Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy
Identifieur interne : 000399 ( Pmc/Corpus ); précédent : 000398; suivant : 000400Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy
Auteurs : Juan F. Masa ; Jaime Corral ; Javier Gomez De Terreros ; Joaquin Duran-Cantolla ; Marta Cabello ; Luis Hernández-Blasco ; Carmen Monasterio ; Alberto Alonso ; Eusebi Chiner ; Felipe Aizpuru ; Jose Zamorano ; Ricardo Cano ; Jose M. Montserrat ; Estefania Garcia-Ledesma ; Ricardo Pereira ; Laura Cancelo ; Angeles Martinez ; Lirios Sacristan ; Neus Salord ; Miguel Carrera ; José N. Sancho-Chust ; Cristina EmbidSource :
- Sleep [ 0161-8105 ] ; 2013.
Abstract
Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals.
We performed a multicentric, randomized, blinded crossover study to determine the agreement between home respiratory polygraphy (HRP) and PSG, and between simultaneous respiratory polygraphy (respiratory polygraphy with PSG) (SimultRP) and PSG by means of 2 AHI scoring protocols with or without hyperventilation following flow reduction considered as a surrogate arousal.
We included suspected SAHS patients from 8 hospitals. They were assigned to home and hospital protocols at random. We determined the agreement between respiratory polygraphy AHI and PSG AHI scorings using Bland and Altman plots and diagnostic agreement using receiver operating characteristic (ROC) curves. The agreement in therapeutic decisions (continuous positive airway pressure treatment or not) between HRP and PSG scorings was done with likelihood ratios and post-test probability calculations.
Of 366 randomized patients, 342 completed the protocol. AHI from HRP scorings (with and without surrogate arousal) had similar agreement with PSG. AHI from SimultRP with surrogate arousal scoring had better agreement with PSG than AHI from SimultRP without surrogate arousal. HRP with surrogate arousal scoring had slightly worse ROC curves than HRP without surrogate arousal, and the opposite was true for SimultRP scorings. HRP with surrogate arousal showed slightly better agreement with PSG in therapeutic decisions than for HRP without surrogate arousal.
Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).
Masa JF; Corral J; Gomez de Terreros J; Duran-Cantolla J; Cabello M; Hernández-Blasco L; Monasterio C; Alonso A; Chiner E; Aizpuru F; Zamorano J; Cano R; Monterrat JM. Significance of including a surrogate arousal for sleep apnea-hypopnea syndrome diagnosis by respiratory polygraphy.
Url:
DOI: 10.5665/sleep.2384
PubMed: 23372273
PubMed Central: 3543063
Links to Exploration step
PMC:3543063Le document en format XML
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<author><name sortKey="Masa, Juan F" sort="Masa, Juan F" uniqKey="Masa J" first="Juan F." last="Masa">Juan F. Masa</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Corral, Jaime" sort="Corral, Jaime" uniqKey="Corral J" first="Jaime" last="Corral">Jaime Corral</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
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<author><name sortKey="Gomez De Terreros, Javier" sort="Gomez De Terreros, Javier" uniqKey="Gomez De Terreros J" first="Javier" last="Gomez De Terreros">Javier Gomez De Terreros</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Duran Cantolla, Joaquin" sort="Duran Cantolla, Joaquin" uniqKey="Duran Cantolla J" first="Joaquin" last="Duran-Cantolla">Joaquin Duran-Cantolla</name>
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</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
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<author><name sortKey="Cabello, Marta" sort="Cabello, Marta" uniqKey="Cabello M" first="Marta" last="Cabello">Marta Cabello</name>
<affiliation><nlm:aff id="aff3">Valdecilla Hospital, Santander, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hernandez Blasco, Luis" sort="Hernandez Blasco, Luis" uniqKey="Hernandez Blasco L" first="Luis" last="Hernández-Blasco">Luis Hernández-Blasco</name>
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</affiliation>
</author>
<author><name sortKey="Monasterio, Carmen" sort="Monasterio, Carmen" uniqKey="Monasterio C" first="Carmen" last="Monasterio">Carmen Monasterio</name>
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</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
