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Original Research: SLEEP MEDICINE |

Diagnosis of Obstructive Sleep Apnea Syndrome and Its Outcomes With Home Portable Monitoring

Ana Claudia Tonelli de Oliveira, MD, MSc; Denis Martinez, MD, PhD; Luiz Felipe T. Vasconcelos, MD; Sandro Cadaval Gonçalves, MD, PhD; Maria do Carmo Lenz, MD, PhD; Sandra Costa Fuchs, MD, PhD; Miguel Gus, MD, PhD; Erlon Oliveira de Abreu-Silva, MD; Leila Beltrami Moreira, MD, PhD; Flávio Danni Fuchs, MD, PhD
Author and Funding Information

*From the Graduate Program in Medical Sciences (Drs. Tonelli de Oliveira, Martinez, Vasconcelos, Gus, Moreira, and Danni Fuchs), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Cardiology Unit (Drs. Martinez, Gonçalves, Costa Fuchs, Gus, Oliveira de Abreu-Silva, Moreira, and Danni Fuchs), Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil; Clinica do Sono Sleep Clinic (Drs. Martinez and do Carmo Lenz), Porto Alegre, RS, Brazil; Programa de Pós-graduação em Epidemiologia (Dr. Costa Fuchs), Faculdade de Medicina, Porto Alegre, RS, Brazil.

Correspondence to: Denis Martinez, MD, PhD, Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Avenida Paulo Gama 110-Reitoria, Porto Alegre, RS, Brazil 90040-060; e-mail: dm@ufrgs.br


Financial support was granted by the Brazilian government through a research incentive fund (FIPE) of the Hospital de Clinicas de Porto Alegre.

No conflict of interest exists for any of the authors.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):330-336. doi:10.1378/chest.08-1859
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Background:  The use of portable respiratory monitoring (PM) has been proposed for the diagnosis of obstructive sleep apnea syndrome (OSAS), but most studies that validate PM accuracy have not followed the best standards for diagnostic test validation. The objective of the present study was to evaluate the accuracy of PM performed at home to diagnose OSAS and its outcomes after first validating PM in the laboratory setting by comparing it to polysomnography (PSG).

Methods:  Patients with suspected OSAS were submitted, in random order, to PM at the sleep laboratory concurrently with PSG (lab-PM) or at home-PM. The diagnostic performance was assessed by sensitivity, specificity, positive and negative predictive values, positive likelihood ratio (+LR), negative likelihood ratio (−LR), intraclass correlation coefficients, κ statistic, and Bland-Altman plot.

Results:  One hundred fifty-seven subjects (73% men, mean age ± SD, 45 ± 12 yr) with an apnea-hypopnea index (AHI) of 31 (SD ± 29) events/h were studied. Excluding inadequate recordings, 149 valid comparisons with lab-PM and 121 with unattended home-PM were obtained. Compared to PSG for detecting AHI > 5, the lab-PM demonstrated sensitivity of 95.3%, specificity of 75%, +LR of 3.8, and −LR of 0.11; the home-PM exhibited sensitivity of 96%, specificity of 64%, +LR of 2.7, and −LR of 0.05. Kappa statistics indicated substantial correlation between PSG and PM results. Bland-Altman plot showed smaller dispersion for lab-PM than for home-PM. Pearson product moment correlation coefficients among the three AHIs and clinical outcomes were similar, denoting comparable diagnostic ability.

Conclusions:  This study used all available comparison methods to demonstrate accuracy of PM in-home recordings similar to that of repeated PSGs. PM increases the possibility of correctly diagnosing and effectively treating OSAS in populations worldwide.

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