Shane A Landry1,2,3, Simon A Joosten4,5,6, Luke D J Thomson1,2, Anthony Turton4, Ai-Ming Wong4,5, Paul Leong5, Philip I Terrill7, Dwayne Mann7, Scott A Sands8,9, Garun S Hamilton4,5,6, Bradley A Edwards1,2,3. 1. Department of Physiology, School of Biomedical Sciences. 2. Monash Biomedicine Discovery Institute. 3. Turner Institute for Brain and Mental Health, and. 4. School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia. 5. Monash Lung and Sleep, Monash Medical Centre, Clayton, Victoria, Australia. 6. Monash Partners-Epworth, Melbourne, Victoria, Australia. 7. School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Queensland, Australia. 8. Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts; and. 9. The Alfred and Monash University, Melbourne, Victoria, Australia.
Abstract
Rationale: Unstable ventilatory control (high loop gain) is a causal factor in the development of obstructive sleep apnea. Methods for quantifying loop gain using polysomnography have been developed that predict favorable responses to upper airway surgery. However, this method is reliant on respiratory event scoring and hence may be affected by hypopnea scoring criteria. Objectives: To determine to what extent differences in hypopnea scoring influence loop gain measurement. Methods: We performed a retrospective analysis of 46 polysomnograms before and after upper airway surgery. Polysomnograms were rescored according to three different American Academy of Sleep Medicine hypopnea definitions (2007Alternative, 2012Recommended, and 2012Acceptable criteria). Loop gain and apnea-hypopnea indexes (AHIs) were compared between criteria using linear regression and Bland-Altman limits of agreement (LOA). Responders to surgery were classified by a 50% or greater reduction in AHI and AHIpostsurgery less than 10 events per hour. Responders were determined separately for each American Academy of Sleep Medicine criterion. Receiver operating characteristic curve analysis predicting surgical outcome was performed for each loop gain measurement derived from each criterion. Results: A near-perfect agreement was found between loop gains derived using the 2007Alternative and 2012Recommended criteria (r2 = 0.99; bias = -0.003; LOA, -0.016 to 0.010). Greater variability was found for 2012Acceptable compared to the 2007Alternative (r2 = 0.70; bias = -0.015; LOA, -0.099 to 0.070) and 2012Recommended (r2 = 0.69; bias = +0.018; LOA, -0.068 to 0.104) criteria. Both 2007Alternative and 2012Recommended loop gains significantly predicted surgical response with similar areas under the curve (AUCs; 2007Alternative AUC = 0.86 [95% confidence interval (CI), 0.75-0.97]; 2012Recommended AUC = 0.84 [95% CI, 0.71-0.97]). 2012Acceptable loop gains were a poor predictor of surgical response (AUC = 0.62 [95% CI, 0.43-0.80]).Conclusions: Loop gain measured noninvasively by polysomnography can be influenced by respiratory event scoring. We recommend caution when using the 2012Acceptable criteria with this method, because such findings may not be directly generalizable to other loop gain values derived from other scoring criteria.
Rationale: Unstable ventilatory control (high loop gain) is a causal factor in the development of obstructive sleep apnea. Methods for quantifying loop gain using polysomnography have been developed that predict favorable responses to upper airway surgery. However, this method is reliant on respiratory event scoring and hence may be affected by hypopnea scoring criteria. Objectives: To determine to what extent differences in hypopnea scoring influence loop gain measurement. Methods: We performed a retrospective analysis of 46 polysomnograms before and after upper airway surgery. Polysomnograms were rescored according to three different American Academy of Sleep Medicine hypopnea definitions (2007Alternative, 2012Recommended, and 2012Acceptable criteria). Loop gain and apnea-hypopnea indexes (AHIs) were compared between criteria using linear regression and Bland-Altman limits of agreement (LOA). Responders to surgery were classified by a 50% or greater reduction in AHI and AHIpostsurgery less than 10 events per hour. Responders were determined separately for each American Academy of Sleep Medicine criterion. Receiver operating characteristic curve analysis predicting surgical outcome was performed for each loop gain measurement derived from each criterion. Results: A near-perfect agreement was found between loop gains derived using the 2007Alternative and 2012Recommended criteria (r2 = 0.99; bias = -0.003; LOA, -0.016 to 0.010). Greater variability was found for 2012Acceptable compared to the 2007Alternative (r2 = 0.70; bias = -0.015; LOA, -0.099 to 0.070) and 2012Recommended (r2 = 0.69; bias = +0.018; LOA, -0.068 to 0.104) criteria. Both 2007Alternative and 2012Recommended loop gains significantly predicted surgical response with similar areas under the curve (AUCs; 2007Alternative AUC = 0.86 [95% confidence interval (CI), 0.75-0.97]; 2012Recommended AUC = 0.84 [95% CI, 0.71-0.97]). 2012Acceptable loop gains were a poor predictor of surgical response (AUC = 0.62 [95% CI, 0.43-0.80]).Conclusions: Loop gain measured noninvasively by polysomnography can be influenced by respiratory event scoring. We recommend caution when using the 2012Acceptable criteria with this method, because such findings may not be directly generalizable to other loop gain values derived from other scoring criteria.
Authors: Christopher N Schmickl; Jeremy E Orr; Paul Kim; Brandon Nokes; Scott Sands; Sreeganesh Manoharan; Lana McGinnis; Gabriela Parra; Pamela DeYoung; Robert L Owens; Atul Malhotra Journal: BMC Pulm Med Date: 2022-04-25 Impact factor: 3.320
Authors: Andrey V Zinchuk; Jen-Hwa Chu; Jiasheng Liang; Yeliz Celik; Sara Op de Beeck; Nancy S Redeker; Andrew Wellman; H Klar Yaggi; Yüksel Peker; Scott A Sands Journal: Am J Respir Crit Care Med Date: 2021-09-15 Impact factor: 30.528
Authors: Eysteinn Finnsson; Guðrún H Ólafsdóttir; Dagmar L Loftsdóttir; Sigurður Æ Jónsson; Halla Helgadóttir; Jón S Ágústsson; Scott A Sands; Andrew Wellman Journal: Sleep Date: 2021-01-21 Impact factor: 6.313