Ying Y Zhao1,2, Jia Weng1, Daniel R Mobley1, Rui Wang1,3, Younghoon Kwon4, Phyllis C Zee5, Pamela L Lutsey6, Susan Redline1,2,7. 1. Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA. 2. Harvard Medical School, Boston, MA. 3. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA. 4. Department of Medicine, University of Virginia, Charlottesville, VA. 5. Northwestern University, Chicago, IL. 6. University of Minnesota, Minneapolis, MN. 7. Beth Israel Deaconess Medical Center, Boston, MA.
Abstract
STUDY OBJECTIVES: Type 3 home sleep apnea tests may underestimate the apnea-hypopnea index (AHI) due to overestimation of total sleep time (TST). We aimed to evaluate the effect of manual editing of the total recording time (TRT) on the TST and AHI. METHODS: Thirty 15-channel in-home polysomnography studies (AHI 0 to 30 events/h) scored using American Academy of Sleep Medicine criteria were rescored by two blinded polysomnologists after data from electroencephalogram, electrooculogram, and electromyogram were masked. In method 1, periods of probable wakefulness and artifact were manually edited and removed from analysis. Method 2 identified TST as the TRT without manual editing. Paired t-tests were used to compare the TST and AHI between these methods. Sensitivity and specificity of each method were calculated for gold standard AHI cutoffs of ≥ 5 and ≥ 15 events/h. RESULTS: TST (mean [standard deviation, SD]) by polysomnography, method 1, and method 2 was 366.0 (70.1), 447.1 (59.0), and 542 (61.9) min, respectively. The corresponding AHI was 12.5 (8.2), 10.8 (7.0), and 9.1 (6.1) events/h, respectively. Compared to polysomnography, both alternative methods overestimated the TST (method 1: mean difference [SD] 81.1 [56.1] min, method 2: 176.0 [89.7] min; both p < 0.001) and underestimated the AHI (method 1: mean difference [SD] -1.6 [3.3], method 2: -3.3 [3.9]; both p < 0.001). The sensitivity was 100% and 70.0% for method 1, and 91.3% and 40.0% for method 2 for identifying sleep-disordered breathing using AHI cutoffs of ≥ 5 and ≥ 15 events/h, respectively. CONCLUSIONS: Manual editing of TRT reduces the overestimation of TST and improves the sensitivity for identifying studies with sleep-disordered breathing. COMMENTARY: A commentary on this article appears in this issue on page 9.
STUDY OBJECTIVES: Type 3 home sleep apnea tests may underestimate the apnea-hypopnea index (AHI) due to overestimation of total sleep time (TST). We aimed to evaluate the effect of manual editing of the total recording time (TRT) on the TST and AHI. METHODS: Thirty 15-channel in-home polysomnography studies (AHI 0 to 30 events/h) scored using American Academy of Sleep Medicine criteria were rescored by two blinded polysomnologists after data from electroencephalogram, electrooculogram, and electromyogram were masked. In method 1, periods of probable wakefulness and artifact were manually edited and removed from analysis. Method 2 identified TST as the TRT without manual editing. Paired t-tests were used to compare the TST and AHI between these methods. Sensitivity and specificity of each method were calculated for gold standard AHI cutoffs of ≥ 5 and ≥ 15 events/h. RESULTS: TST (mean [standard deviation, SD]) by polysomnography, method 1, and method 2 was 366.0 (70.1), 447.1 (59.0), and 542 (61.9) min, respectively. The corresponding AHI was 12.5 (8.2), 10.8 (7.0), and 9.1 (6.1) events/h, respectively. Compared to polysomnography, both alternative methods overestimated the TST (method 1: mean difference [SD] 81.1 [56.1] min, method 2: 176.0 [89.7] min; both p < 0.001) and underestimated the AHI (method 1: mean difference [SD] -1.6 [3.3], method 2: -3.3 [3.9]; both p < 0.001). The sensitivity was 100% and 70.0% for method 1, and 91.3% and 40.0% for method 2 for identifying sleep-disordered breathing using AHI cutoffs of ≥ 5 and ≥ 15 events/h, respectively. CONCLUSIONS: Manual editing of TRT reduces the overestimation of TST and improves the sensitivity for identifying studies with sleep-disordered breathing. COMMENTARY: A commentary on this article appears in this issue on page 9.
