The accuracy of a portable sleep monitor to diagnose obstructive sleep apnea in adolescent patients

Abstract

Study objectives: The efficacy of portable-monitor (PM) sleep testing in children is not well understood. While most studies have evaluated PM in a lab setting, the utility of PM in the home environment is relatively unknown. We sought to determine whether home PM accurately diagnoses obstructive sleep apnea in adolescents and to assess patient satisfaction with home PM sleep testing.

Methods: We evaluated adolescents (age 12-18 years) with suspected obstructive sleep apnea using a PM device. In addition to in-laboratory polysomnography (PSG), all participants had PM testing performed twice, once in their home and once concurrent to in-laboratory PSG. PM was compared to PSG using 2 primary outcomes: the apnea-hypopnea index and oxygen desaturation index. All participants were approached for interview to evaluate their experience with PM sleep testing.

Results: Twenty adolescents participated. Bland-Altman analysis comparing the apnea-hypopnea index and oxygen desaturation index determined by home or in-laboratory PM to in-laboratory PSG revealed mostly agreement; however, some deviations were observed when either parameter was markedly increased. While PM testing tended to underestimate the apnea-hypopnea index, the diagnostic agreement between home PM and PSG was 80% (by the White-Westbrook method). Most preferred PM to PSG and found PM easy to very easy to set up.

Conclusions: In a small cohort of adolescents, our study supports the application of home PM in the diagnosis of suspected obstructive sleep apnea. Until studies implementing PM using larger cohorts become readily available, the findings from this preliminary study could contribute to adolescents receiving sleep apnea therapy more promptly.

Clinical trial registration: Registry: ClinicalTrials.gov; Identifier: NCT03748771. At the time of issue publication, this registration is not publicly available because the trial includes a device that is not approved or cleared for use in pediatric populations. Once the device is FDA cleared, the registration will become public.

Keywords: adolescents; diagnosis; home sleep apnea testing; obstructive sleep apnea; pediatrics; polysomnography.

Conflict of interest statement

All authors have seen and approved the final manuscript. This study was funded by ResMed Corp. Representatives from the study sponsor were involved in the study design, collection, analysis, and interpretation of data; writing of the report; and in the decision to submit the paper for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The authors report no conflictsof interest.

© 2021 American Academy of Sleep Medicine.

Figures

Figure 1. Bland-Altman analysis evaluating accuracy of AHI measure.

(A) Bland-Altman analysis comparing PSG AHI to HSAT AHI. (B) Bland-Altman analysis comparing PSG AHI to ALT AHI. AHI = apnea-hypopnea index, ALT = ApneaLink Lab Test, HSAT (HST) = home sleep apnea test, PSG = polysomnogram.

Figure 2. Bland-Altman analysis evaluating accuracy of ODI measure.

(A) Bland-Altman analysis comparing PSG ODI to HSAT ODI. (B) Bland-Altman analysis comparing PSG ODI to ALT ODI. ALT = ApneaLink Lab Test, HSAT (HST) = home sleep apnea test, ODI = oxygen desaturation index, PSG = polysomnogram.

Figure 3. Correlation analysis evaluating accuracy of AHI and ODI measures.

(A) Correlation analysis comparing AHI measured by HSAT and ALT to PSG. HSAT AHI ρ = 0.386, P = .093. ALT AHI ρ = 0.790, P < .001. (B) Correlation analysis comparing ODI measured by HSAT and ALT to PSG. HSAT ODI ρ = 0.334, P = .146. ALT AHI ρ = 0.770, P < .001. AHI = apnea-hypopnea index, ALT = ApneaLink Lab Test, HSAT (HST) = home sleep apnea test, ODI = oxygen desaturation index, PSG = polysomnogram.

Figure 4. Patient opinions of and preferences for HST compared to PSG. HST = home sleep apnea test, PSG = polysomnogram.