Yue-Nan Ni1, Robert Joseph Thomas2. 1. Department of Respiratory, Critical Care and Sleep Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China. 2. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Abstract
STUDY OBJECTIVES: During positive airway pressure (PAP) therapy for sleep apnea syndromes, the machine-detected respiratory event index (REIFLOW) is an important method for clinicians to evaluate the beneficial effects of PAP. There are concerns about the accuracy of this detection, which also confounds a related question, How common and severe are residual events on PAP? METHODS: Patients with obstructive sleep apnea who underwent a split-night polysomnography were recruited prospectively. Those treated with PAP and tracked by the EncoreAnywhere system (Philips Respironics, Murrysville, PA) were analyzed. Those who stopped PAP within 1 month were excluded from this analysis. Compliance, therapy data, and waveform data were analyzed. Machine-detected vs manually scored events were compared at the first, third, sixth, and 12th month from PAP initiation. Logistic regression was used to determine factors associated with a high REIFLOW difference. RESULTS: One hundred and seventy-nine patients with a mean age 59.06 ± 13.97 years, median body mass index of 33.60 (29.75-38.75) kg/m2, and median baseline apnea-hypopnea index of 46.30 (31.50-65.90) events/h were included. The difference between the machine-detected REIFLOW and manually scored REIFLOW was 10.72 ± 8.43 events/h in the first month and remained stable for up to 12 months. Male sex and large leak ≥ 1.5% were more frequent in patients who had an REIFLOW difference of ≥ 5 events/h of use. A titration arousal index ≥ 15 events/h of sleep, and higher ratio of unstable to stable breathing were also associated with an REIFLOW difference ≥ 5 events/h of use. CONCLUSIONS: There is a substantial and sustained difference between manual and automated event estimates during PAP therapy, and some associated factors were identified. CITATION: Ni Y-N, Thomas RJ. A longitudinal study of the accuracy of positive airway pressure therapy machine-detected apnea-hypopnea events. J Clin Sleep Med. 2022;18(4):1121-1134.
STUDY OBJECTIVES: During positive airway pressure (PAP) therapy for sleep apnea syndromes, the machine-detected respiratory event index (REIFLOW) is an important method for clinicians to evaluate the beneficial effects of PAP. There are concerns about the accuracy of this detection, which also confounds a related question, How common and severe are residual events on PAP? METHODS: Patients with obstructive sleep apnea who underwent a split-night polysomnography were recruited prospectively. Those treated with PAP and tracked by the EncoreAnywhere system (Philips Respironics, Murrysville, PA) were analyzed. Those who stopped PAP within 1 month were excluded from this analysis. Compliance, therapy data, and waveform data were analyzed. Machine-detected vs manually scored events were compared at the first, third, sixth, and 12th month from PAP initiation. Logistic regression was used to determine factors associated with a high REIFLOW difference. RESULTS: One hundred and seventy-nine patients with a mean age 59.06 ± 13.97 years, median body mass index of 33.60 (29.75-38.75) kg/m2, and median baseline apnea-hypopnea index of 46.30 (31.50-65.90) events/h were included. The difference between the machine-detected REIFLOW and manually scored REIFLOW was 10.72 ± 8.43 events/h in the first month and remained stable for up to 12 months. Male sex and large leak ≥ 1.5% were more frequent in patients who had an REIFLOW difference of ≥ 5 events/h of use. A titration arousal index ≥ 15 events/h of sleep, and higher ratio of unstable to stable breathing were also associated with an REIFLOW difference ≥ 5 events/h of use. CONCLUSIONS: There is a substantial and sustained difference between manual and automated event estimates during PAP therapy, and some associated factors were identified. CITATION: Ni Y-N, Thomas RJ. A longitudinal study of the accuracy of positive airway pressure therapy machine-detected apnea-hypopnea events. J Clin Sleep Med. 2022;18(4):1121-1134.
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