Reliability of respiratory event detection with continuous positive airway pressure in moderate to severe obstructive sleep apnea - comparison of polysomnography with a device-based analysis

Matthias Richter, Maik Schroeder, Ulrike Domanski, Matthias Schwaibold, Georg Nilius, Matthias Richter, Maik Schroeder, Ulrike Domanski, Matthias Schwaibold, Georg Nilius

Abstract

Purpose: Monitored polysomnography (PSG) is considered the gold standard technique to diagnose obstructive sleep apnea (OSA) and titrate continuous positive airway pressure (CPAP), the accepted primary treatment method. Currently, the American Academy of Sleep Medicine (AASM) considers automatic PAP therapy initiation at home comparable to laboratory titration and recommends telemonitoring-guided interventions. Advanced CPAP devices evaluate and report the residual apnea-hypopnea index (AHI). However, in order to control the effectiveness of the prescribed therapy outside of a PSG setting, the automatic event detection must provide reliable data.

Methods: A CPAP titration was performed in the sleep laboratory by PSG in patients with OSA. The residual event indices detected by the tested device (prismaLine, Loewenstein Medical Technology) were compared to the manually scored PSG indices. Results of the device (AHIFLOW) were compared according to the AASM scoring criteria 1A (AHI1A, hypopneas with a flow signal reduction of ≥ 30% with ≥ 3% oxygen reduction and/or an arousal) and 1B (AHI1B, hypopneas with a flow signal decrease by ≥ 30% with a ≥ 4% oxygen desaturation).

Results: In 50 patients with OSA, the mean PSG AHI1A was 10.5 ± 13.8/h and the PSG AHI1B was 7.4 ± 12.6/h compared to a mean device AHIFlow of 8.4 ± 10.0/h. The correlation coefficient regarding PSG AHI1A and AHIFlow was 0.968. The correlation regarding central hypopneas on the other hand was 0.153. There were few central events to be compared in this patient group.

Conclusion: The device-based analysis showed a high correlation in the determination of residual obstructive AHI under therapy. The recorded residual respiratory event indices in combination with the data about leakage and adherence of the studied device provide reliable information for the implementation and follow-up of CPAP therapy in a typical group of patients with OSA.

Trial registration number: ClinicalTrials.gov Identifier: NCT04407949, May 29, 2020, retrospectively registered.

Keywords: AHI; Automatic event detection; OSA; PSG.

Conflict of interest statement

M Richter, M Schroeder, and U Domanski have no financial or other potential conflicts of interest associated with this study. M Schwaibold is employee of Loewenstein Medical Technology. G Nilius has received research support from Loewenstein Medical Technology, Fisher & Paykel Healthcare, ResMed and Weinmann; this has gone into department funds.

© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Bland–Altman analysis PSG 1A vs AHIFlow
Fig. 3
Fig. 3
Bland–Altman analysis PSG 1B vs AHIFlow
Fig. 4
Fig. 4
ROC analysis for AHIFlow cut-off values of 10 and 5

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