Khalil Carlos, Zarabi Sahar, Kirkham Kyle, Soni Vedish, Li Qixuan, Huszti Ella, Yadollahi Azadeh, Taati Babak, Englesakis Marina, Singh Mandeep
University of Toronto, 27 King's College Cir, Toronto, ON M5S 1A1, Canada.
University of Toronto, 27 King's College Cir, Toronto, ON M5S 1A1, Canada; Department of Anesthesiology and Pain Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
J Clin Anesth. 2023 Aug;87:111087. doi: 10.1016/j.jclinane.2023.111087. Epub 2023 Mar 1.
Obstructive Sleep Apnea (OSA) is associated with increased perioperative cardiac, respiratory and neurological complications. Pre-operative OSA risk assessment is currently done through screening questionnaires with high sensitivity but poor specificity. The objective of this study was to evaluate the validity and diagnostic accuracy of portable, non-contact devices in the diagnosis of OSA as compared with polysomnography.
This study is a systematic review of English observational cohort studies with meta-analysis and risk of bias assessment.
Pre-operative, including in the hospital and clinic setting.
Adult patients undergoing sleep apnea assessment using polysomnography and an experimental non-contact tool.
A novel non-contact device, which does not utilize any monitor that makes direct contact with the patient's body, in conjunction with polysomnography.
Primary outcomes included pooled sensitivity and specificity of the experimental device in the diagnosis of obstructive sleep apnea, in comparison to gold-standard polysomnography.
Twenty-eight of 4929 screened studies were included in the meta-analysis. A total of 2653 patients were included with the majority being patients referred to a sleep clinic (88.8%). Average age was 49.7(SD±6.1) years, female sex (31%), average body mass index of 29.5(SD±3.2) kg/m, average apnea-hypopnea index (AHI) of 24.7(SD±5.6) events/h, and pooled OSA prevalence of 72%. Non-contact technology used was mainly video, sound, or bio-motion analysis. Pooled sensitivity and specificity of non-contact methods in moderate to severe OSA diagnosis (AHI > 15) was 0.871 (95% CI 0.841,0.896, I 0%) and 0.8 (95% CI 0.719,0.862), respectively (AUC 0.902). Risk of bias assessment showed an overall low risk of bias across all domains except for applicability concerns (none were conducted in the perioperative setting).
Available data indicate contactless methods have high pooled sensitivity and specificity for OSA diagnosis with moderate to high level of evidence. Future research is needed to evaluate these tools in the perioperative setting.
阻塞性睡眠呼吸暂停（OSA）与围手术期心脏、呼吸及神经并发症的增加相关。目前术前OSA风险评估是通过筛查问卷进行的，其敏感性高但特异性差。本研究的目的是评估便携式非接触设备与多导睡眠图相比在诊断OSA中的有效性和诊断准确性。
本研究是一项对英文观察性队列研究的系统评价，并进行荟萃分析和偏倚风险评估。
术前，包括在医院和诊所环境中。
使用多导睡眠图和一种实验性非接触工具进行睡眠呼吸暂停评估的成年患者。
一种新型非接触设备，其不使用任何与患者身体直接接触的监测器，与多导睡眠图联合使用。
主要结局包括与金标准多导睡眠图相比，实验设备在诊断阻塞性睡眠呼吸暂停中的合并敏感性和特异性。
4929项筛查研究中的28项纳入了荟萃分析。共纳入2653例患者，大多数是转诊至睡眠诊所的患者（88.8%）。平均年龄为49.7（标准差±6.1）岁，女性占31%，平均体重指数为29.5（标准差±3.2）kg/m²，平均呼吸暂停低通气指数（AHI）为24.7（标准差±5.6）次/小时，OSA合并患病率为72%。所使用的非接触技术主要是视频、声音或生物运动分析。非接触方法在中重度OSA诊断（AHI>15）中的合并敏感性和特异性分别为0.871（95%CI 0.841,0.896，I² 0%）和0.8（95%CI 0.719,0.862）（AUC 0.902）。偏倚风险评估显示，除适用性问题外（围手术期均未进行），所有领域的总体偏倚风险较低。
现有数据表明，非接触方法对OSA诊断具有较高的合并敏感性和特异性，证据水平为中到高。未来需要在围手术期环境中评估这些工具。
