Journal Information
Vol. 41. Issue 2.
Pages 71-77 (February 2005)
Share
Share
Download PDF
More article options
Vol. 41. Issue 2.
Pages 71-77 (February 2005)
Original Articles
Full text access
Validation of a Respiratory Polygraphy System in the Diagnosis of Sleep Apnea Syndrome
Visits
4514
A. Candelaa,
Corresponding author
candela_alf@gva.es

Correspondence: Dr. A. Candela. Servicio de Neumología. Hospital General Universitario de Alicante. PintorBaeza, s/n. 03010 Alicante. España
, L. Hernándeza, S. Asensioa, J. Sánchez-Payáb, J. Vilaa, N. Benitoa, S. Romeroa
a Servicio de Neumología, Hospital General Universitario de Alicante, Alicante, Spain
b Servicio de Medicina Preventiva, Hospital General Universitario de Alicante, Alicante, Spain
This item has received
Article information
Objective

To validate a cardiorespiratory polygraphy system (BITMED NGP 140) by comparing it to conventional polysomnography in the diagnosis of sleep apnea-hypopnea syndrome.

Patients and methods

Polysomnography and cardiorespiratory polygraphy were performed simultaneously on 103 consecutive patients referred because of suspected sleep apnea-hypopnea syndrome. The Bland and Altman method and intraclass correlation coefficients were used to assess agreement between the 2 methods of measurement. Receiver operating characteristic (ROC) curves were used to calculate the yield of cardiorespiratory polygraphy compared to that of conventional polysomnography.

Results

Ninety-two valid studies were obtained for 72 men and 20 women (mean [SD] age: 52.4 [12] years). By the Bland and Altman method, the difference between the respiratory event index obtained with the BITMED NGP140 and the apnea-hypopnea index (AHI) obtained by conventional polysomnography was 7.6 (13.2) in the manual analysis (95% confidence interval [CI], 4.9-10.4) and 12 (15.3) (95% CI, 8.8-15.3) in the automatic analysis. For a corrected AHI (AH/total time in bed) mean differences were -2.2 (5.9) and 2.4 (8.2) for manual and automatic analyses. The intraclass correlation coefficients were greater than 0.94.

The areas under the ROC curves of the respiratory event index were greater than 0.97 for all cut points. For an AHI of 30 or higher, the best cut-off point determined by manual cardiorespiratory polygraphy analysis was 27 (sensitivity, 98% and specificity, 98%). For the different cut-off points cardiorespiratory polygraphy correctly classified between 92% and 98% of patients in both the manual and automatic analyses.

Conclusions

The BITMED NGP140 had good agreement with conventional polysomnography for the measurement of respiratory events and provided high diagnostic yield.

Key Words:
Sleep apnea
Polysomnography
Polygraphy
Validation study
Sensitivity
Specificity
Objetivo

Validar un dispositivo de poligrafía (PGR) cardiorrespiratoria, BITMED NGP140, frente a la polisomno-grafía convencional (PSG) en el síndrome de apneas e hipopneas durante el sueño.

Pacientes Y Métodos

Se realizó PSG y, simultáneamente, PGR a 103 pacientes consecutivos enviados por sospecha de síndrome de apneas e hipopneas durante el sueño. Se aplicaron el método de Bland y Altman, y el coeficiente de correlación intraclase para analizar la concordancia de los 2 dispositivos. La rentabilidad diagnóstica de la PGR frente a la PSG se calculó mediante las curvas de eficacia diagnóstica.

Resultados

Se obtuvieron 92 estudios válidos, en 72 varones y 20 mujeres con una media de edad (± desviación estándar) de 52,4 ± 12 años. Con el método de Bland y Altman la diferencia del índice de eventos respiratorios del BITMED NGP140 con el índice de apneashipopneas (IAH) de la PSG era, en el análisis manual, de 7,6 ± 13,2 (intervalo de confianza del 95%, 4,9-10,4), y en el análisis automático, de 12 ± 15,3 (intervalo de confianza del 95%, 8,8-15,3), mientras que para el IAH corregido (IAH/tiempo total de registro) la media de la diferencia fue de -2,2 ± 5,9 en el análisis manual y de 2,4 ± 8,2 en el automático. Las correlaciones intraclase eran superiores a 0,94.

