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Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy

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Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy

Auteurs : Juan F. Masa [Espagne] ; Jaime Corral [Espagne] ; Javier Gomez De Terreros [Espagne] ; Joaquin Duran-Cantolla [Espagne] ; Marta Cabello [Espagne] ; Luis Hernández-Blasco [Espagne] ; Carmen Monasterio [Espagne] ; Alberto Alonso [Espagne] ; Eusebi Chiner [Espagne] ; Felipe Aizpuru [Espagne] ; Jose Zamorano [Espagne] ; Ricardo Cano [Espagne] ; Jose M. Montserrat [Espagne] ; Estefania Garcia-Ledesma [Espagne] ; Ricardo Pereira [Espagne] ; Laura Cancelo [Espagne] ; Angeles Martinez [Espagne] ; Lirios Sacristan [Espagne] ; Neus Salord [Espagne] ; Miguel Carrera [Espagne] ; José N. Sancho-Chust [Espagne] ; Cristina Embid [Espagne]

Source :

Sleep [ 0161-8105 ] ; 2013.

RBID : PMC:3543063

Abstract

Rationale:

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.

Objectives:

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.

Methods:

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.

Results:

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.

Conclusion:

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).

Citation:

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. SLEEP 2013;36(2):249–257.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543063

DOI: 10.5665/sleep.2384
PubMed: 23372273
PubMed Central: 3543063

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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="Garcia Ledesma, Estefania" sort="Garcia Ledesma, Estefania" uniqKey="Garcia Ledesma E" first="Estefania" last="Garcia-Ledesma">Estefania Garcia-Ledesma</name>
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<author><name sortKey="Cancelo, Laura" sort="Cancelo, Laura" uniqKey="Cancelo L" first="Laura" last="Cancelo">Laura Cancelo</name>
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<author><name sortKey="Martinez, Angeles" sort="Martinez, Angeles" uniqKey="Martinez A" first="Angeles" last="Martinez">Angeles Martinez</name>
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<author><name sortKey="Sacristan, Lirios" sort="Sacristan, Lirios" uniqKey="Sacristan L" first="Lirios" last="Sacristan">Lirios Sacristan</name>
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<author><name sortKey="Salord, Neus" sort="Salord, Neus" uniqKey="Salord N" first="Neus" last="Salord">Neus Salord</name>
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<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>
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<author><name sortKey="Embid, Cristina" sort="Embid, Cristina" uniqKey="Embid C" first="Cristina" last="Embid">Cristina Embid</name>
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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 wicri:level="1"><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
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<wicri:regionArea>San Pedro de Alcantara Hospital, Caceres</wicri:regionArea>
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<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER de Enfermedades Respiratorias (CIBERES), Madrid</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Corral, Jaime" sort="Corral, Jaime" uniqKey="Corral J" first="Jaime" last="Corral">Jaime Corral</name>
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<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Pedro de Alcantara Hospital, Caceres</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
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</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>
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<country xml:lang="fr">Espagne</country>
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</affiliation>
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<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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<wicri:regionArea>Txagoritxu Hospital, Vitoria</wicri:regionArea>
</affiliation>
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<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER de Enfermedades Respiratorias (CIBERES), Madrid</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Cabello, Marta" sort="Cabello, Marta" uniqKey="Cabello M" first="Marta" last="Cabello">Marta Cabello</name>
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<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Valdecilla Hospital, Santander</wicri:regionArea>
</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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<wicri:regionArea>General Universitario Hospital, Alicante</wicri:regionArea>
</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 wicri:level="1"><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
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</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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<country xml:lang="fr">Espagne</country>
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</affiliation>
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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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<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Juan Hospital, Alicante</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Aizpuru, Felipe" sort="Aizpuru, Felipe" uniqKey="Aizpuru F" first="Felipe" last="Aizpuru">Felipe Aizpuru</name>
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<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Txagoritxu Hospital, Vitoria</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER de Enfermedades Respiratorias (CIBERES), Madrid</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Zamorano, Jose" sort="Zamorano, Jose" uniqKey="Zamorano J" first="Jose" last="Zamorano">Jose Zamorano</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Pedro de Alcantara Hospital, Caceres</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Cano, Ricardo" sort="Cano, Ricardo" uniqKey="Cano R" first="Ricardo" last="Cano">Ricardo Cano</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Pedro de Alcantara Hospital, Caceres</wicri:regionArea>
</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 wicri:level="1"><nlm:aff id="aff8">Clinic Hospital, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Clinic Hospital, Barcelona</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER de Enfermedades Respiratorias (CIBERES), Madrid</wicri:regionArea>
</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 wicri:level="1"><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Pedro de Alcantara Hospital, Caceres</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Pereira, Ricardo" sort="Pereira, Ricardo" uniqKey="Pereira R" first="Ricardo" last="Pereira">Ricardo Pereira</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Pedro de Alcantara Hospital, Caceres</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Cancelo, Laura" sort="Cancelo, Laura" uniqKey="Cancelo L" first="Laura" last="Cancelo">Laura Cancelo</name>
<affiliation wicri:level="1"><nlm:aff id="aff2">Txagoritxu Hospital, Vitoria, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Txagoritxu Hospital, Vitoria</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Martinez, Angeles" sort="Martinez, Angeles" uniqKey="Martinez A" first="Angeles" last="Martinez">Angeles Martinez</name>
<affiliation wicri:level="1"><nlm:aff id="aff3">Valdecilla Hospital, Santander, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Valdecilla Hospital, Santander</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Sacristan, Lirios" sort="Sacristan, Lirios" uniqKey="Sacristan L" first="Lirios" last="Sacristan">Lirios Sacristan</name>
<affiliation wicri:level="1"><nlm:aff id="aff4">General Universitario Hospital, Alicante, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>General Universitario Hospital, Alicante</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Salord, Neus" sort="Salord, Neus" uniqKey="Salord N" first="Neus" last="Salord">Neus Salord</name>
<affiliation wicri:level="1"><nlm:aff id="aff5">Belvitge Hospital, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Belvitge Hospital, Barcelona</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff9">CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER de Enfermedades Respiratorias (CIBERES), Madrid</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Carrera, Miguel" sort="Carrera, Miguel" uniqKey="Carrera M" first="Miguel" last="Carrera">Miguel Carrera</name>
<affiliation wicri:level="1"><nlm:aff id="aff6">Son Dureta Hospital, Palma de Mallorca, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Son Dureta Hospital, Palma de Mallorca</wicri:regionArea>
</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 wicri:level="1"><nlm:aff id="aff7">San Juan Hospital, Alicante, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Juan Hospital, Alicante</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Embid, Cristina" sort="Embid, Cristina" uniqKey="Embid C" first="Cristina" last="Embid">Cristina Embid</name>
<affiliation wicri:level="1"><nlm:aff id="aff8">Clinic Hospital, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Clinic Hospital, Barcelona</wicri:regionArea>
</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>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<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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Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy

Significance of Including a Surrogate Arousal for Sleep Apnea-Hypopnea Syndrome Diagnosis by Respiratory Polygraphy

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