Madigan Army Medical Center, Tacoma, Washington.
Walter Reed National Military Medical Center, Bethesda, Maryland.
J Clin Sleep Med. 2022 Jun 1;18(6):1523-1530. doi: 10.5664/jcsm.9894.
Obstructive sleep apnea (OSA) is increasingly common among military personnel, but diagnostic capabilities are challenged by limited capability for polysomnography (PSG). We sought to evaluate the diagnostic properties of peripheral arterial tonometry (PAT)-based home sleep apnea testing (HSAT) to accurately identify and classify OSA among active-duty military personnel.
This study was a retrospective review of all patients suspected of having OSA who completed an initial PAT-based HSAT followed by confirmatory PSG within 120 days. The diagnostic properties of a PAT-based, HSAT-derived apnea-hypopnea index (AHI) vs a PSG-derived AHI were assessed.
Two hundred eight matched pairs of asynchronous studies were analyzed. The prevalence of OSA was 63.5%. PAT-based HSAT overdiagnosed 27.4% of patients with OSA and underdiagnosed 46.6% of patients with OSA. The majority (n = 116, 55.8%) of patients changed OSA severity classification (absent, mild, moderate, severe) after PSG. OSA severity classification concordance between PAT-based HSAT and PSG was observed in 53.4%, 40.5%, 28.6%, and 40.0% of patients with absent, mild, moderate, and severe OSA, respectively. Receiver operating characteristic curve analysis showed an area under the curve of 0.715 and a proposed PAT-based, HSAT-derived AHI cutoff score for OSA diagnosis of 9.0 events/h. This PAT-based, HSAT-derived AHI provided a 52% sensitivity, 83% specificity, 84% positive predictive value, and 50% negative predictive value. Bland-Altman plots showed an unacceptable degree of agreement between PAT-based, HSAT-derived AHI and AHI.
There is significant discordance between PAT-based HSAT and PSG among active-duty military personnel evaluated for OSA. PAT-based HSAT may have limited utility for diagnosing OSA and grading severity in this unique patient population.
O'Reilly BM, Wang Q, Collen J, Matsangas P, Colombo CJ, Mysliwiec V. Performance comparison of peripheral arterial tonometry-based testing and polysomnography to diagnose obstructive sleep apnea in military personnel. 2022;18(6):1523-1530.
阻塞性睡眠呼吸暂停（OSA）在军人中越来越常见，但由于多导睡眠图（PSG）的能力有限，诊断能力受到挑战。我们旨在评估基于外周动脉张力测定（PAT）的家庭睡眠呼吸暂停测试（HSAT）的诊断性能，以准确识别和分类现役军人中的 OSA。
这是一项回顾性研究，纳入了所有疑似患有 OSA 并在 120 天内完成初始基于 PAT 的 HSAT 后进行确认性 PSG 的患者。评估了基于 PAT 的 HSAT 衍生的呼吸暂停低通气指数（AHI）与 PSG 衍生的 AHI 的诊断性能。
分析了 208 对异步研究。OSA 的患病率为 63.5%。基于 PAT 的 HSAT 过度诊断了 27.4%的 OSA 患者，漏诊了 46.6%的 OSA 患者。大多数（n=116，55.8%）患者在 PSG 后改变了 OSA 严重程度分类（无、轻度、中度、重度）。在无、轻度、中度和重度 OSA 的患者中，分别有 53.4%、40.5%、28.6%和 40.0%的患者观察到基于 PAT 的 HSAT 和 PSG 之间的 OSA 严重程度分类一致。受试者工作特征曲线分析显示曲线下面积为 0.715，建议将基于 PAT 的 HSAT 衍生的 AHI 截断值设定为 9.0 事件/小时，用于 OSA 诊断。基于 PAT 的 HSAT 衍生的 AHI 的敏感性为 52%，特异性为 83%，阳性预测值为 84%，阴性预测值为 50%。Bland-Altman 图显示，在接受 OSA 评估的现役军人中，基于 PAT 的 HSAT 与 PSG 之间存在显著不一致。基于 PAT 的 HSAT 可能对诊断 OSA 和评估该独特患者人群的严重程度的作用有限。
在接受 OSA 评估的现役军人中，基于 PAT 的 HSAT 与 PSG 之间存在显著差异。
