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Validating respiratory index of auto-titrating positive airway pressure device with polysomnography

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Positive airway pressure (PAP) devices have been widely used as the first line of treatment in obstructive sleep apnea (OSA). Most advanced PAP devices support the estimation of respiratory index (RI) using the patient’s mask airflow. In addition to the compliance factor for PAP device use, which is important for monitoring patient sleep health, RI is also becoming important for monitoring. However, there are few reports that validate RI of a PAP device with polysomnography.

Methods

Between January 2015 and December 2017, 50 participants were enrolled who were diagnosed with OSA and prescribed auto-titration PAP (APAP) devices. The RIs of participants were measured at night using APAP devices, concurrently with electroencephalography, respiratory inductance plethysmography sensors, and other polysomnographic sensors in a sleep laboratory. The respiratory-related data of APAP were prospectively analyzed with the manually scored polysomnographic data.

Results

The apnea-hypopnea index and apnea index showed a statistically close relationship between the auto-scored respiratory data from the APAP device and the manually scored respiratory data from polysomnographic sensors. Obstructive apnea and central apnea indices showed relatively low correlations. The differences between the auto-scored RI and manually scored RI were influenced by BMI, waist circumference, weight, oxygen saturation, and respiratory distress indices of diagnostic polysomnographic factors.

Conclusions

The RIs of APAP devices have a tendency to be underestimated or mismatched when compared with polysomnography. Sleep specialists are advised to consider additional anthropometric and diagnostic factors to account for these differences during PAP treatment.

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Funding

This was not an industry-supported study. This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (2017R1E1A1A01074543) and the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HC15C3415). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea

    Do-Yang Park, Gayoung Gu, Jang Gyu Han & Hyun Jun Kim

  2. Sleep Center, Ajou University Hospital, Suwon, Republic of Korea

    Do-Yang Park & Hyun Jun Kim

  3. Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea

    Bumhee Park

  4. Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea

    Bumhee Park

Authors
  1. Do-Yang Park
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  2. Gayoung Gu
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  3. Jang Gyu Han
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  4. Bumhee Park
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  5. Hyun Jun Kim
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Corresponding author

Correspondence to Hyun Jun Kim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Comment

This study demonstrates to considerable inadequacy and lack of validity of current "AHI" measures, as determined by machine algorithm. The issues of leak, and possible under/over therapy are crucial. These machine-derived events are, in reality, "Airflow Limited Events". They should be described as such. The ALE is not an AHI!!! Without measure of plethysmography, EEG determined sleep or saturation, the value of these observations, is helpful, but not a valid measure for clinically complex patients. This paper makes a very important contribution to our understanding of machine determined algorithms, versus gold standard measure. I applaud the authors.

David Joffe

NSW, Australia

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Park, DY., Gu, G., Han, J.G. et al. Validating respiratory index of auto-titrating positive airway pressure device with polysomnography. Sleep Breath 25, 1477–1485 (2021). https://doi.org/10.1007/s11325-020-02278-9

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  • DOI: https://doi.org/10.1007/s11325-020-02278-9

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