Las áreas bajo la curva de eficacia diagnóstica del índice de eventos respiratorios eran superiores a 0,97 en todos los puntos de corte. Para un IAH de 30 o superior, el mejor punto de corte del análisis manual de la PGR era de 27 (sensibilidad del 98% y especificidad del 98%). Para los diferentes puntos de corte, la PGR clasificaba correctamente entre el 92 y el 98% de los pacientes tanto con el análisis manual como con el automático.

Conclusiones

El BITMED NGP140 tiene una buena concordancia con la PSG en la medición de los eventos respiratorios y ofrece un alto rendimiento diagnóstico.

Palabras clave:
Apneas durante el sueño
Polisomnografía
Poligrafía
Estudio de validación
Sensibilidad
Especificidad
Full text is only aviable in PDF
REFERENCES
[1]
T Young, M Palta, J Dempsey, J Skatrud, S Weber, S Badr.
The occurrence of sleep-disordered breathing among middle-aged adults.
N Engl J Med., 328 (1993), pp. 1230-1235
[2]
E Phillipson.
Sleep apnea—a major public health problem.
N Engl J Med., 328 (1993), pp. 1271-1273
[3]
J Durán, S Esnaola, R Rubio, A Iztueta.
Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 years.
Am J Respir Crit Care Med., 163 (2001), pp. 685-689
[4]
MM Mitler, MA Carskadon, CA Czeisler, WC Dement, DF Dinges, RC Graeber.
Catastrophes, sleep, and public policy: consensus report.
Sleep, 11 (1988), pp. 100-109
[5]
J Terán-Santos, A Jiménez-Gómez, J Cordero-Guevara.
The association between sleep apnea and the risk of traffic accidents.
N Engl J Med., 340 (1999), pp. 847-851
[6]
KM Hla, TB Young, T Bidwell, M Palta, JB Skatrud, J Dempsey.
Sleep apnea and hypertension: a population based study.
Ann Intern Med., 120 (1994), pp. 382-388
[7]
P Lavie, P Herer, V Hoffstein.
Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study.
BMJ., 320 (2000), pp. 479-482
[8]
FJ Nieto, TB Young, BK Lind, E Shahar, JM Samet, S Redline, et al.
Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study.
JAMA, 283 (2000), pp. 1829-1836
[9]
J Hung, EG Whitford, RW Parsons, DR Hillman.
Association of sleep apnoea with myocardial infarction in men.
Lancet, 336 (1990), pp. 261-264
[10]
S Viner, J Szalai, V Hoffstein.
Is history and physical examination a good screening test for obstructive sleep apnea?.
Ann Intern Med., 115 (1991), pp. 356-359
[11]
L Kapuniai, D Andrew, D Crowell.
Identifying sleep apnea from self-reports.
Sleep, 11 (1988), pp. 430-436
[12]
Standards of Practice Committee of the American Sleep Disorders Association.
Practice parameters for the use of portable recording in the assessment of obstructive sleep apnoea.
Sleep, 17 (1994), pp. 372-377
[13]
American Thoracic Society.
Indications and standards for cardiopulmonary sleep studies.
Am Rev Respir Dis., 139 (1989), pp. 559-568
[14]
American Academy of Sleep Medicine.
Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research.
Sleep, 22 (1999), pp. 667-689
[15]
A Ferrer.
Alternativas a la polisomnografía convencional en el diagnóstico y tratamiento del síndrome de apneas durante el sueño.
Arch Bronconeumol., 31 (1995), pp. 258-263
[16]
NJ Douglas, S Thomas, MA Jan.
Clinical value of polysomnography.
Lancet, 339 (1992), pp. 347-350
[17]
S Gyulay, D Gould, B Sawyer, D Pond, A Mant, N Saunders.
Evaluation of a microprocessor-based portable home monitoring system to measure breathing during sleep.
Sleep, 10 (1987), pp. 130-142
[18]
S Redline, T Tosteson, MA Boucher, RP Millman.
Measurement of sleep-related breathing disturbances in epidemiological studies. Assessment of the validity and reproducibility of a portable monitoring device.
Chest, 100 (1991), pp. 1281-1286
[19]
R Stoohs, C Guilleminault.
MESAM 4: an ambulatory device for the detection of patients at risk for obstructive sleep apnea syndrome (OSAS).
Chest, 101 (1992), pp. 1221-1227
[20]
WC Orr, T Eiken, V Pegram, R Jones, OH Rundell.
A laboratory validation study of a portable system for the remote recording of sleep-related breathing disorders.