Authors: Virend K Somers; David P White; Raouf Amin; William T Abraham; Fernando Costa; Antonio Culebras; Stephen Daniels; John S Floras; Carl E Hunt; Lyle J Olson; Thomas G Pickering; Richard Russell; Mary Woo; Terry Young Journal: Circulation Date: 2008-08-25 Impact factor: 29.690
Authors: Ana Claudia Tonelli de Oliveira; Denis Martinez; Luiz Felipe T Vasconcelos; Sandro Cadaval Gonçalves; Maria do Carmo Lenz; Sandra Costa Fuchs; Miguel Gus; Erlon Oliveira de Abreu-Silva; Leila Beltrami Moreira; Flávio Danni Fuchs Journal: Chest Date: 2009-02 Impact factor: 9.410
Authors: Nancy A Collop; W McDowell Anderson; Brian Boehlecke; David Claman; Rochelle Goldberg; Daniel J Gottlieb; David Hudgel; Michael Sateia; Richard Schwab Journal: J Clin Sleep Med Date: 2007-12-15 Impact factor: 4.062
Authors: Diane E Bild; David A Bluemke; Gregory L Burke; Robert Detrano; Ana V Diez Roux; Aaron R Folsom; Philip Greenland; David R Jacob; Richard Kronmal; Kiang Liu; Jennifer Clark Nelson; Daniel O'Leary; Mohammed F Saad; Steven Shea; Moyses Szklo; Russell P Tracy Journal: Am J Epidemiol Date: 2002-11-01 Impact factor: 4.897
Authors: Richard D Kim; Vishesh K Kapur; Julie Redline-Bruch; Michael Rueschman; Dennis H Auckley; Ruth M Benca; Nancy R Foldvary-Schafer; Conrad Iber; Phyllis C Zee; Carol L Rosen; Susan Redline; Scott D Ramsey Journal: Sleep Date: 2015-07-01 Impact factor: 5.849
Authors: Ilene M Rosen; Douglas B Kirsch; Kelly A Carden; Raman K Malhotra; Kannan Ramar; R Nisha Aurora; David A Kristo; Jennifer L Martin; Eric J Olson; Carol L Rosen; James A Rowley; Anita V Shelgikar Journal: J Clin Sleep Med Date: 2018-12-15 Impact factor: 4.062
Authors: Jennifer N Miller; Paula Schulz; Bunny Pozehl; Douglas Fiedler; Alissa Fial; Ann M Berger Journal: Sleep Breath Date: 2017-11-14 Impact factor: 2.816
Authors: Oren Cohen; Garrett M Strizich; Alberto R Ramos; Phyllis C Zee; Kathryn J Reid; Venkatesh Mani; David M Rapoport; Susan Redline; Robert C Kaplan; Neomi A Shah Journal: Chest Date: 2019-05-16 Impact factor: 9.410
Authors: Ilene M Rosen; Douglas B Kirsch; Ronald D Chervin; Kelly A Carden; Kannan Ramar; R Nisha Aurora; David A Kristo; Raman K Malhotra; Jennifer L Martin; Eric J Olson; Carol L Rosen; James A Rowley Journal: J Clin Sleep Med Date: 2017-10-15 Impact factor: 4.062
Authors: Judette M Louis; Matthew A Koch; Uma M Reddy; Robert M Silver; Corette B Parker; Francesca L Facco; Susan Redline; Chia-Ling Nhan-Chang; Judith H Chung; Grace W Pien; Robert C Basner; William A Grobman; Deborah A Wing; Hyagriv N Simhan; David M Haas; Brian M Mercer; Samuel Parry; Daniel Mobley; Benjamin Carper; George R Saade; Frank P Schubert; Phyllis C Zee Journal: Am J Obstet Gynecol Date: 2018-02-02 Impact factor: 8.661
Authors: Dayna A Johnson; S Justin Thomas; Marwah Abdalla; Na Guo; Yuichiro Yano; Michael Rueschman; Rikki M Tanner; Murray A Mittleman; David A Calhoun; James G Wilson; Paul Muntner; Susan Redline Journal: Circulation Date: 2019-03-05 Impact factor: 29.690
Authors: Dayna A Johnson; Sogol Javaheri; Na Guo; Cora L Champion; Jeraline F Sims; Michelene P Brock; Mario Sims; Sanjay R Patel; David R Williams; James G Wilson; Susan Redline Journal: Psychosom Med Date: 2020-04 Impact factor: 3.864