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<author><name sortKey="Alonso, Alberto" sort="Alonso, Alberto" uniqKey="Alonso A" first="Alberto" last="Alonso">Alberto Alonso</name>
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<author><name sortKey="Chiner, Eusebi" sort="Chiner, Eusebi" uniqKey="Chiner E" first="Eusebi" last="Chiner">Eusebi Chiner</name>
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</affiliation>
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<author><name sortKey="Aizpuru, Felipe" sort="Aizpuru, Felipe" uniqKey="Aizpuru F" first="Felipe" last="Aizpuru">Felipe Aizpuru</name>
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<author><name sortKey="Zamorano, Jose" sort="Zamorano, Jose" uniqKey="Zamorano J" first="Jose" last="Zamorano">Jose Zamorano</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cano, Ricardo" sort="Cano, Ricardo" uniqKey="Cano R" first="Ricardo" last="Cano">Ricardo Cano</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Montserrat, Jose M" sort="Montserrat, Jose M" uniqKey="Montserrat J" first="Jose M." last="Montserrat">Jose M. Montserrat</name>
<affiliation><nlm:aff id="aff8">Clinic Hospital, Barcelona, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Garcia Ledesma, Estefania" sort="Garcia Ledesma, Estefania" uniqKey="Garcia Ledesma E" first="Estefania" last="Garcia-Ledesma">Estefania Garcia-Ledesma</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Pereira, Ricardo" sort="Pereira, Ricardo" uniqKey="Pereira R" first="Ricardo" last="Pereira">Ricardo Pereira</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cancelo, Laura" sort="Cancelo, Laura" uniqKey="Cancelo L" first="Laura" last="Cancelo">Laura Cancelo</name>
<affiliation><nlm:aff id="aff2">Txagoritxu Hospital, Vitoria, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Martinez, Angeles" sort="Martinez, Angeles" uniqKey="Martinez A" first="Angeles" last="Martinez">Angeles Martinez</name>
<affiliation><nlm:aff id="aff3">Valdecilla Hospital, Santander, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sacristan, Lirios" sort="Sacristan, Lirios" uniqKey="Sacristan L" first="Lirios" last="Sacristan">Lirios Sacristan</name>
<affiliation><nlm:aff id="aff4">General Universitario Hospital, Alicante, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Salord, Neus" sort="Salord, Neus" uniqKey="Salord N" first="Neus" last="Salord">Neus Salord</name>
<affiliation><nlm:aff id="aff5">Belvitge Hospital, Barcelona, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Carrera, Miguel" sort="Carrera, Miguel" uniqKey="Carrera M" first="Miguel" last="Carrera">Miguel Carrera</name>
<affiliation><nlm:aff id="aff6">Son Dureta Hospital, Palma de Mallorca, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sancho Chust, Jose N" sort="Sancho Chust, Jose N" uniqKey="Sancho Chust J" first="José N." last="Sancho-Chust">José N. Sancho-Chust</name>
<affiliation><nlm:aff id="aff7">San Juan Hospital, Alicante, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Embid, Cristina" sort="Embid, Cristina" uniqKey="Embid C" first="Cristina" last="Embid">Cristina Embid</name>
<affiliation><nlm:aff id="aff8">Clinic Hospital, Barcelona, Spain</nlm:aff>
</affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy</title>
<author><name sortKey="Masa, Juan F" sort="Masa, Juan F" uniqKey="Masa J" first="Juan F." last="Masa">Juan F. Masa</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Corral, Jaime" sort="Corral, Jaime" uniqKey="Corral J" first="Jaime" last="Corral">Jaime Corral</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Gomez De Terreros, Javier" sort="Gomez De Terreros, Javier" uniqKey="Gomez De Terreros J" first="Javier" last="Gomez De Terreros">Javier Gomez De Terreros</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Duran Cantolla, Joaquin" sort="Duran Cantolla, Joaquin" uniqKey="Duran Cantolla J" first="Joaquin" last="Duran-Cantolla">Joaquin Duran-Cantolla</name>
<affiliation><nlm:aff id="aff2">Txagoritxu Hospital, Vitoria, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cabello, Marta" sort="Cabello, Marta" uniqKey="Cabello M" first="Marta" last="Cabello">Marta Cabello</name>
<affiliation><nlm:aff id="aff3">Valdecilla Hospital, Santander, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hernandez Blasco, Luis" sort="Hernandez Blasco, Luis" uniqKey="Hernandez Blasco L" first="Luis" last="Hernández-Blasco">Luis Hernández-Blasco</name>
