Detecting central sleep apnea in adult patients using WatchPAT—a multicenter validation study

• Published in: Sleep & breathing Vol. 24; no. 1; pp. 387 - 398
• Main Authors: Pillar, Giora, Berall, Murray, Berry, Richard, Etzioni, Tamar, Shrater, Noam, Hwang, Dennis, Ibrahim, Marai, Litman, Efrat, Manthena, Prasanth, Koren-Morag, Nira, Rama, Anil, Schnall, Robert P., Sheffy, Koby, Spiegel, Rebecca, Tauman, Riva, Penzel, Thomas
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2020; Springer Nature B.V
• Subjects: Adult; Algorithms; Apnea; Dentistry; Diagnosis, Differential; Humans; Internal Medicine; Israel; Medicine; Medicine & Public Health; Methods • Original; Methods • Original Article; Neurology; Otorhinolaryngology; Pediatrics; Pneumology/Respiratory System; Polysomnography - methods; Polysomnography - statistics & numerical data; Prevalence; Reproducibility of Results; Sleep; Sleep apnea; Sleep Apnea, Central - diagnosis; Sleep Apnea, Central - epidemiology; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - epidemiology; Sleep disorders; Snoring - diagnosis; Snoring - epidemiology; Validation studies; Validation Studies as Topic; Israel; Sleep apnea; Central sleep apnea; Peripheral arterial tone; Home sleep testing; Ambulatory monitoring
• ISSN: 1520-9512; 1522-1709; 1522-1709
• DOI: 10.1007/s11325-019-01904-5

Study objectives To assess the accuracy of WatchPAT (WP—Itamar-Medical, Caesarea, Israel) enhanced with a novel systolic upstroke analysis coupled with respiratory movement analysis derived from a dedicated snoring and body position (SBP) sensor, to enable automated algorithmic differentiation between central sleep apnea (CSA) and obstructive sleep apnea (OSA) compared with simultaneous in-lab sleep studies with polysomnography (PSG). Methods Eighty-four patients with suspected sleep-disordered breathing (SDB) underwent simultaneous WP and PSG studies in 11 sleep centers. PSG scoring was blinded to the automatically analyzed WP data. Results Overall WP apnea-hypopnea index (AHI; mean ± SD) was 25.2 ± 21.3 (range 0.2–101) versus PSG AHI 24.4 ± 21.2 (range 0–110) ( p  = 0.514), and correlation was 0.87 ( p  < 0.001). Using a threshold of AHI ≥ 15, the sensitivity and specificity of WP versus PSG for diagnosing sleep apnea were 85% and 70% respectively and agreement was 79% (kappa = 0.867). WP central AHI (AHIc) was 4.2 ± 7.7 (range 0–38) versus PSG AHIc 5.9 ± 11.8 (range 0–63) ( p  = 0.034), while correlation was 0.90 ( p  < 0.001). Using a threshold of AHI ≥ 15, the sensitivity and specificity of WP versus PSG for diagnosing CSA were 67% and 100% respectively with agreement of 95% (kappa = 0.774), and receiver operator characteristic (ROC) area under the curve of 0.866, ( p  < 0.01). Using a threshold of AHI ≥ 10 showed comparable overall sleep apnea and CSA diagnostic accuracies. Conclusions These findings show that WP can accurately detect overall AHI and effectively differentiate between CSA and OSA.