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European Archives of... Aug 2017The Otorhinolaryngologist (ENT) frequently has to deal with OSA or suspicious OSA patients and undergone polysomnography (PSG) or portable monitoring (PM) and should be...
UNLABELLED
The Otorhinolaryngologist (ENT) frequently has to deal with OSA or suspicious OSA patients and undergone polysomnography (PSG) or portable monitoring (PM) and should be confident about the quality and consistency of the polysomnographic diagnosis. The main polysomnographic traces compressed in a unique epoch, defined as compact PSG/PM (CP), could represent an efficient tool to confirm the quality of PSG/PM Sleep Breathing Disorders diagnosis. This is a validation's study of a CP interpretation's method, analyzing the learning curve, the level of diagnostic accuracy, and the inter-operator agreement in interpreting the CP pattern between a group of ENT specialists not skilled in PSG/PM scoring, but managing SBD patients during daily practice. Seven ENT specialists have been enrolled in the study. 50 CP traces (ranging from normal to all main SBD patterns) have been showed to each participant for the interpretation and scoring process, before and after a 2-h theoretical-practical interactive lesson, focusing on the recognition of the four main oximetric patterns on CP traces (normal, phasic, prolonged, and overlap patterns).
RESULTS
before and after the theoretical-practical interactive lesson, the whole diagnostic accuracy in interpreting the 50 CP has been reported improved from 0.12 to 0.80 (median 0.52) to 0.82-0.96 (median 0.92) (p = 0.006) and the inter-scorers' agreement showed a kappa value increased from of 0.18 to 0.75 (p < 0.0001). A complete clinical diagnostic evaluation is essential in OSA patients and the ENT specialist should be concerned to verify if the patient, suitable for surgical therapy, is affected really by an isolated form of OSA. The CP interpretation allows a checking of the proper nosographic SBD framework and could be significantly important for all ENT specialists not skilled in PSG/PM scoring, but managing SBD patients during daily practice. The data reported in our validation's study showed that the CP interpretation's method is easy to apply, with a rapid learning curve. The level of diagnostic accuracy is high with a high inter-scorer agreement in interpreting the CP patterns.
Topics: Dimensional Measurement Accuracy; Female; Humans; Italy; Learning Curve; Male; Middle Aged; Otolaryngology; Oximetry; Patient Care Management; Point-of-Care Testing; Polysomnography; Sleep Apnea Syndromes; Staff Development
PubMed: 28451755
DOI: 10.1007/s00405-017-4578-8 -
Sleep Feb 2013Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the... (Randomized Controlled Trial)
Randomized Controlled Trial
RATIONALE
Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals.
OBJECTIVES
We performed a multicentric, randomized, blinded crossover study to determine the agreement between home respiratory polygraphy (HRP) and PSG, and between simultaneous respiratory polygraphy (respiratory polygraphy with PSG) (SimultRP) and PSG by means of 2 AHI scoring protocols with or without hyperventilation following flow reduction considered as a surrogate arousal.
METHODS
We included suspected SAHS patients from 8 hospitals. They were assigned to home and hospital protocols at random. We determined the agreement between respiratory polygraphy AHI and PSG AHI scorings using Bland and Altman plots and diagnostic agreement using receiver operating characteristic (ROC) curves. The agreement in therapeutic decisions (continuous positive airway pressure treatment or not) between HRP and PSG scorings was done with likelihood ratios and post-test probability calculations.
RESULTS
Of 366 randomized patients, 342 completed the protocol. AHI from HRP scorings (with and without surrogate arousal) had similar agreement with PSG. AHI from SimultRP with surrogate arousal scoring had better agreement with PSG than AHI from SimultRP without surrogate arousal. HRP with surrogate arousal scoring had slightly worse ROC curves than HRP without surrogate arousal, and the opposite was true for SimultRP scorings. HRP with surrogate arousal showed slightly better agreement with PSG in therapeutic decisions than for HRP without surrogate arousal.
CONCLUSION
Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).
Topics: Adolescent; Adult; Aged; Arousal; Cross-Over Studies; Female; Humans; Male; Middle Aged; Monitoring, Physiologic; Polysomnography; Respiratory Physiological Phenomena; Sleep Apnea Syndromes; Syndrome; Young Adult
PubMed: 23372273
DOI: 10.5665/sleep.2384 -
Archivos de Bronconeumologia Feb 1997The traditional way of diagnosing obstructive sleep apnea syndrome (OSAS) is all-night polysomnographic recording. A proposed alternative is respiratory polygraphy, a...
