Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study aimed to assess the accuracy of a wrist-worn device based on peripheral arterial tonometry (Watch_PAT 100) to detect residual episodes of respiratory disturbance during continuous positive airway pressure (CPAP) therapy. Concurrent polysomnography was used as the reference standard to identify sleep disordered breathing (SDB) events. The study was conducted in three sleep laboratories affiliated with tertiary care academic medical centers. Seventy patients using CPAP to treat obstructive sleep apnea for at least 3 months, following an in-laboratory titration to determine the optimal therapeutic positive airway pressure, participated in this study. Symptoms indicating suboptimal therapy were not required for participation, but self-reported adherence to CPAP therapy was necessary for inclusion. Interventions are not applicable in this study. The accuracy of the PAT-derived respiratory disturbance index (PAT RDI scored by automated algorithm) to detect residual SDB on CPAP was assessed against polysomnography (PSG) using Bland-Altman analysis, receiver-operator characteristic (ROC) curves, and likelihood ratios for increasing (LR+) and decreasing (LR-) the probability of moderate-severe SDB in the study population. Respiratory events on the PSG were quantified using standard criteria for research investigations ("Chicago criteria") to yield a PSG RDI.C. Based on the PSG results, 19% of the participants had moderate-severe SDB (PSG RDI.C>15 events per hour) on their prescribed pressure. For PAT RDI >15 events per hour, the area under the ROC curve was 0.95 (SE 0.03, p < 0.0001, 95% CI 0.89 to 1.00), the LR+ was 8.04 (95% CI 3.64-17.7), and the LR- was 0.17 (95% CI 0.05-0.62). The mean difference between the PAT RDI and PSG RDI.C was three (2SD 14.5) events per hour. Therefore, residual moderate-severe SDB on CPAP was not uncommon in a multicenter population self-reporting adherence to CPAP therapy to treat obstructive sleep apnea. The Watch_PAT device accurately identified participants with moderate-severe SDB while using CPAP in the attended setting of a sleep laboratory.
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PMID:Follow-up assessment of CPAP efficacy in patients with obstructive sleep apnea using an ambulatory device based on peripheral arterial tonometry. 1658 36

Outside sleep laboratory settings, peripheral arterial tonometry (PAT, eg, WatchPat) represents a validated modality for diagnosing obstructive sleep apnea (OSA). We have shown before that the accuracy of home sleep apnea testing by WatchPat 200 devices in diagnosing OSA is suboptimal (50%-70%). In order to improve its diagnostic performance, we built several models that predict the main functional parameter of polysomnography (PSG), Apnea Hypopnea Index (AHI). Participants were recruited in our Sleep Center and underwent concurrent in-laboratory PSG and PAT recordings. Statistical models were then developed to predict AHI by using robust functional parameters from PAT-based testing, in concert with available demographic and anthropometric data, and their performance was confirmed in a random validation subgroup of the cohort. Five hundred synchronous PSG and WatchPat sets were analyzed. Mean diagnostic accuracy of PAT was improved to 67%, 81% and 85% in mild, moderate-severe or no OSA, respectively, by several models that included participants' age, gender, neck circumference, body mass index and the number of 4% desaturations/hour. WatchPat had an overall accuracy of 85.7% and a positive predictive value of 87.3% in diagnosing OSA (by predicted AHI above 5). In this large cohort of patients with high pretest probability of OSA, we built several models based on 4% oxygen desaturations, neck circumference, body mass index and several other variables. These simple models can be used at the point-of-care, in order to improve the diagnostic accuracy of the PAT-based testing, thus ameliorating the high rates of misclassification for OSA presence or disease severity.
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PMID:Improving the performance of peripheral arterial tonometry-based testing for the diagnosis of obstructive sleep apnea. 3290 Jul 84