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Original Investigation |

Diagnosis of Obstructive Sleep Apnea by Peripheral Arterial Tonometry:  Meta-analysis

Sreeya Yalamanchali, MD1; Viken Farajian, MS1; Craig Hamilton, MBChB1; Thomas R. Pott, MD1; Christian G. Samuelson, MD1; Michael Friedman, MD1,2
[+] Author Affiliations
1Chicago ENT Advanced Center for Specialty Care, Department of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago
2Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center, Chicago, Illinois
JAMA Otolaryngol Head Neck Surg. 2013;139(12):1343-1350. doi:10.1001/jamaoto.2013.5338.
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Importance  Efficient diagnosis and early treatment of obstructive sleep apnea may help prevent the development of related morbidity and mortality. Compared with polysomnography (PSG), ambulatory sleep study devices offer the possibility of an accurate diagnosis with convenience and low cost.

Objective  To assess the correlation between sleep indexes measured by a portable sleep-testing device (peripheral arterial tonometry [PAT]) and those measured by PSG.

Data Sources  We searched PubMed, MEDLINE, the Cochrane Trial Registry (through May 2013), and relevant article bibliographies.

Study Selection  Systematic review and meta-analysis of studies assessing correlation of sleep indexes between PAT devices and PSG in adults (aged >18 years). Included studies provided a bivariate correlation coefficient for sleep indexes, specifically the respiratory disturbance index (RDI), apnea-hypopnea index (AHI), and oxygen desaturation index (ODI).

Data Extraction and Synthesis  Included studies were reviewed by 2 independent reviewers. Reported correlation values for the RDI, AHI, and ODI between a commercially available PAT device (WatchPAT) and PSG were systematically reviewed. A comprehensive meta-analysis software package was used for statistical analysis.

Main Outcomes and Measures  Assessment of the correlation between PAT and PSG as measured by AHI, RDI, and ODI.

Results  Fourteen studies met inclusion criteria and had data suitable for pooling (909 patients). Of these, 13 studies had blinded study designs, with PAT and PSG conducted simultaneously in the home or the laboratory setting. One study contained 2 trial phases for the same patient group (n = 29), one laboratory based and the other home based, which were analyzed separately. One study contained 2 different study groups based on age. Overall, correlation of the RDI and AHI was high (r = 0.889 [95% CI, 0.862-0.911]; P < .001). Studies comparing the RDI between PAT and PSG had a combined correlation of 0.879 (95% CI, 0.849-0.904; P < .001); those comparing the AHI, 0.893 (0.857-0.920; P < .001); and those comparing the ODI, 0.942 (0.894-0.969; P < .001). Analysis of publication bias revealed a nonsignificant Egger regression intercept.

Conclusions and Relevance  Respiratory indexes calculated using PAT-based portable devices positively correlated with those calculated from the scoring of PSG. Strengthened by the blinded design of most of the included studies, this technology represents a viable alternative to PSG for confirmation of clinically suspected sleep apnea.

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Figures

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Figure 1.
The Peripheral Arterial Tonometer (WatchPAT; Itamar Medical, Ltd)

The device uses peripheral arterial tonometry in conjunction with pulse oximetry and actigraphy to assess for respiratory disturbances.

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Figure 2.
Graphic Representation of the Literature Review

Inclusion and exclusion criteria were used to arrive at studies to be included for statistical analysis. AHI indicates apnea-hypopnea index; RDI, respiratory disturbance index.

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Figure 3.
Precision Fisher Z Funnel Plot to Access Publication Bias

Circle dots represent published studies used in the meta-analysis; dotted center line, corrected effect size; solid lines, overall effect size.

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Figure 4.
Overall Correlation of the Respiratory Disturbance Index (RDI) and Apnea-Hypopnea Index (AHI) Between Polysomonography (PSG) and Peripheral Arterial Tonometry (PAT)

We calculated overall correlation using the random-effects model. Size of the data marker corresponds to the relative weight assigned in the pooled analysis. B indicates blinded; H, home setting; L, laboratory setting; and NB, nonblinded. aStudy reported the value as RDI; however, recent American Academy of Sleep Medicine criteria defined the value as AHI.

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Figure 5.
Correlation Analysis of the Oxygen Desaturation Index (ODI) Between Polysomonography (PSG) and Peripheral Arterial Tonometry (PAT)

Correlation analysis of studies reporting ODI between PSG and PAT using the random-effects model. Size of the data marker corresponds to the relative weight assigned in the pooled analysis. B indicates blinded; H, home setting; L, laboratory setting; and NB, nonblinded.

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Figure 6.
Correlation Analysis of All Laboratory-Based Studies Reporting Respiratory Disturbance Index (RDI) and Apnea-Hypopnea Index (AHI)

Correlation analysis of all laboratory-based studies reporting RDI and AHI using the random-effects model. Size of the data marker corresponds to the relative weight assigned in the pooled analysis. B indicates blinded; H, home setting; L, laboratory setting; and NB, nonblinded. aStudy reports this value as RDI; however, recent American Academy of Sleep Medicine criteria defined the value as AHI.

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