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Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders
INTRODUCTION: Portable monitoring (PM) is an alternative to laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA). However, PM tends to underestimate the apnea-hypopnea index (AHI), as it does not identify non-desaturating events associated with electroencephalographic (EEG)...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove
2019
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927566/ https://www.ncbi.nlm.nih.gov/pubmed/31908554 http://dx.doi.org/10.2147/NSS.S234703 |
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author | Mayer, Pierre Herrero Babiloni, Alberto Aubé, Jean-Louis Kaddaha, Zeina Marshansky, Serguei Rompré, Pierre H Jobin, Vincent Lavigne, Gilles J |
author_facet | Mayer, Pierre Herrero Babiloni, Alberto Aubé, Jean-Louis Kaddaha, Zeina Marshansky, Serguei Rompré, Pierre H Jobin, Vincent Lavigne, Gilles J |
author_sort | Mayer, Pierre |
collection | PubMed |
description | INTRODUCTION: Portable monitoring (PM) is an alternative to laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA). However, PM tends to underestimate the apnea-hypopnea index (AHI), as it does not identify non-desaturating events associated with electroencephalographic (EEG) arousal. The objectives were to explore heart rate acceleration (HRa) and decrease in pulse transit time (PTT) as surrogates to EEG arousal for non-desaturating hypopnea and respiratory effort-related arousal (RERA), and to estimate cut-off values for their use with both total sleep time (TST), the standard method for PSG, and total recording time (TRT), the usual method for PM. METHODS: Twenty-four consecutive individuals with suspected OSA were studied with PSG. Calculated outcomes were: AHI, respiratory disturbance index with EEG arousal (RDIe) and autonomic arousal by HRa (RDI-HRa) and PTT decreases (RDI-PTT) at different time cut-offs. Using RDIe as reference, Bland Altman and intraclass coefficient of correlation (ICC) were used to calculate agreement between indexes, and receiver operating curves (ROC) for sensitivity/specificity of the different cut-offs. RESULTS: Autonomic arousals, limited to respiratory events, were present in 36% of non-desaturating hypopneas and 29% of RERAs. Using TST, RDI-HRa of 10 bpm (ICC= 0.89) and RDI-PTT with a decrease of −15 msec (ICC=0.90) agreed better with RDIe. With TRT, the RDI-HRa of 5 bpm agreed better with the RDIe (ICC=0.89). Bland–Altman plots showed mean differences of 1.53 between RDI-HRa10-TST and RDIe and 0.89 between RDI-HRa5-TRT and RDIe. CONCLUSION: Autonomic arousals (HRa and PTT) may be a suitable proxy of EEG arousals associated with respiratory events, using both TST and TRT. Therefore, they could potentially help to capture borderline symptomatic patients and to monitor treatment outcomes. |
format | Online Article Text |
id | pubmed-6927566 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-69275662020-01-06 Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders Mayer, Pierre Herrero Babiloni, Alberto Aubé, Jean-Louis Kaddaha, Zeina Marshansky, Serguei Rompré, Pierre H Jobin, Vincent Lavigne, Gilles J Nat Sci Sleep Original Research INTRODUCTION: Portable monitoring (PM) is an alternative to laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA). However, PM tends to underestimate the apnea-hypopnea index (AHI), as it does not identify non-desaturating events associated with electroencephalographic (EEG) arousal. The objectives were to explore heart rate acceleration (HRa) and decrease in pulse transit time (PTT) as surrogates to EEG arousal for non-desaturating hypopnea and respiratory effort-related arousal (RERA), and to estimate cut-off values for their use with both total sleep time (TST), the standard method for PSG, and total recording time (TRT), the usual method for PM. METHODS: Twenty-four consecutive individuals with suspected OSA were studied with PSG. Calculated outcomes were: AHI, respiratory disturbance index with EEG arousal (RDIe) and autonomic arousal by HRa (RDI-HRa) and PTT decreases (RDI-PTT) at different time cut-offs. Using RDIe as reference, Bland Altman and intraclass coefficient of correlation (ICC) were used to calculate agreement between indexes, and receiver operating curves (ROC) for sensitivity/specificity of the different cut-offs. RESULTS: Autonomic arousals, limited to respiratory events, were present in 36% of non-desaturating hypopneas and 29% of RERAs. Using TST, RDI-HRa of 10 bpm (ICC= 0.89) and RDI-PTT with a decrease of −15 msec (ICC=0.90) agreed better with RDIe. With TRT, the RDI-HRa of 5 bpm agreed better with the RDIe (ICC=0.89). Bland–Altman plots showed mean differences of 1.53 between RDI-HRa10-TST and RDIe and 0.89 between RDI-HRa5-TRT and RDIe. CONCLUSION: Autonomic arousals (HRa and PTT) may be a suitable proxy of EEG arousals associated with respiratory events, using both TST and TRT. Therefore, they could potentially help to capture borderline symptomatic patients and to monitor treatment outcomes. Dove 2019-12-19 /pmc/articles/PMC6927566/ /pubmed/31908554 http://dx.doi.org/10.2147/NSS.S234703 Text en © 2019 Mayer et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Mayer, Pierre Herrero Babiloni, Alberto Aubé, Jean-Louis Kaddaha, Zeina Marshansky, Serguei Rompré, Pierre H Jobin, Vincent Lavigne, Gilles J Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders |
title | Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders |
title_full | Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders |
title_fullStr | Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders |
title_full_unstemmed | Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders |
title_short | Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders |
title_sort | autonomic arousals as surrogates for cortical arousals caused by respiratory events: a methodological optimization study in the diagnosis of sleep breathing disorders |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927566/ https://www.ncbi.nlm.nih.gov/pubmed/31908554 http://dx.doi.org/10.2147/NSS.S234703 |
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