest, during squeeze, and evacuation were measured with diagnostic and biofeedback catheters using Mcompass portable device in healthy subjects. Balloon expulsion time and rectal sensation were evaluated. The effects of age and gender were assessed.
RESULTS
The final dataset comprised 108 (74 women) of 124 participants with normal rectal balloon expulsion time (less than 60 s). During squeeze, anal resting pressure increased by approximately twofold in women and threefold in men. During evacuation, anal pressure exceeded rectal pressure in 87 participants (diagnostic catheter). The specific rectoanal pressures (e.g., resting pressure) were significantly correlated and not different between diagnostic and biofeedback catheters. With the diagnostic catheter, the anal squeeze pressure and rectal pressure during evacuation were greater in men than women (p ≤ 0.02). Among women, women aged 50 years and older had lower anal resting pressure; rectal pressure and the rectoanal gradient during evacuation were greater in older than younger women (p ≤ 0.01).
CONCLUSIONS
Anal and rectal pressures measured with diagnostic and biofeedback manometry catheters were correlated and not significantly different. Pressures were influenced by age and sex, providing reference values in men and women.
Topics: Adult; Aged; Aging; Anal Canal; Biofeedback, Psychology; Catheters; Fecal Incontinence; Female; Healthy Volunteers; Humans; Male; Manometry; Middle Aged; Pressure; Rectum; Reference Values; Sensation; Sex Characteristics; Young Adult
PubMed: 33462889
DOI: 10.1111/nmo.14067 -
Clinical Gastroenterology and... Jun 2015High-definition anorectal manometry (HDAM-3D) provides a topographic and 3-dimensional profile of anorectal pressure. We assessed anorectal sensorimotor function and the...
BACKGROUND & AIMS
High-definition anorectal manometry (HDAM-3D) provides a topographic and 3-dimensional profile of anorectal pressure. We assessed anorectal sensorimotor function and the reproducibility of measurements made with HDAM-3D in healthy adults, and the accuracy of data analysis by its software.
METHODS
Anal sphincter pressures and rectal sensory thresholds were measured in 78 healthy subjects via placement of a 10-mm rigid probe, with 256 circumferentially arrayed pressure sensors, and a balloon in the rectum. The bearing down maneuver was assessed in a subset of 18 subjects. We compared data analyzed by an expert with findings from automated software analysis. Measurements made in a subset of 16 subjects, 2 weeks apart, were compared to determine reproducibility.
RESULTS
Resting, squeezing, and sustained squeezing pressures were significantly higher in men than in women (P < .05); other parameters were similar. Desire and urgency to defecate were similar between men and women, but the maximal tolerable volume was significantly lower in women (P < .05). Older women (>50 years) had significantly lower resting (P < .01) and sustained squeeze pressures (P < .04). Dyssynergic patterns of defecation were observed in 12 of 18 subjects (67%) who attempted to defecate without the 60-mL rectal balloon distention and in 6 of 18 subjects (33%) with the 60-mL rectal balloon distention. Test-retest values correlated (r = 0.81), as did analyses made by an expert vs software analyses of data (r = 0.99).
CONCLUSIONS
On the basis of HDAM-3D measurements in healthy adults, anal sphincter pressures are higher in men than in women, but sensory and other parameters are similar; older subjects have weaker sphincters. Many people were found to have dyssynergic patterns of defecation, which could be related to the probe or other technical issues, so this technique may not be suitable for assessing defecation patterns. Measurements made by HDAM-3D are reproducible, and data can be accurately analyzed by its software.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anal Canal; Data Interpretation, Statistical; Female; Healthy Volunteers; Humans; Male; Manometry; Middle Aged; Pressure; Reproducibility of Results; Software; Young Adult
PubMed: 25616028
DOI: 10.1016/j.cgh.2014.12.034