<affiliation><nlm:aff id="aff4">General Universitario Hospital, Alicante, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Monasterio, Carmen" sort="Monasterio, Carmen" uniqKey="Monasterio C" first="Carmen" last="Monasterio">Carmen Monasterio</name>
<affiliation><nlm:aff id="aff5">Belvitge Hospital, Barcelona, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Alonso, Alberto" sort="Alonso, Alberto" uniqKey="Alonso A" first="Alberto" last="Alonso">Alberto Alonso</name>
<affiliation><nlm:aff id="aff6">Son Dureta Hospital, Palma de Mallorca, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Chiner, Eusebi" sort="Chiner, Eusebi" uniqKey="Chiner E" first="Eusebi" last="Chiner">Eusebi Chiner</name>
<affiliation><nlm:aff id="aff7">San Juan Hospital, Alicante, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Aizpuru, Felipe" sort="Aizpuru, Felipe" uniqKey="Aizpuru F" first="Felipe" last="Aizpuru">Felipe Aizpuru</name>
<affiliation><nlm:aff id="aff2">Txagoritxu Hospital, Vitoria, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Zamorano, Jose" sort="Zamorano, Jose" uniqKey="Zamorano J" first="Jose" last="Zamorano">Jose Zamorano</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cano, Ricardo" sort="Cano, Ricardo" uniqKey="Cano R" first="Ricardo" last="Cano">Ricardo Cano</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Montserrat, Jose M" sort="Montserrat, Jose M" uniqKey="Montserrat J" first="Jose M." last="Montserrat">Jose M. Montserrat</name>
<affiliation><nlm:aff id="aff8">Clinic Hospital, Barcelona, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Garcia Ledesma, Estefania" sort="Garcia Ledesma, Estefania" uniqKey="Garcia Ledesma E" first="Estefania" last="Garcia-Ledesma">Estefania Garcia-Ledesma</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Pereira, Ricardo" sort="Pereira, Ricardo" uniqKey="Pereira R" first="Ricardo" last="Pereira">Ricardo Pereira</name>
<affiliation><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cancelo, Laura" sort="Cancelo, Laura" uniqKey="Cancelo L" first="Laura" last="Cancelo">Laura Cancelo</name>
<affiliation><nlm:aff id="aff2">Txagoritxu Hospital, Vitoria, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Martinez, Angeles" sort="Martinez, Angeles" uniqKey="Martinez A" first="Angeles" last="Martinez">Angeles Martinez</name>
<affiliation><nlm:aff id="aff3">Valdecilla Hospital, Santander, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sacristan, Lirios" sort="Sacristan, Lirios" uniqKey="Sacristan L" first="Lirios" last="Sacristan">Lirios Sacristan</name>
<affiliation><nlm:aff id="aff4">General Universitario Hospital, Alicante, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Salord, Neus" sort="Salord, Neus" uniqKey="Salord N" first="Neus" last="Salord">Neus Salord</name>
<affiliation><nlm:aff id="aff5">Belvitge Hospital, Barcelona, Spain</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Carrera, Miguel" sort="Carrera, Miguel" uniqKey="Carrera M" first="Miguel" last="Carrera">Miguel Carrera</name>
<affiliation><nlm:aff id="aff6">Son Dureta Hospital, Palma de Mallorca, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sancho Chust, Jose N" sort="Sancho Chust, Jose N" uniqKey="Sancho Chust J" first="José N." last="Sancho-Chust">José N. Sancho-Chust</name>
<affiliation><nlm:aff id="aff7">San Juan Hospital, Alicante, Spain</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Embid, Cristina" sort="Embid, Cristina" uniqKey="Embid C" first="Cristina" last="Embid">Cristina Embid</name>
<affiliation><nlm:aff id="aff8">Clinic Hospital, Barcelona, Spain</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Sleep</title>
<idno type="ISSN">0161-8105</idno>
<idno type="eISSN">1550-9109</idno>
<imprint><date when="2013">2013</date>
</imprint>
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<front><div type="abstract" xml:lang="en"><sec><title>Rationale:</title>
<p>Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals.</p>
</sec>
<sec><title>Objectives:</title>
<p>We performed a multicentric, randomized, blinded crossover study to determine the agreement between home respiratory polygraphy (HRP) and PSG, and between simultaneous respiratory polygraphy (respiratory polygraphy with PSG) (SimultRP) and PSG by means of 2 AHI scoring protocols with or without hyperventilation following flow reduction considered as a surrogate arousal.</p>
</sec>
<sec><title>Methods:</title>
