Skip to main content

Advertisement

SpringerLink
Log in

Follow-up assessment of CPAP efficacy in patients with obstructive sleep apnea using an ambulatory device based on peripheral arterial tonometry

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

This study aimed to assess the accuracy of a wrist-worn device based on peripheral arterial tonometry (Watch_PAT 100) to detect residual episodes of respiratory disturbance during continuous positive airway pressure (CPAP) therapy. Concurrent polysomnography was used as the reference standard to identify sleep disordered breathing (SDB) events. The study was conducted in three sleep laboratories affiliated with tertiary care academic medical centers. Seventy patients using CPAP to treat obstructive sleep apnea for at least 3 months, following an in-laboratory titration to determine the optimal therapeutic positive airway pressure, participated in this study. Symptoms indicating suboptimal therapy were not required for participation, but self-reported adherence to CPAP therapy was necessary for inclusion. Interventions are not applicable in this study. The accuracy of the PAT-derived respiratory disturbance index (PAT RDI scored by automated algorithm) to detect residual SDB on CPAP was assessed against polysomnography (PSG) using Bland–Altman analysis, receiver–operator characteristic (ROC) curves, and likelihood ratios for increasing (LR+) and decreasing (LR−) the probability of moderate–severe SDB in the study population. Respiratory events on the PSG were quantified using standard criteria for research investigations (“Chicago criteria”) to yield a PSG RDI.C. Based on the PSG results, 19% of the participants had moderate–severe SDB (PSG RDI.C>15 events per hour) on their prescribed pressure. For PAT RDI >15 events per hour, the area under the ROC curve was 0.95 (SE 0.03, p<0.0001, 95% CI 0.89 to 1.00), the LR+ was 8.04 (95% CI 3.64–17.7), and the LR− was 0.17 (95% CI 0.05–0.62). The mean difference between the PAT RDI and PSG RDI.C was three (2SD 14.5) events per hour. Therefore, residual moderate–severe SDB on CPAP was not uncommon in a multicenter population self-reporting adherence to CPAP therapy to treat obstructive sleep apnea. The Watch_PAT device accurately identified participants with moderate–severe SDB while using CPAP in the attended setting of a sleep laboratory.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Remmers JE, deGroot WJ, Sauerland EK, Anch AM (1978) Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 44:931–938

    PubMed  CAS  Google Scholar 

  2. Lavie P, Herer P, Hoffstein V (2000) Obstructive sleep apnea syndrome as a risk factor for hypertension: population study. BMJ 320:479–482

    Article  PubMed  CAS  Google Scholar 

  3. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384

    Article  PubMed  CAS  Google Scholar 

  4. Hung J, Whitford EG, Parsons RW, Hillman DR (1990) Association of sleep apnea with myocardial infarction in men. Lancet 336:261–264

    Article  PubMed  CAS  Google Scholar 

  5. Dyken ME, Somers VK, Yamada T, Ren ZY, Zimmerman MB (1996) Investigating the relationship between stroke and obstructive sleep apnea. Stroke 27:401–407

    PubMed  CAS  Google Scholar 

  6. Leuenberger U, Jacob E, Sweer L, Waravdekar N, Zwillich C, Sinoway L (1995) Surges of muscle sympathetic nerve activity during obstructive apnea are linked to hypoxemia. J Appl Physiol 79:581–588

    PubMed  CAS  Google Scholar 

  7. Hedner J, Darpo B, Ejnell H, Carlson J, Caidahl K (1995) Reduction in sympathetic activity after long-term CPAP treatment in sleep apnea: cardiovascular implications. Eur Respir J 8:222–229

    Article  PubMed  CAS  Google Scholar 

  8. Narkiewicz K, Kato M, Phillips BG, Pesek CA, Davison DE, Somers VK (1999) Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation 100:2332–2335

    PubMed  CAS  Google Scholar 

  9. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnea–hypopnea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    PubMed  Google Scholar 

  10. White DP, Gibb TJ (1998) Evaluation of the Healthdyne NightWatch system to titrate CPAP in the home. Sleep 21:198–204

    PubMed  CAS  Google Scholar 

  11. Pack AI, Black JE, Schwartz JR, Matheson JK (2001) Modafinil as adjunct therapy for daytime sleepiness in obstructive sleep apnea. Am J Respir Crit Care Med 164:1675–1681

    PubMed  CAS  Google Scholar 

  12. Shahar E, Whitney CW, Redline S et al (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25

    PubMed  CAS  Google Scholar 

  13. Grote L, Hedner J, Grunstein R, Kraiczi H (2000) Therapy with nCPAP: incomplete elimination of sleep related breathing disorder. Eur Respir J 16:921–927