Chest, 105 (1994), pp. 160-162
[21]
DP White, TJ Gibb, JM Wall, PR Westbrook.
Assessment of accuracy and analysis time of a novel device to monitor sleep and breathing in the home.
Sleep, 18 (1995), pp. 115-126
[22]
GC Man, BV Kang.
Validation of a portable sleep apnea monitoring device.
Chest, 108 (1995), pp. 388-393
[23]
S Esnaola, J Durán, C Infante-Rivard, R Rubio, A Fernández.
Diagnostic accuracy of a portable recording device (MESAM IV) in suspected obstructive sleep apnoea.
Eur Respir J., 9 (1996), pp. 2597-2605
[24]
O Carrasco, JM Montserrat, P Lloberes, C Ascasco, E Ballester, C Fornas, et al.
Visual and different automatic scoring profiles of respiratory variables in the diagnosis of sleep apnoea-hypopnoea syndrome.
Eur Respir J., 9 (1996), pp. 125-130
[25]
P Lloberes, JM Montserrat, A Ascaso, O Parra, A Granados, P Alonso, et al.
Comparison of partially attended night time respiratory recording and full polysomnography in patients with suspected sleep apnoea/hypopnoea syndrome.
Thorax, 51 (1996), pp. 1043-1047
[26]
E Ballester, M Solans, X Vila, L Hernández, L Quinto, I Bolívar, et al.
Evaluation of a portable respiratory recording device for detecting apnoeas and hypopnoeas in subjects from a general population.
Eur Respir J., 16 (2000), pp. 123-127
[27]
T Verse, W Pirsing, B Junge-Hulsing, B Kroker.
Validation of the POLY-MESAM seven channel ambulatory recording unit.
Chest, 117 (2000), pp. 1613-1618
[28]
JM Calleja, S Esnaola, R Rubio, J Durán.
Comparison of a cardiorespiratory device versus polysomnography for diagnosis of sleep apnoea.
Eur Respir J., 20 (2002), pp. 1505-1510
[29]
SD Ross, IA Sheinhait, KJ Harrison, M Kvasz, JE Connelly, SA Shea, et al.
Systematic review and meta-analysis of the literature regarding the diagnosis of sleep apnea.
Sleep, 23 (2000), pp. 519-532
[30]
E Chiner, JM Arriero, J Signes-Costa, J Marco, I Fuentes.
Validación de la versión española del test de somnolencia Epworth en pacientes con síndrome de apneas del sueño.
Arch Bronconeumol., 35 (1999), pp. 422-427
[31]
A Rechtschaffen, AA Kales.
A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects, US Government Printing Office, (1979),
[32]
M Bonnet, D Carley, M Carskadon, P Easton, C Guilleminault, R Harper, et al.
EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of The American Sleep Disorders Association.
Sleep, 15 (1994), pp. 173-184
[33]
JM Bland, DG Altman.
Statistical methods for assessing agreement between two methods of clinical measurement.
Lancet, 1 (1986), pp. 307-310
[34]
GR Norman, DL Streiner.
Repeated measures ANOVA.
Biostatistics. The bare essentials, pp. 88-96
[35]
JA Hanley, BJ Mc Neil.
The meaning and use of the area under receiver operating characteristic (ROC) curve.
[36]
J Terán Santos, C Fernández García, J Cordero Guevara.
Situación en España de los recursos diagnósticos y de los tratamientos con presión positiva continua sobre la vía aérea, en el síndrome de apneas-hipopneas obstructivas del sueño.
Arch Bronconeumol., 36 (2000), pp. 494-499
[37]
TJ Meyer, SE Eveloff, LR Kline, RP Millman.
One negative polysomnogram does not exclude obstructive sleep apnea.
Chest, 103 (1993), pp. 756-760
[38]
WW Flemons.
Obstructive sleep apnea.
N Engl J Med., 347 (2002), pp. 498-504
[39]
JM Montserrat, J Amilibia, F Barbé, F Capote, J Durán, NG Mangado, et al.
Tratamiento del síndrome de las apneas-hipopneas durante el sueño.
Arch Bronconeumol., 34 (1998), pp. 204-206
[40]
DI Loube, PC Gay, KP Strohl, AI Pack, DP White, NA Collop.
Indications for positive airway pressure treatment of adult obstructive sleep apnea patients.
Chest, 115 (1999), pp. 863-866

This study was funded by the Office of Health Technology Assessment, Department of Health, Government of the Autonomous Community of Valencia (Generalitat) (Project No. 006/2001).

Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?