The traditional way of diagnosing obstructive sleep apnea syndrome (OSAS) is all-night polysomnographic recording. A proposed alternative is respiratory polygraphy, a simplified procedure that consists in nighttime monitoring of oxygen saturation, oronasal flow and respiratory movements. Our aim was to evaluate the efficacy of respiratory polygraphy in diagnosing OSAS in comparison with conventional polysomnography. We studied 101 patients (92 men and 9 women) who had undergone polysomnography. An apnea-hypopnea index (AHI) > or = 10 was considered to be the diagnostic criterion for OSAS. To assess the diagnostic validity of respiratory polygraphy we considered that an AHI per hour of recording > or = 10 and a desaturation index per hour of recording > or = 10 were consistent with a diagnosis of OSAS. Sixty patients were diagnosed of OSAS. The AHI per hour of recording was > or = 10 in 56 patients, with 4 false negatives (sensitivity 93.3% and specificity 100%). The desaturation index per hour of recording was > or = 10 in 65 patients, with 7 false positives and 2 false negatives (sensitivity 96.6% and specificity 82.9%). We conclude that respiratory polysomnography is a specific, highly sensitive method for diagnosing OSAS.
Topics: Female; Humans; Male; Middle Aged; Polysomnography; Reproducibility of Results; Sleep Apnea Syndromes
PubMed: 9091116
DOI: 10.1016/s0300-2896(15)30656-6 -
Acute and Critical Care Nov 2020Before the main trial in which respiratory polygraphy will be used to evaluate postextubation sleep apnea in critically ill patients, we performed a prospective pilot...
BACKGROUND
Before the main trial in which respiratory polygraphy will be used to evaluate postextubation sleep apnea in critically ill patients, we performed a prospective pilot study to ensure that any issues with the conduct of the trial would be identified.
METHODS
In the present study, 13 adult patients who had received mechanical ventilation for ≥24 hours were prospectively recruited. Among the patients, 10 successfully completed respiratory polygraphy on the first or second night after extubation. Data regarding the types and doses of corticosteroids, analgesics, sedatives, and muscle relaxants as well as the methods of oxygen delivery were recorded.
RESULTS
During the night of respiratory polygraphy, all 10 patients received supplemental oxygen (low-flow oxygen, n=5; high-flow oxygen, n=5), and seven patients received intravenous corticosteroids. Three of the 10 patients had a respiratory event index (REI) ≥5/hr. All respiratory events were obstructive episodes. None of the patients receiving high-flow oxygen therapy had an REI ≥5/hr. Two of the seven patients who received corticosteroids and one of the other three patients who did not receive this medication had an REI ≥5/hr. Although low- or high-flow oxygen therapy was provided, all patients had episodes of oxygen saturation (SpO2) <90%. Two of the three patients with an REI ≥5/hr underwent in-laboratory polysomnography. The patients' Apnea-Hypopnea Index and REI obtained via polysomnography and respiratory polygraphy, respectively, were similar.
CONCLUSIONS
In a future trial to evaluate postextubation sleep apnea in critically ill patients, pre-stratification based on the use of corticosteroids and high-flow oxygen therapy should be considered.
PubMed: 33176403
DOI: 10.4266/acc.2020.00479 -
Epileptic Disorders : International... Apr 2018A 56-year-old man with refractory bitemporal epilepsy was monitored in the Epilepsy Monitoring Unit (EMU). In a video-EEG captured seizure, brief oroalimentary...
A 56-year-old man with refractory bitemporal epilepsy was monitored in the Epilepsy Monitoring Unit (EMU). In a video-EEG captured seizure, brief oroalimentary automatisms were followed by increased inspiratory effort, accompanied by prominent, visible tracheal movements and audible inspiratory stridor. The patient's oxygen saturation rapidly declined to 62%; persistent severe hypoxemia ended with spontaneous effective respiration commencing at seizure end. Subsequent seizures necessitated intensive care unit admission for respiratory distress, and ventilator support. This case suggests that ictal laryngospasm, a rare seizure manifestation, may represent another potential mechanism of sudden unexpected death in epilepsy (SUDEP). [Published with video sequence on www.epilepticdisorders.com].
Topics: Death, Sudden; Electroencephalography; Humans; Laryngismus; Male; Middle Aged; Seizures
PubMed: 29620011
DOI: 10.1684/epd.2018.0964 -
Expert Review of Cardiovascular Therapy Feb 2022Sleep-disordered breathing (SDB) is present in 21-74% of all patients with atrial fibrillation (AF). Treatment of SDB by positive airway pressure may help to prevent... (Review)
Review
INTRODUCTION
Sleep-disordered breathing (SDB) is present in 21-74% of all patients with atrial fibrillation (AF). Treatment of SDB by positive airway pressure may help to prevent recurrence of AF after electrical cardioversion and help to improve AF ablation success rates in non-randomized studies.
