Assessment of automated analysis of portable oximetry as a screening test for moderate-to-severe sleep apnea in patients with chronic obstructive pulmonary disease

Ana M Andrés-Blanco, Daniel Álvarez, Andrea Crespo, C Ainhoa Arroyo, Ana Cerezo-Hernández, Gonzalo C Gutiérrez-Tobal, Roberto Hornero, Félix Del Campo, Ana M Andrés-Blanco, Daniel Álvarez, Andrea Crespo, C Ainhoa Arroyo, Ana Cerezo-Hernández, Gonzalo C Gutiérrez-Tobal, Roberto Hornero, Félix Del Campo

Abstract

Background: The coexistence of obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) leads to increased morbidity and mortality. The development of home-based screening tests is essential to expedite diagnosis. Nevertheless, there is still very limited evidence on the effectiveness of portable monitoring to diagnose OSAS in patients with pulmonary comorbidities.

Objective: To assess the influence of suffering from COPD in the performance of an oximetry-based screening test for moderate-to-severe OSAS, both in the hospital and at home.

Methods: A total of 407 patients showing moderate-to-high clinical suspicion of OSAS were involved in the study. All subjects underwent (i) supervised portable oximetry simultaneously to in-hospital polysomnography (PSG) and (ii) unsupervised portable oximetry at home. A regression-based multilayer perceptron (MLP) artificial neural network (ANN) was trained to estimate the apnea-hypopnea index (AHI) from portable oximetry recordings. Two independent validation datasets were analyzed: COPD versus non-COPD.

Results: The portable oximetry-based MLP ANN reached similar intra-class correlation coefficient (ICC) values between the estimated AHI and the actual AHI for the non-COPD and the COPD groups either in the hospital (non-COPD: 0.937, 0.909-0.956 CI95%; COPD: 0.936, 0.899-0.960 CI95%) and at home (non-COPD: 0.731, 0.631-0.808 CI95%; COPD: 0.788, 0.678-0.864 CI95%). Regarding the area under the receiver operating characteristics curve (AUC), no statistically significant differences (p >0.01) between COPD and non-COPD groups were found in both settings, particularly for severe OSAS (AHI ≥30 events/h): 0.97 (0.92-0.99 CI95%) non-COPD vs. 0.98 (0.92-1.0 CI95%) COPD in the hospital, and 0.87 (0.79-0.92 CI95%) non-COPD vs. 0.86 (0.75-0.93 CI95%) COPD at home.

Conclusion: The agreement and the diagnostic performance of the estimated AHI from automated analysis of portable oximetry were similar regardless of the presence of COPD both in-lab and at-home. Particularly, portable oximetry could be used as an abbreviated screening test for moderate-to-severe OSAS in patients with COPD.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Patient recruitment flowchart.
Fig 1. Patient recruitment flowchart.
PSG: polysomnography; TST: total sleep time.
Fig 2. Optimization (model selection) of the…
Fig 2. Optimization (model selection) of the MLP ANN in the training set.
(A) In-hospital supervised monitoring. (B) At-home unattended monitoring. ICC: intra-class correlation coefficient; NH: number of neurons in the hidden layer; ν: regularization parameter.
Fig 3. Bland-Altman plots showing agreement between…
Fig 3. Bland-Altman plots showing agreement between estimated AHI from nocturnal oximetry and actual AHI from PSG.
(A) Supervised oximetry in the laboratory for non-COPD subjects. (B) Supervised oximetry in the laboratory for COPD patients. (C) Unattended oximetry at home for non-COPD subjects. (D) Unattended oximetry at home for COPD patients. AHIOX-LAB: apnea-hypopnea index from in-hospital oximetry; PSG: polysomnography; in-LAB: supervised setting in the hospital; non-COPD: patients without chronic obstructive pulmonary disease; COPD: patients with chronic obstructive pulmonary disease; AHIOX-HOME: apnea-hypopnea index from at-home oximetry; at-HOME: supervised setting at home.
Fig 4. Mountain plots showing differences between…
Fig 4. Mountain plots showing differences between the reference AHI from PSG and the estimated AHI of non-COPD and COPD groups.
(A) Supervised portable oximetry in the hospital simultaneous to PSG. (B) Unattended portable oximetry at home in a different night. AHIOX-LAB: apnea-hypopnea index from in-hospital oximetry; PSG: polysomnography; non-COPD: patients without chronic obstructive pulmonary disease; COPD: patients with chronic obstructive pulmonary disease; AHIOX-HOME: apnea-hypopnea index from at-home oximetry.
Fig 5. Receiver operating characteristics curves of…
Fig 5. Receiver operating characteristics curves of the estimated AHI.
(A) Supervised portable oximetry in the hospital using a cutoff of AHI ≥15 events/h. (B) Supervised portable oximetry in the hospital using a cutoff of AHI ≥30 events/h. (C) Unattended portable oximetry at home using a cutoff of AHI ≥15 events/h. (D) Unattended portable oximetry at home using a cutoff of AHI ≥30 events/h. AHI: apnea-hypopnea index from standard PSG; non-COPD: patients without chronic obstructive pulmonary disease; COPD: patients with chronic obstructive pulmonary disease; AUC: area under the ROC curve.

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