Flow limitation/obstruction with recovery breath (FLOW) event for improved scoring of mild obstructive sleep apnea without electroencephalography.,Sleep Medicine

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Flow limitation/obstruction with recovery breath (FLOW) event for improved scoring of mild obstructive sleep apnea without electroencephalography.
Sleep Medicine ( IF 3.8 ) Pub Date : 2018-11-30 , DOI: 10.1016/j.sleep.2018.11.014
Karin Gardner Johnson ₁ , Douglas Clark Johnson ₂ , Robert Joseph Thomas ₃ , Edward Feldmann ₄ , Peter K Lindenauer ₅ , Paul Visintainer ₆ , Meir H Kryger ₇

Affiliation

Department of Neurology, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA; Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
Department of Medicine, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA.
Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
Department of Neurology, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA.
Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA; Department of Medicine, Baystate Medical Center, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA, 01199, USA; Department of Quantitative Health Sciences University of Massachusetts Medical School, Worcester, MA, USA.
Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, Yale New Haven Medical Center, Yale School of Medicine, 20 York Street New Haven, CT, 06510, USA.

Objective

Apnea/hypopnea index (AHI), especially without arousal criteria, does not adequately risk stratify patients with mild obstructive sleep apnea (OSA). We describe and test scoring reliability of an event, Flow Limitation/Obstruction With recovery breath (FLOW), representing obstructive airflow disruptions using only pressure transducer and snore signals available without electroencephalography.

Methods

The following process was used (i) Development of FLOW event definition, (ii) Training period and definition refinement, and (iii) Reliability testing on 10 100-epoch polysomnography (PSG) samples and two 100-sample tests. Twenty full-night in-laboratory baseline PSGs in OSA patients with AHI with ≥4% desaturations <15 were rescored for FLOW events, traditional hypopneas with desaturations, respiratory-related arousal (RRA) events (hypopneas with arousals and respiratory-effort related arousals) and non-respiratory arousals (NRA).

Results

Scoring of FLOW events in 100-epoch samples had good reliability with intraclass correlation (ICC) of 0.91. The overall kappa for presence of events on two sets of 100 sample events was 0.84 and 0.87 demonstrating good agreement. Moreover, 80% of RRA and 8% of NRA were concurrent with FLOW events. Furthermore, 56% of FLOW events were independent of RRA events. FLOW stratifies patients in traditional AHI categories with 50%/8% of AHI with ≥3% desaturations (AHI3) <5 and 12%/63% of AHI3 >5 in lowest/highest tertiles of AHI3 plus FLOW index.

Conclusions

Scoring of FLOW after training is reliable. FLOW scores a high proportion of RRA and many currently unrepresented obstructive airflow disruptions. FLOW allows for stratification within the current normal-mild OSA category, which may better identify patients who will benefit from treatment.

中文翻译：

流量限制/阻塞与恢复呼吸 (FLOW) 事件可改善轻度阻塞性睡眠呼吸暂停的评分，无需脑电图。

客观的

呼吸暂停/低通气指数 (AHI)，尤其是在没有觉醒标准的情况下，不足以对轻度阻塞性睡眠呼吸暂停 (OSA) 患者进行风险分层。我们描述和测试了一个事件的评分可靠性，流量限制/阻塞与恢复呼吸 (FLOW)，代表阻塞性气流中断，仅使用压力传感器和没有脑电图可用的打鼾信号。

方法

使用了以下过程 (i) FLOW 事件定义的开发，(ii) 训练期和定义细化，以及 (iii) 对 10 100 次多导睡眠图 (PSG) 样本和两个 100 样本测试的可靠性测试。OSA 患者的 20 次全夜实验室基线 PSG 对 AHI ≥4% 饱和度 <15 次进行重新评分，包括 FLOW 事件、传统的低通气导致的饱和度下降、呼吸相关觉醒 (RRA) 事件（呼吸不足伴随觉醒和呼吸努力相关觉醒） ) 和非呼吸唤醒 (NRA)。

结果

100 个时期样本中 FLOW 事件的评分具有良好的可靠性，类内相关性 (ICC) 为 0.91。两组 100 个样本事件的事件存在的总体 kappa 为 0.84 和 0.87，表明良好的一致性。此外，80% 的 RRA 和 8% 的 NRA 与 FLOW 事件同时发生。此外，56% 的 FLOW 事件与 RRA 事件无关。FLOW 将传统 AHI 类别中的患者分层，其中 AHI 的 50%/8% 具有 ≥3% 的饱和度 (AHI3) <5 和 AHI3 > 5 的 12%/63% 的 AHI3 加 FLOW 指数的最低/最高三分位数。