<p>We included suspected SAHS patients from 8 hospitals. They were assigned to home and hospital protocols at random. We determined the agreement between respiratory polygraphy AHI and PSG AHI scorings using Bland and Altman plots and diagnostic agreement using receiver operating characteristic (ROC) curves. The agreement in therapeutic decisions (continuous positive airway pressure treatment or not) between HRP and PSG scorings was done with likelihood ratios and post-test probability calculations.</p>
</sec>
<sec><title>Results:</title>
<p>Of 366 randomized patients, 342 completed the protocol. AHI from HRP scorings (with and without surrogate arousal) had similar agreement with PSG. AHI from SimultRP with surrogate arousal scoring had better agreement with PSG than AHI from SimultRP without surrogate arousal. HRP with surrogate arousal scoring had slightly worse ROC curves than HRP without surrogate arousal, and the opposite was true for SimultRP scorings. HRP with surrogate arousal showed slightly better agreement with PSG in therapeutic decisions than for HRP without surrogate arousal.</p>
</sec>
<sec><title>Conclusion:</title>
<p>Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).</p>
</sec>
<sec><title>Citation:</title>
<p>Masa JF; Corral J; Gomez de Terreros J; Duran-Cantolla J; Cabello M; Hernández-Blasco L; Monasterio C; Alonso A; Chiner E; Aizpuru F; Zamorano J; Cano R; Monterrat JM. Significance of including a surrogate arousal for sleep apnea-hypopnea syndrome diagnosis by respiratory polygraphy. <italic>SLEEP</italic>
2013;36(2):249–257.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Sleep</journal-id>
<journal-id journal-id-type="iso-abbrev">Sleep</journal-id>
<journal-id journal-id-type="publisher-id">Sleep</journal-id>
<journal-title-group><journal-title>Sleep</journal-title>
</journal-title-group>
<issn pub-type="ppub">0161-8105</issn>
<issn pub-type="epub">1550-9109</issn>
<publisher><publisher-name>Associated Professional Sleep Societies, LLC</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">23372273</article-id>
<article-id pub-id-type="pmc">3543063</article-id>
<article-id pub-id-type="doi">10.5665/sleep.2384</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis</subject>
</subj-group>
</article-categories>
<title-group><article-title>Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Masa</surname>
<given-names>Juan F.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Corral</surname>
<given-names>Jaime</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gomez de Terreros</surname>
<given-names>Javier</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Duran-Cantolla</surname>
<given-names>Joaquin</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cabello</surname>
<given-names>Marta</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hernández-Blasco</surname>
<given-names>Luis</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Monasterio</surname>
<given-names>Carmen</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Alonso</surname>
<given-names>Alberto</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff6"><sup>6</sup>
</xref>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chiner</surname>
<given-names>Eusebi</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff7"><sup>7</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Aizpuru</surname>
<given-names>Felipe</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Zamorano</surname>
<given-names>Jose</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cano</surname>
<given-names>Ricardo</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Montserrat</surname>
<given-names>Jose M.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff8"><sup>8</sup>
</xref>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author"><collab>Collaborating group</collab>
</contrib>
<contrib contrib-type="author"><name><surname>Garcia-Ledesma</surname>
<given-names>Estefania</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Pereira</surname>
<given-names>Ricardo</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cancelo</surname>
<given-names>Laura</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Martinez</surname>
<given-names>Angeles</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sacristan</surname>
<given-names>Lirios</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Salord</surname>
<given-names>Neus</given-names>