AREAS COVERED
In this review, the current understanding of the atrial arrhythmogenic pathophysiology of SDB is summarized, and diagnostic and therapeutic challenges in AF patients are discussed. Current international recommendations are presented, and a comprehensive literature search is undertaken.
EXPERT OPINION
AF patients with SDB rarely report SDB-related symptoms such as daytime sleepiness. Therefore, systematic home sleep testing evaluation should be considered for all patients eligible for rhythm control strategy. A close interdisciplinary collaboration between the electrophysiologist/cardiologist, nurses and sleep-specialists are required for the management of SDB in AF patients. An arrhythmia-orientated assessment of SDB may better quantify SDB-related AF risk in an individual patient and may help to better guide targeted and personalized SDB treatment in AF patients as a component of rhythm and symptom control strategies. Finally, randomized controlled trials are needed to confirm the relationship between SDB and AF, and the benefits of routine testing and treatment of SDB in AF patients.
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Polysomnography; Sleep Apnea Syndromes; Translational Research, Biomedical
PubMed: 35094618
DOI: 10.1080/14779072.2022.2036606 -
Sleep Feb 2014Substantial discrepancies exist in the type of sleep studies performed to diagnose pediatric obstructive sleep apnea (OSA) in different countries. Respiratory... (Comparative Study)
Comparative Study
BACKGROUND
Substantial discrepancies exist in the type of sleep studies performed to diagnose pediatric obstructive sleep apnea (OSA) in different countries. Respiratory polygraphic (RP) recordings are primarily performed in sleep laboratories in Europe, whereas polysomnography (PSG) constitutes the majority in the US and Australia. Home RP show consistent apnea-hypopnea index (AHI) underscoring, primarily because the total recording time is used as the denominator when calculating the AHI compared to total sleep time (TST). However, laboratory-based RP are less likely affected, since the presence of sleep technicians and video monitoring may enable more accurate TST estimates. We therefore examined differences in AHI in PSG and in-lab RP, and whether RP-based AHI may impact clinical decision making.
METHODS
Of all the children assessed for possible OSA who underwent PSG evaluation, 100 were identified and divided into 4 groups: (A) those with AHI < 1/h TST (n = 20), (B) 1 ≤ AHI < 5/h TST (n = 40), (C) 5 ≤ AHI < 10/h TST (n = 20), and (D) AHI ≥ 10/h TST (n = 20). Electroencephalography, electrooculography, and electromyography channels were deleted from the original unscored recordings to transform them into RP, and then rescored in random sequence. AHI-RP were compared to AHI-PSG, and therapeutic decisions based on AHI-RP and AHI-PSG were formulated and analyzed using clinical details derived from the patient's clinic letter.
RESULTS
Bland Altman analysis showed that in lab RP underestimated the AHI despite more accurate estimates of TST. This underestimation was due to missed hypopneas causing arousals without desaturation. Basing the therapeutic management decision on RP instead of PSG results changed the clinical management in 23% of all patients. The clinical management for patients in groups A and D was unaffected. However, 27.5% of patients in group B would have been given no treatment, as they would be diagnosed as having no OSA (AHI < 1/h TST) when they should have received a trial of anti-inflammatory therapy or been referred for ear, nose, and throat (ENT) review. Sixty percent of patients in group C would have received either a trial of medical treatment to treat mild OSA or no treatment, instead of referral to ENT services or commencement of continuous positive airway pressure.
CONCLUSION
Apnea-hypopnea index (AHI) is underestimated in respiratory polygraphy (RP), and the disparity in AHI-RP and AHI-polysomnography can significantly affect clinical management decisions, particularly in children with mild and moderate obstructive sleep apnea (1 < AHI < 10/h total sleep time).
Topics: Adolescent; Arousal; Child; Child, Preschool; Electroencephalography; Electromyography; Electrooculography; Female; Humans; Male; Pediatrics; Polysomnography; Sleep Apnea, Obstructive
PubMed: 24497654
DOI: 10.5665/sleep.3392 -
Tidsskrift For Den Norske Laegeforening... Jan 2013Sleeping problems are very common, and many patients need a comprehensive assessment with polysomnography, possibly followed by a sleep latency test. These methods and... (Review)
Review
BACKGROUND
Sleeping problems are very common, and many patients need a comprehensive assessment with polysomnography, possibly followed by a sleep latency test. These methods and indications for the tests are described below.
