Is portable monitoring for diagnosing obstructive sleep apnea syndrome suitable in elderly population?

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is highly prevalent in the elderly. Unattended, at-home portable monitoring (PM) is a diagnostic alternative to polysomnography in adults with high clinical probability of OSAS. However, no studies have evaluated the diagnostic accuracy of PM in elderly population. The aim of our study was to evaluate the effectiveness of PM in elderly patients. METHODS: We selected patients aged over 65 years with suspected OSAS. Two-order randomized evaluations were performed: one night of at-home PM (PMhome) and one night of simultaneous PM and polysomnography (PSG) in the sleep lab (PSG+PM). We obtained three different apnea-hypopnea index (AHI): AHI from PSG (AHI PSG), AHI from at-home PM (AHI PMhome), and AHI from PM+PSG (AHI PM+PSG). Two technicians, blinded to the recording order, scored each sleep study. RESULTS: We studied a total of 43 patients. No difference between the AHI values for each of the different recordings was found (p > 0.05). There was good correlation between AHI PSG and AHI PMhome (r = 0.67) and AHI PSG+PM (r = 0.84). The area under the receiver operator curve was above 0.83, indicating good sensitivity and a positive predictive value for AHI with cutoffs of 5, 15, and 30 and good specificity and negative predictive value for AHI values above 15. Correlation, accuracy, and agreement were greater when the recordings were made simultaneously. CONCLUSIONS: PM was effective for diagnosing OSAS in the elderly and can be used as an alternative to PSG in elderly patients with a high clinical probability of OSAS.

Portable monitoring devices in the diagnosis of obstructive sleep apnea: current status, advantages, and limitations.

Recent years have seen a growing interest in the use of portable monitoring devices for the diagnosis of obstructive sleep apnea syndrome. These have the potential to be used in lieu of the more complicated and uncomfortable alternative, polysomnography, which has long been considered to be the gold standard for the diagnosis of this relatively prevalent condition. Following their approval in 2008 by the Center of Medicare and Medicaid Services, the federal agency which administers Medicare and Medicaid in the United States, there has been extensive discussion about the utility and validity of these devices for use in the diagnosis of obstructive sleep apnea syndrome. Although there are various models of portable monitoring devices, the literature contains little information regarding how each device should be used in specific age groups, patients presenting comorbidities, and asymptomatic patients. Additionally, studies about the cost-effectiveness of this diagnostic method are scarce and conflicting. Therefore, this objective of this study was to review what has been learned about portable monitoring devices over time, as well as to examine the recent progress, advantages, limitations, and applications of these devices in the diagnosis of obstructive sleep apnea syndrome in different groups of patients.

Monitorização portátil no diagnóstico da apneia obstrutiva do sono: situação atual, vantagens e limitações / Portable monitoring devices in the diagnosis of obstructive sleep apnea: current status, advantages, and limitations

Nos últimos anos, é crescente o interesse pela utilização de aparelhos de monitoramento portáteis para o diagnóstico da síndrome da apneia obstrutiva do sono, como uma alternativa mais simples e confortável à polissonografia, que é o exame considerado o padrão ouro para o diagnóstico dessa condição relativamente prevalente. A liberação do uso desses equipamentos pelo Center of Medicare and Medicaid Services, agência federal que administra os serviços médicos nos Estados Unidos da América, em 2008, resultou em ampla discussão sobre a utilidade e validade desses equipamentos para o diagnóstico de síndrome da apneia obstrutiva do sono. Apesar de haver vários modelos de equipamentos de monitorização portátil, há pouca informação na literatura a respeito de como cada equipamento deveria ser utilizado em grupos etários específicos, portadores de comorbidades e pacientes assintomáticos. Além disso, estudos de custo-efetividade desse método diagnóstico são escassos e conflitantes. Portanto, o objetivo do presente estudo foi revisar a evolução dos conhecimentos no uso de equipamentos de monitorização portátil, bem como examinar os avanços recentes, vantagens, limitações e aplicações desses equipamentos para o diagnóstico de apneia obstrutiva do sono em diferentes grupos de pacientes.

Recent years have seen a growing interest in the use of portable monitoring devices for the diagnosis of obstructive sleep apnea syndrome. These have the potential to be used in lieu of the more complicated and uncomfortable alternative, polysomnography, which has long been considered to be the gold standard for the diagnosis of this relatively prevalent condition. Following their approval in 2008 by the Center of Medicare and Medicaid Services, the federal agency which administers Medicare and Medicaid in the United States, there has been extensive discussion about the utility and validity of these devices for use in the diagnosis of obstructive sleep apnea syndrome. Although there are various models of portable monitoring devices, the literature contains little information regarding how each device should be used in specific age groups, patients presenting comorbidities, and asymptomatic patients. Additionally, studies about the cost-effectiveness of this diagnostic method are scarce and conflicting. Therefore, this objective of this study was to review what has been learned about portable monitoring devices over time, as well as to examine the recent progress, advantages, limitations, and applications of these devices in the diagnosis of obstructive sleep apnea syndrome in different groups of patients.