Chest
Volume 131, Issue 3, March 2007, Pages 725-732
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Original Research
Respiratory Polygraphy With Actigraphy in the Diagnosis of Sleep Apnea-Hypopnea Syndrome

https://doi.org/10.1378/chest.06-1604Get rights and content

Abstract

Objective:To determine the utility and reliability of a respiratory polygraphy (RP) device with actigraphy (Apnoescreen II; Erich Jaeger GMBH & CoKg; Wuerzburg, Germany) in the diagnosis of sleep apnea-hypopnea syndrome (SAHS).

Design:A prospective randomized study with blinded analysis.

Patients:Sixty-two patients with suspected SAHS.

Measurements:the following two RP studies were performed: one in the sleep laboratory (sleep laboratory RP [LRP]), simultaneously with polysomnography; and the other at home (home RP [HRP]). To study the interobserver reliability of RP, two manual analyses were carried out by two different researchers.

Results:In LRP, when the respiratory disturbance index was calculated using the total sleep time estimated by actigraphy (RDI) as a denominator, the sensitivity ranged between 94.6% and 100%, and the specificity between 88% and 96.7% for the different cutoff points of the apnea-hypopnea indexes studied. When the respiratory disturbance index was calculated according to the total recording time (RDITRT), the sensitivity was slightly lower (91.6 to 96.9%) and the specificity was similar (92 to 96.7%). In HRP, the sensitivity of the RDI ranged between 83.8% and 95.8%, and the specificity between 92% and 100%, whereas, when the RDITRT was used, the sensitivity was between 83.8% and 87.5%, and the specificity was between 94.7% and 100%. With regard to interobserver reliability, the intraclass correlation coefficient for the RDI of the two analyses of the RP was 0.99 for both LPR and HPR.

Conclusion:HPR is an effective and reliable technique for the diagnosis of SAHS, although it is less sensitive than LRP. Wrist actigraphy improves the results of HRP only slightly.

Section snippets

Patients

The study group included patients living in the city of Seville, Spain, who were consecutively referred to the sleep laboratory for polysomnography because of suspected SAHS. Exclusion criteria were physical or mental impairment that ruled out the use of the equipment. The following data were collected for all the patients: sex; age; personal history; symptoms of SAHS; body mass index (in kilograms per square millimeter); systolic and diastolic arterial pressure; and results of spirometry and

Results

Three of the 65 patients were excluded from the study, one due to a technical failure involving the polysomnography, and the other two withdrew during the course of the study. In one case, it was necessary to repeat polysomnography and the LRP because the sleep time was < 3 h. The home study had to be repeated in two cases (3%), one due to a technical failure on the transfer of the data to the computer and the other because of the poor quality of the oronasal airflow signal. The recordings

Discussion

The results of the present study show that HRP is a valid method, with a high sensitivity and specificity for the diagnosis of SAHS, after comparing it with standard polysomnography. The diagnostic accuracy of HRP was only slightly lower than that of LRP. Moreover, in our study, the interobserver reliability in the analysis of the RP recordings was very high. On the other hand, in the case of the AP-II, wrist actigraphy contributed little to improving the efficacy of RP.

In the validation

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    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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