METHOD
The article is based on the authors' own literature archives, clinical experience and Retningslinjer for metoder i klinisk neurofysiologi [Guidelines for methodology in clinical neurophysiology]
RESULTS
Polysomnography involves monitoring sleep through the course of one night and scoring the stages of sleep on the basis of EEG activity, eye movements and muscular tension. Also recorded are inter alia respiratory variables. Polysomnography followed by a multiple sleep latency test (MSLT) is used when narcolepsy or excessive daytime sleepiness is suspected. If parasomnia is suspected, the examination should include polysomnography, preferably with video recording. If sleep apnoea is suspected in adults, respiratory polygraphy is often sufficient. As a rule, polysomnography is preferable to respiratory polygraphy for studying sleep disorders in children.
INTERPRETATION
Sleep disorders take many forms and are dealt with by many different specialities. Good cooperation between the different specialities is necessary to ensure an optimal result for the patients.
Topics: Humans; Polysomnography; Sleep; Sleep Wake Disorders
PubMed: 23306997
DOI: 10.4045/tidsskr.12.0172 -
Journal of Sleep Research Apr 2019Polysomnography (PSG) is necessary for the accurate estimation of total sleep time (TST) and the calculation of the apnea-hypopnea index (AHI). In type III home sleep...
Polysomnography (PSG) is necessary for the accurate estimation of total sleep time (TST) and the calculation of the apnea-hypopnea index (AHI). In type III home sleep apnea testing (HSAT), TST is overestimated because of the lack of electrophysiological sleep recordings. The aim of this study was to evaluate the accuracy and reliability of a novel automated sleep/wake scoring algorithm combining a single electroencephalogram (EEG) channel with actimetry and HSAT signals. The study included 160 patients investigated by PSG for suspected obstructive sleep apnea (OSA). Each PSG was recorded and scored manually using American Academy of Sleep Medicine (AASM) rules. The automatic sleep/wake-scoring algorithm was based on a single-channel EEG (FP2-A1) and the variability analysis of HSAT signals (airflow, snoring, actimetry, light and respiratory inductive plethysmography). Optimal detection thresholds were derived for each signal using a training set. Automatic and manual scorings were then compared epoch by epoch considering two states (sleep and wake). Cohen's kappa coefficient between the manual scoring and the proposed automatic algorithm was substantial, 0.74 ± 0.18, in separating wakefulness and sleep. The sensitivity, specificity and the positive and negative predictive values for the detection of wakefulness were 76.51% ± 21.67%, 95.48% ± 5.27%, 81.84% ± 15.42% and 93.85% ± 6.23% respectively. Compared with HSAT signals alone, AHI increased by 22.12% and 27 patients changed categories of OSA severity with the automatic sleep/wake-scoring algorithm. Automatic sleep/wake detection using a single-channel EEG combined with HSAT signals was a reliable method for TST estimation and improved AHI calculation compared with HSAT.
Topics: Adult; Aged; Aged, 80 and over; Electroencephalography; Female; Humans; Male; Middle Aged; Polysomnography; Reproducibility of Results; Sleep; Sleep Apnea, Obstructive; Wakefulness
PubMed: 30478923
DOI: 10.1111/jsr.12795 -
Archives de Pediatrie : Organe Officiel... Feb 2017The French Society of Research and Sleep Medicine (SFRMS) organized a meeting on obstructive sleep apnea syndrome (OSAS) in children. A multidisciplinary group of...
The French Society of Research and Sleep Medicine (SFRMS) organized a meeting on obstructive sleep apnea syndrome (OSAS) in children. A multidisciplinary group of specialists (pulmonologists, ENT surgeons, pediatricians, neurophysiologists, sleep specialists) drew up a consensus document on the value of electrophysiological recordings in the diagnosis of OSAS in children. Technical considerations and recommended sensors, respiratory event definitions, and scoring criteria are presented according to the 2012 and 2014 recommendations of the American Academy of Sleep Medicine (AASM). Polysomnographic criteria for sleep-disordered breathing in children and the French National Authority for Health guidelines for indications of polysomnographic studies were reported. Relevance and limits of in-lab PSG, home PSG, and respiratory polygraphy were presented and guidelines were proposed to improve the diagnosis and follow-up of these children.
Topics: Child; Humans; Polysomnography; Respiratory Function Tests; Sleep Apnea, Obstructive
PubMed: 27793516
DOI: 10.1016/j.arcped.2016.09.050