</name>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff9"><sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Carrera</surname>
<given-names>Miguel</given-names>
</name>
<xref ref-type="aff" rid="aff6"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sancho-Chust</surname>
<given-names>José N.</given-names>
</name>
<xref ref-type="aff" rid="aff7"><sup>7</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Embid</surname>
<given-names>Cristina</given-names>
</name>
<xref ref-type="aff" rid="aff8"><sup>8</sup>
</xref>
</contrib>
<aff id="aff1"><label>1</label>
San Pedro de Alcantara Hospital, Caceres, Spain</aff>
<aff id="aff2"><label>2</label>
Txagoritxu Hospital, Vitoria, Spain</aff>
<aff id="aff3"><label>3</label>
Valdecilla Hospital, Santander, Spain</aff>
<aff id="aff4"><label>4</label>
General Universitario Hospital, Alicante, Spain</aff>
<aff id="aff5"><label>5</label>
Belvitge Hospital, Barcelona, Spain</aff>
<aff id="aff6"><label>6</label>
Son Dureta Hospital, Palma de Mallorca, Spain</aff>
<aff id="aff7"><label>7</label>
San Juan Hospital, Alicante, Spain</aff>
<aff id="aff8"><label>8</label>
Clinic Hospital, Barcelona, Spain</aff>
<aff id="aff9"><label>9</label>
CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</aff>
</contrib-group>
<author-notes><corresp id="cor1">Address correspondence to: Juan F. Masa, MD, <addr-line>San Pedro de Alcantara Hospital, Caceres, Spain</addr-line>
<phone>0034927256296</phone>
<fax>0034927256297</fax>
<email>fmasa@separ.es</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>1</day>
<month>2</month>
<year>2013</year>
</pub-date>
<volume>36</volume>
<issue>2</issue>
<fpage>249</fpage>
<lpage>257</lpage>
<history><date date-type="received"><month>3</month>
<year>2012</year>
</date>
<date date-type="rev-recd"><month>8</month>
<year>2012</year>
</date>
<date date-type="accepted"><month>8</month>
<year>2012</year>
</date>
</history>
<permissions><copyright-statement>© 2013 Associated Professional Sleep Societies, LLC.</copyright-statement>
<copyright-year>2013</copyright-year>
</permissions>
<abstract><sec><title>Rationale:</title>
<p>Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals.</p>
</sec>
<sec><title>Objectives:</title>
<p>We performed a multicentric, randomized, blinded crossover study to determine the agreement between home respiratory polygraphy (HRP) and PSG, and between simultaneous respiratory polygraphy (respiratory polygraphy with PSG) (SimultRP) and PSG by means of 2 AHI scoring protocols with or without hyperventilation following flow reduction considered as a surrogate arousal.</p>
</sec>
<sec><title>Methods:</title>
<p>We included suspected SAHS patients from 8 hospitals. They were assigned to home and hospital protocols at random. We determined the agreement between respiratory polygraphy AHI and PSG AHI scorings using Bland and Altman plots and diagnostic agreement using receiver operating characteristic (ROC) curves. The agreement in therapeutic decisions (continuous positive airway pressure treatment or not) between HRP and PSG scorings was done with likelihood ratios and post-test probability calculations.</p>
</sec>
<sec><title>Results:</title>
<p>Of 366 randomized patients, 342 completed the protocol. AHI from HRP scorings (with and without surrogate arousal) had similar agreement with PSG. AHI from SimultRP with surrogate arousal scoring had better agreement with PSG than AHI from SimultRP without surrogate arousal. HRP with surrogate arousal scoring had slightly worse ROC curves than HRP without surrogate arousal, and the opposite was true for SimultRP scorings. HRP with surrogate arousal showed slightly better agreement with PSG in therapeutic decisions than for HRP without surrogate arousal.</p>
</sec>
<sec><title>Conclusion:</title>
<p>Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).</p>
</sec>
<sec><title>Citation:</title>
<p>Masa JF; Corral J; Gomez de Terreros J; Duran-Cantolla J; Cabello M; Hernández-Blasco L; Monasterio C; Alonso A; Chiner E; Aizpuru F; Zamorano J; Cano R; Monterrat JM. Significance of including a surrogate arousal for sleep apnea-hypopnea syndrome diagnosis by respiratory polygraphy. <italic>SLEEP</italic>
2013;36(2):249–257.</p>
</sec>
</abstract>
<kwd-group><kwd>Sleep apnea</kwd>
<kwd>portable monitor</kwd>
<kwd>respiratory polygraphy</kwd>
<kwd>CPAP treatment</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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