Reliability of automatic detection of AHI during positive airway pressure treatment in obstructive sleep apnea patients: A “real-life study”

Reliability of automatic detection of AHI during positive airway pressure treatment in obstructive sleep apnea patients: A “real-life study”

Automatic event detection (AED) of residual apnea-hypopnea index (AHI) by ventilators is a current practice in sleep and mechanical ventilation Units but this methodology has not been validated in an unselected population of OSA patients. Aim of the present study was to assess in a “real-life” condi...

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Bibliographic Details
Published in:Respiratory medicine Vol. 177; p. 106303
Main Authors: Fanfulla, F., D'Artavilla Lupo, N., Malovini, A., Arcovio, S., Prpa, A., Mogavero, M.P., Pronzato, C., Bonsignore, Maria R.
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01-02-2021
Elsevier Limited
Subjects:
Apnea
Computer programs
Continuous positive airway pressure
CPAP
Gender
Laboratories
Likelihood ratio
Mechanical ventilation
OSA
Patients
Polysomnography
Reliability analysis
Reliability aspects
Residual OSA
Respiratory tract
Sleep
Sleep and wakefulness
Sleep apnea
Sleep disorders
Sleepiness
Software
Ventilation
Ventilators
Sleep apnea
CPAP
OSA
Polysomnography
Residual OSA
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Summary:Automatic event detection (AED) of residual apnea-hypopnea index (AHI) by ventilators is a current practice in sleep and mechanical ventilation Units but this methodology has not been validated in an unselected population of OSA patients. Aim of the present study was to assess in a “real-life” condition the reliability of AED during PAP therapy by the in-built software compared to full polysomnography during follow-up. We enrolled 300 OSA patients (105 F; AHI 45.3 ± 27.8) already on Positive airway pressure (PAP) therapy: 53% of the patients were on CPAP while other modalities were used in the rest of the sample. Overall, the built-in software identified residual obstructive AHI (AHIPAP) > 5, 10 or 15 in 18.7, 8.6 or 4.6% of patients, respectively. By using AHIPAP, 28.4% of patients were wrongly classified as “well controlled” despite a residual AHIPSG>5 (6% considering a residual AHIVENT >15); 7% of patients were classified as not controlled while AHIPSG was <5 (1.4% considering a residual AHIVENT >15). Type of ventilation, ventilator parameters, adherence to treatment and level of baseline or follow-up Epworth Sleepiness Scale score were similar between groups. The sensitivity and positive predicted values were very low. Positive likelihood ratio appears adequate only for residual AHIPAP ≥10, but negative likelihood ratio was inconclusive for all the cut-off considered. The results of the present study suggest a more cautious approach in the follow-up of OSA patients, since a protocol based only on AED detection and symptoms assessment may not be accurate especially for AHIPAP<15.
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ISSN:0954-6111
1532-3064
DOI:10.1016/j.rmed.2021.106303