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Evaluation of a portable recording device (ApneaLink™) for case selection of obstructive sleep apnea

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Abstract

Objective

This study was designed to assess the sensitivity and specificity of a portable sleep apnea recording device (ApneaLink™) using standard polysomnography (PSG) as a reference and to evaluate the possibility of using the ApneaLink™ as a case selection technique for patients with suspected obstructive sleep apnea (OSA).

Materials and methods

Fifty patients (mean age 48.7 ± 12.6 years, 32 males) were recruited during a 4-week period. A simultaneous recording of both the standard in-laboratory PSG and an ambulatory level 4 sleep monitor (ApneaLink™) was performed during an overnight study for each patient. PSG sleep and respiratory events were scored manually according to standard criteria. ApneaLink™ data were analyzed either with the automated computerized algorithm provided by the manufacturer following the American Academy of Sleep Medicine standards (default setting DFAL) or The University of British Columbia Hospital sleep laboratory standards (alternative setting, ATAL). The ApneaLink respiratory disturbance indices (RDI), PSG apnea–hypopnea indices (AHI), and PSG oxygen desaturation index (ODI) were compared.

Results

The mean PSG-AHI was 30.0 ± 25.8 events per hour. The means of DFAL-RDI and ATAL-RDI were 23.8 ± 21.9 events per hour and 29.5 ± 22.2 events per hour, respectively. Intraclass correlation coefficients were 0.958 between PSG-AHI and DFAL-RDI and 0.966 between PSG-AHI and ATAL-RDI. Receiver operator characteristic curves were constructed using a variety of PSG-AHI cutoff values (5, 10, 15, 20, and 30 events per hour). Optimal combinations of sensitivity and specificity for the various cutoffs were 97.7/66.7, 95.0/90.0, 87.5/88.9, 88.0/88.0, and 88.2/93.9, respectively for the default setting. The ApneaLink™ demonstrated the best agreement with laboratory PSG data at cutoffs of AHI ≥ 10. There were no significant differences among PSG-AHI, DFAL-RDI, and ATAL-RDI when all subjects were considered as one group. ODI at 2%, 3%, and 4% desaturation levels showed significant differences (p < 0.05) compared with PSG-AHI, DFAL-RDI, and ATAL-RDI for the entire group.

Conclusion

The ApneaLink™ is an ambulatory sleep monitor that can detect OSA and/or hypopnea with acceptable reliability. The screening and diagnostic capability needs to be verified by further evaluation and manual scoring of the ApneaLink™. It could be a better choice than traditional oximetry in terms of recording respiratory events, although severity may be under- or overestimated.

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Acknowledgments

The authors would like to thank Mrs. Ingrid Ellis for her editorial assistance in the final preparation of this manuscript and the polysomnographic technologists in UBC Hospital sleep disorder laboratory. As a postdoctoral fellow, Dr. Hui Chen was supported in part from royalties paid to The University of British Columbia from worldwide Klearway™ sales.

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Authors and Affiliations

  1. Division of Orthodontics, Department of Oral Health Sciences, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada, V6T 1Z3

    Hui Chen & Alan A. Lowe

  2. Department of Orthodontics, Faculty of Stomatology, The University of Medical Sciences, Beijing, People’s Republic of China

    Hui Chen & Yuxing Bai

  3. Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, Canada

    Peter Hamilton & John A. Fleetham

  4. Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, Canada

    Fernanda R. Almeida

Authors
  1. Hui Chen
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  2. Alan A. Lowe
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  3. Yuxing Bai
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  4. Peter Hamilton
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  5. John A. Fleetham
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  6. Fernanda R. Almeida
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Correspondence to Hui Chen.

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Chen, H., Lowe, A.A., Bai, Y. et al. Evaluation of a portable recording device (ApneaLink™) for case selection of obstructive sleep apnea. Sleep Breath 13, 213–219 (2009). https://doi.org/10.1007/s11325-008-0232-4

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  • DOI: https://doi.org/10.1007/s11325-008-0232-4

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