    Article  PubMed  CAS  Google Scholar 

  14. Thomas RJ, Daly RW, Weiss JW (2005) Low-concentration carbon dioxide is an effective adjunct to positive airway pressure in the treatment of refractory mixed central and obstructive sleep-disordered breathing. Sleep 28:69–77

    PubMed  Google Scholar 

  15. Schnall RP, Shlitner A, Sheffy J, Kedar R, Lavie P (1999) Periodic, profound peripheral vasoconstriction—a new marker of obstructive sleep apnea. Sleep 22:939–946

    PubMed  CAS  Google Scholar 

  16. Bar A, Pillar G, Dvir I, Sheffy J, Schnall RP, Lavie P (2003) Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies. Chest 123:695–703

    Article  PubMed  Google Scholar 

  17. Ayas NT, Pittman S, MacDonald M, White DP (2003) Assessment of a wrist-worn device in the detection of obstructive sleep apnea. Sleep Med 4:435–442

    Article  PubMed  Google Scholar 

  18. Pittman SD, Ayas NT, MacDonald MM, Malhotra A, Fogel RB, White DP (2004) Using a wrist-worn device based on peripheral arterial tonometry to diagnose obstructive sleep apnea: in-laboratory and ambulatory validation. Sleep 27:923–933

    PubMed  Google Scholar 

  19. O’Donnell CP, Allan L, Atkinson P, Schwartz AR (2002) The effect of upper airway obstruction and arousal on peripheral arterial tonometry in obstructive sleep apnea. Am J Respir Crit Care Med 166:965–971

    Article  PubMed  Google Scholar 

  20. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    PubMed  CAS  Google Scholar 

  21. Hedner J, Pillar G, Pittman SD, Zou D, Grote L, White DP (2004) A novel adaptive wrist actigraphy algorithm for sleep–wake assessment in sleep apnea patients. Sleep 27:1560–1566

    PubMed  Google Scholar 

  22. American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689

    Google Scholar 

  23. Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects. Brain Information Service, Los Angeles

    Google Scholar 

  24. Sleep Disorders Atlas Task Force of the American Sleep Disorders Association (1992) EEG arousals: scoring rules and examples: a preliminary report. Sleep 15:173–184

    Google Scholar 

  25. Portney LG, Watkins MP (1993) Foundations of clinical research: applications to Practice, 1st edn. Appleton & Lange, Norwalk, CT

    Google Scholar 

  26. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    PubMed  CAS  Google Scholar 

  27. Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36

    PubMed  CAS  Google Scholar 

  28. Flemons WW, Littner MR, Rowley JA et al (2003) Home diagnosis of sleep apnea: a systematic review of the literature. An evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society. Chest 124:1543–1579

    Article  PubMed  Google Scholar 

  29. Standards of medical care in diabetes (2004) Diabetes Care 27:15S–35S

    Article  Google Scholar 

  30. Sackett D, Strauss S, Richardson W, Rosenberg W, Haynes R (2000) Evidence-based medicine: how to practice and teach EBM, 2nd edn. Churchill Livingston, Edinburgh, Scotland

    Google Scholar 

Download references

Acknowledgements

S.D. Pittman, Dr. Pillar and Dr. White have served as consultants for Itamar Medical, the developer of the Watch_PAT device. Itamar Medical Ltd. provided the research support necessary to conduct this study. S.D. Pittman is currently employed by Respironics. Dr. Berry has also received research support from Fisher Paykel, Dymedix, and ResMed. Dr. Malhotra has received unrestricted research support from Respironics and is a member of the speaker’s bureau for Respironics and Sepracor. Dr. White is also a consultant for Respironics, WideMED, the Alfred Mann Foundation, Cephalon, and Aspire Medical.

Author information

Authors and Affiliations

  1. Division of Sleep Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115-5817, USA

    Stephen D. Pittman, Atul Malhotra, Mary M. MacDonald & David P. White

  2. Sleep Laboratory, Technion-Israel Institute of Technology, Haifa, Israel

    Giora Pillar

  3. Pulmonary Medicine, Malcolm Randall VA Medical Center, Gainesville, FL, USA

    Richard B. Berry

  4. Pulmonary Medicine, University of Florida, Gainesville, FL, USA

    Richard B. Berry

Authors
  1. Stephen D. Pittman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giora Pillar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard B. Berry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Atul Malhotra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mary M. MacDonald
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David P. White
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephen D. Pittman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pittman, S.D., Pillar, G., Berry, R.B. et al. Follow-up assessment of CPAP efficacy in patients with obstructive sleep apnea using an ambulatory device based on peripheral arterial tonometry. Sleep Breath 10, 123–131 (2006). https://doi.org/10.1007/s11325-006-0058-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-006-0058-x

Keywords

Search

Navigation