An evaluation of peripheral arterial tonometry for the diagnosis of obstructive sleep apnea

Yıl 2018, Cilt: 8 Sayı: 1, 19 - 26, 05.04.2018

Zerrin Özergin Coşkun Engin Dursun Ünal Şahin Özlem Çelebi Erdivanlı Suat Terzi Metin Çeliker Münir Demirci

Öz

Objective: Peripheral arterial tonometry
(PAT) as a portable method of monitoring sleep quality is a relatively
recent innovation. The aim was to compare the results of PAT and
polysomnography (PSG) and to evaluate the role of PAT in diagnosing
obstructive sleep apnea syndrome (OSAS).




Methods: This
study included adult patients who admitted to ENT clinic with OSAS
complaints (excessive daytime sleepiness, snoring, and witnessed apnea),
undergone sleep monitorization using PAT system (WatchPAT 200TM; Itamar
Medical Ltd., Caesarea, Israel) and had single-blind, level 1
polysomnography at sleep laboratory of Chest Diseases Department.




Results: For
the two sleep monitoring sessions as conducted at different times: the
apnea-hypopnea index (AHI) and respiratory disturbance index (RDI)
values were strongly correlated between sessions (r=0.749, r=0.753;
p<0.001). The oxygen desaturation index (ODI) values were very
strongly correlated (r=0.861; p<0.001). When the AHI scores
calculated using PAT for the patients enrolled in the trial were taken
into consideration; 89.7% of the patients were correctly diagnosed with
OSAS (AHI≥5); for RDI calculated (RDI≥5) using PAT, 100% of OSAS
diagnoses were correct; for AHI values calculated with the PAT method,
taking 15 as cut-off point, the sensitivity was found to be at an
extremely high level of 96.1%.




Conclusion: PAT
and PSG values were highly correlated. This finding demonstrated that
the reproducibility of the results obtained with PAT was also high. This
study shows that PAT can be used as a screening test for OSAS and in a
group of patients who are highly suspected for OSAS.

Anahtar Kelimeler

Obstructive sleep apnea, peripheral artery tonometry, polysomnography, apnea-hypopnea index, oxygen desaturation index

Kaynakça

• 1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006–14. 2. Lam JC, Sharma SK, Lam B. Obstructive sleep apnea: definitions, epidemiology & natural history. Indian J Med Res 2010;131:165– 70. 3. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008;5:136–43. 4. Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructive sleep apnea? The Rational Clinical Examination sys- tematic review. JAMA 2013;310:731–41. 5. Wittine LM, Olson EJ, Morgenthaler TI. Effect of recording duration on the diagnostic accuracy of out-of-center sleep testing for obstructive sleep apnea. Sleep 2014;37:969–75. 6. Zhang W, Si LY. Obstructive sleep apnea syndrome (OSAS) and hypertension: pathogenic mechanisms and possible therapeutic approaches. Ups J Med Sci 2012;117:370–82. 7. Pittman SD, Ayas NT, MacDonald MM, Malhotra A, Fogel RB, White DP. Using a wrist-worn device based on peripheral arterial tonometry to diagnose obstructive sleep apnea: in-laboratory and ambulatory validation. Sleep 2004;27923–33. 8. Berry RB, Budhiraja R, Gottlieb DJ, et al.; American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8:597–619. 9. Dündar Y, Tatar EC, Saylam G, et al. The evaluation of inflam- matory process, endothelial dysfunction and oxidative stress in sleep apnea. ENT Updates 2014;4:61–5. 10. Schnall RP, Shlitner A, Sheffy J, Kedar R, Lavie P. Periodic, pro- found peripheral vasoconstriction – a new marker of obstructive sleep apnea. Sleep 1999;22:939–46. 11. Ayas NT, Pittman S, MacDonald M, White DP. Assessment of a wrist-worn device in the detection of obstructive sleep apnea. Sleep Med 2003;4:435–42. 12. Pang KP, Gourin CG, Terris DJ.A comparison of polysomnogra- phy and the WatchPAT in the diagnosis of obstructive sleep apnea. Otolaryngol Head Neck Surg 2007;137:665–8. 13. Yalamanchal S, Farajian V, Hamilton C, Pott TR, Samuelson CG, Friedman M. Diagnosis of obstructive sleep apnea by peripheral arterial tonometry: meta-analysis. JAMA Otolaryngol Head Neck Surg 2013;139:1343–50. 14. Kapur VK. Obstructive sleep apnea: diagnosis, epidemiology, and economics. Respir Care 2010;55:1155–67. 15. Epstein LJ, Kristo D, Strollo PJ Jr, et al.; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term- care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5: 263–76. 16. Bar A, Pillar G, Dvir I, Sheffy J, Schnall RP, Lavie P. Evaluation of a portable device based on peripheral arterial tone for unattend- ed home sleep studies. Chest 2003;123:695–703. 17. Pinto JA, Godoy LB, Ribeiro RC, Mizoguchi EI, Hirsch LA, Gomes LM. Accuracy of peripheral arterial tonometry in the diag- nosis of obstructive sleep apnea. Braz J Otorhinolaryngol 2015;81: 473–8. 18. Collop NA, Anderson WM, Boehlecke B, et al.; Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007;3:737–47. 19. Gonçalves M, Amici R, Lucas R, et al.; National Representatives as Study Collaborators. Sleepiness at the wheel across Europe: a sur- vey of 19 countries. J Sleep Res 2015;24:242–53. 20. Strohl KP, Brown DB, Collop N, et al.; ATS Ad Hoc Committee on Sleep Apnea, Sleepiness, and Driving Risk in Noncommercial Drivers. An official American Thoracic Society Clinical Practice Guideline: sleep apnea, sleepiness, and driving risk I noncommer- cial drivers. An update of a 1994 Statement. Am J Respir Crit Care Med 2013;187:1259–66. 21. Bonsignore MR, Randerath W, Riha R, et al. New rules on driver licensing for patients with obstructive sleep apnea: European Union Directive 2014/85/EU. J Sleep Res 2016;25:3–4. 22. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017;13:479–504.