SESSION TITLE: Sleep Disorders I
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM
PURPOSE: We aimed to determine the accuracy of portable monitoring in hospitalized patients in diagnosing obstructive sleep apnea (OSA) that would require treatment.
METHODS: In 9 months, 147 medical inpatients were prospectively referred to the study for suspected OSA. After completing a brief sleep questionnaire, all patients underwent overnight portable sleep monitoring (PM) at their medical ward. PM included the following: nasal pressure/thermistor, effort belts, oximetry, heart rate, and actigraphy using the Alice PDx (Philips Respironics, Murrysville, PA). After multiple attempts to contact them, 68 patients returned for attended laboratory polysomnography (PSG). Studies were scored using AASM criteria (4% desaturation for hypopnea). The IRB approved the study and the patients signed informed consents. The National Clinical Trials identifier is NCT01424592.
RESULTS: Two patients had inadequate PM recording. The 66 included patients had a mean age, neck circumference, BMI, and ESS of 51.4 years, 44.7 cm, 42.7 kg/m2, and 13.9, respectively. The mean lag between the two studies was 87.4 days, (range 2, 274). 32% of patients had AHI-PSG<15. The mean AHI-PSG was 44.5 (range, 0.6-145.7) and AHI-PM was 47.25 (range, 0.6-131). AHI-PM correlated with AHI-PSG (Rsquared = 0.47). Bland-Altman analysis revealed a bias of -3 (SD=29). The area under the ROC curve for AHI-PM to detect AHI-PSG≥15 was 0.81. At AHI-PM of 35, sensitivity and specificity were 0.71 and 0.86, respectively. After excluding 17 patients with PM central apnea index>2, bias was 4(SD=23). Rsquared was 0.61. The area was 0.90. At AHI-PM of 19, sensitivity and specificity were 0.79 and 0.93, respectively.
CONCLUSIONS: During a hospitalization, PM with actigraphy is reasonably specific to rule in OSA that requires treatment with CPAP, especially after excluding patients with central sleep apnea.
CLINICAL IMPLICATIONS: Despite being a common consequence of the obesity epidemic, OSA remains undertreated. The main barrier is testing. Patients with OSA are admitted frequently because they suffer other comorbidities. A hospital admission is an opportunity to diagnose significant OSA and expedite treatment.
DISCLOSURE: The following authors have nothing to disclose: Swamy Nagubadi, Abhishek Vedavalli, Mamoun Abdoh, Venkat Rajasurya, Rohit Mehta, Umer Nagori, Aiman Tulaimat
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