Abstract
BackgroundThe coexistence of obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) leads to increased morbidity and mortality. The development of home-based screening tests is essential to expedite diagnosis. Nevertheless, there is still very limited evidence on the effectiveness of portable monitoring to diagnose OSAS in patients with pulmonary comorbidities.ObjectiveTo assess the influence of suffering from COPD in the performance of an oximetry-based screening test for moderate-to-severe OSAS, both in the hospital and at home.MethodsA total of 407 patients showing moderate-to-high clinical suspicion of OSAS were involved in the study. All subjects underwent (i) supervised portable oximetry simultaneously to in-hospital polysomnography (PSG) and (ii) unsupervised portable oximetry at home. A regression-based multilayer perceptron (MLP) artificial neural network (ANN) was trained to estimate the apnea-hypopnea index (AHI) from portable oximetry recordings. Two independent validation datasets were analyzed: COPD versus non-COPD.ResultsThe portable oximetry-based MLP ANN reached similar intra-class correlation coefficient (ICC) values between the estimated AHI and the actual AHI for the non-COPD and the COPD groups either in the hospital (non-COPD: 0.937, 0.909–0.956 CI95%; COPD: 0.936, 0.899–0.960 CI95%) and at home (non-COPD: 0.731, 0.631–0.808 CI95%; COPD: 0.788, 0.678–0.864 CI95%). Regarding the area under the receiver operating characteristics curve (AUC), no statistically significant differences (p >0.01) between COPD and non-COPD groups were found in both settings, particularly for severe OSAS (AHI ≥30 events/h): 0.97 (0.92–0.99 CI95%) non-COPD vs. 0.98 (0.92–1.0 CI95%) COPD in the hospital, and 0.87 (0.79–0.92 CI95%) non-COPD vs. 0.86 (0.75–0.93 CI95%) COPD at home.ConclusionThe agreement and the diagnostic performance of the estimated AHI from automated analysis of portable oximetry were similar regardless of the presence of COPD both in-lab and at-home. Particularly, portable oximetry could be used as an abbreviated screening test for moderate-to-severe OSAS in patients with COPD.
Highlights
Obstructive sleep apnea syndrome (OSAS) patients suffer from recurrent episodes of airflow limitation due to intermittent complete or partial collapse of the upper airway while sleeping, leading to non-restful sleep and diminished quality of life [1, 2]
Our results revealed that no significant differences exist between chronic obstructive pulmonary disease (COPD) and non-COPD patients concerning the capability of the proposed artificial neural network (ANN) from portable oximetry as a screening test for OSAS
While the proposed ANNs could be optimized in future studies using a more balanced population, our models provide interesting insight into the usefulness of portable monitoring for OSAS detection in COPD patients, i.e., oximetry could be an efficient tool as a simplified screening test for OSAS regardless of suffering from COPD
Summary
Obstructive sleep apnea syndrome (OSAS) patients suffer from recurrent episodes of airflow limitation due to intermittent complete or partial collapse of the upper airway while sleeping, leading to non-restful sleep and diminished quality of life [1, 2]. Most researchers exclude patients with significant cardiovascular and pulmonary comorbidities from the population under study, which is an important limitation in order to generalize the results. A recent report of the American Academy of Sleep Medicine (AASM) does not recommend the use of portable monitoring for OSAS screening in such patients because there is still little if any evidence on its effectiveness [11]. There is currently an increasing demand for studies focusing on the assessment of home testing algorithms in patients showing significant comorbidities, especially chronic obstructive pulmonary disease (COPD) [10, 16, 17]. The coexistence of obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) leads to increased morbidity and mortality. There is still very limited evidence on the effectiveness of portable monitoring to diagnose OSAS in patients with pulmonary comorbidities
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