Dataset Information

Agreement in the Scoring of Respiratory Events Among International Sleep Centers for Home Sleep Testing.

ABSTRACT:

Study objectives

Home sleep testing (HST) is used worldwide to confirm the presence of obstructive sleep apnea (OSA). We sought to determine the agreement of HST scoring among international sleep centers.

Methods

Fifteen HSTs, previously recorded using a type 3 monitor, were deidentified and saved in European Data Format. The studies were scored by nine technologists from the sleep centers of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) using the locally available software. Each study was scored separately using one of three different airflow signals: nasal pressure (NP), transformed (square root) nasal pressure signal (transformed NP), and uncalibrated respiratory inductive plethysmography (RIP) flow. Only one of the three airflow signals was visible to the scorer at each scoring session. The scoring procedure was repeated to determine the intrarater reliability.

Results

The intraclass correlation coefficients (ICCs) using the NP were: apnea-hypopnea index (AHI) = 0.96 (95% confidence interval [CI]: 0.93-0.99); apnea index = 0.91 (0.83-0.96); and hypopnea index = 0.75 (0.59-0.89). The ICCs using the transformed NP were: AHI = 0.98 (0.96-0.99); apnea index = 0.95 (0.90-0.98); and hypopnea index = 0.90 (0.82-0.96). The ICCs using the RIP flow were: AH I = 0.98 (0.96-0.99); apnea index = 0.66 (0.48-0.84); and hypopnea index = 0.78 (0.63-0.90). The mean difference of first and second scoring sessions of the same respiratory variables ranged from -1.02 to 0.75/h.

Conclusion

There is a strong agreement in the scoring of the respiratory events for HST among international sleep centers. Our results suggest that centralized scoring of HSTs may not be necessary in future research collaboration among international sites.

Commentary

A commentary on this article appears in this issue on page 7.

SUBMITTER: Magalang UJ

PROVIDER: S-EPMC4702196 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Agreement in the Scoring of Respiratory Events Among International Sleep Centers for Home Sleep Testing.

Magalang Ulysses J UJ Arnardottir Erna S ES Chen Ning-Hung NH Cistulli Peter A PA Gíslason Thorarinn T Lim Diane D Penzel Thomas T Schwab Richard R Tufik Sergio S Pack Allan I AI

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 20160101 1

<h4>Study objectives</h4>Home sleep testing (HST) is used worldwide to confirm the presence of obstructive sleep apnea (OSA). We sought to determine the agreement of HST scoring among international sleep centers.<h4>Methods</h4>Fifteen HSTs, previously recorded using a type 3 monitor, were deidentified and saved in European Data Format. The studies were scored by nine technologists from the sleep centers of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) using the locally available s ...[more]

PMID: 26350603

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Project description:BackgroundExtreme phenotypes of OSA have not been systematically defined.Research questionThis study developed objective definitions of extreme phenotypes of OSA by using a multivariate approach. The utility of these definitions for identifying characteristics that confer predisposition toward or protection against OSA is shown in a new prospective sample.Study design and methodsIn a large international sample, race-specific liability scores were calculated from a weighted logistic regression that included age, sex, and BMI. Extreme cases were defined as individuals with an apnea-hypopnea index (AHI) ≥ 30 events/hour but low likelihood of OSA based on age, sex, and BMI (liability scores > 90th percentile). Similarly, extreme controls were individuals with an AHI < 5 events/hour but high likelihood of OSA (liability scores < 10th percentile). Definitions were applied to a prospective sample from the Sleep Apnea Global Interdisciplinary Consortium, and differences in photography-based craniofacial and intraoral phenotypes were evaluated.ResultsThis study included retrospective data from 81,338 individuals. A total of 4,168 extreme cases and 1,432 extreme controls were identified by using liability scores. Extreme cases were younger (43.1 ± 14.7 years), overweight (28.6 ± 6.8 kg/m2), and predominantly female (71.1%). Extreme controls were older (53.8 ± 14.1 years), obese (34.0 ± 8.1 kg/m2), and predominantly male (65.8%). These objective definitions identified 29 extreme cases and 87 extreme controls among 1,424 Sleep Apnea Global Interdisciplinary Consortium participants with photography-based phenotyping. Comparisons suggest that a greater cervicomental angle increases risk for OSA in the absence of clinical risk factors, and smaller facial widths are protective in the presence of clinical risk factors.InterpretationThis objective definition can be applied in sleep centers throughout the world to consistently define OSA extreme phenotypes for future studies on genetic, anatomic, and physiologic pathways to OSA.

Project description:BackgroundThe advent of home sleep testing has allowed for the development of an ambulatory care model for OSA that most health-care providers can easily deploy. Although automated algorithms that accompany home sleep monitors can identify and classify disordered breathing events, it is unclear whether manual scoring followed by expert review of home sleep recordings is of any value. Thus, this study examined the agreement between automated and manual scoring of home sleep recordings.MethodsTwo type 3 monitors (ApneaLink Plus [ResMed] and Embletta [Embla Systems]) were examined in distinct study samples. Data from manual and automated scoring were available for 200 subjects. Two thresholds for oxygen desaturation (≥ 3% and ≥ 4%) were used to define disordered breathing events. Agreement between manual and automated scoring was examined using Pearson correlation coefficients and Bland-Altman analyses.ResultsAutomated scoring consistently underscored disordered breathing events compared with manual scoring for both sleep monitors irrespective of whether a ≥ 3% or ≥ 4% oxygen desaturation threshold was used to define the apnea-hypopnea index (AHI). For the ApneaLink Plus monitor, Bland-Altman analyses revealed an average AHI difference between manual and automated scoring of 6.1 (95% CI, 4.9-7.3) and 4.6 (95% CI, 3.5-5.6) events/h for the ≥ 3% and ≥ 4% oxygen desaturation thresholds, respectively. Similarly for the Embletta monitor, the average difference between manual and automated scoring was 5.3 (95% CI, 3.2-7.3) and 8.4 (95% CI, 7.2-9.6) events/h, respectively.ConclusionsAlthough agreement between automated and manual scoring of home sleep recordings varies based on the device used, modest agreement was observed between the two approaches. However, manual review of home sleep test recordings can decrease the misclassification of OSA severity, particularly for those with mild disease.Trial registryClinicalTrials.gov; No.: NCT01503164; www.clinicaltrials.gov.

Dataset Information

Agreement in the Scoring of Respiratory Events Among International Sleep Centers for Home Sleep Testing.

Study objectives

Methods

Results

Conclusion

Commentary

Publications

Agreement in the Scoring of Respiratory Events Among International Sleep Centers for Home Sleep Testing.

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