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Remmers  JE, deGroot  WJ, Sauerland  EK, Anch  AM.  Pathogenesis of upper airway occlusion during sleep.  J Appl Physiol. 1978;44(6):931-938.PubMedGoogle Scholar
Martin  SE, Engleman  HM, Deary  IJ, Douglas  NJ.  The effect of sleep fragmentation on daytime function.  Am J Respir Crit Care Med. 1996;153(4, pt 1):1328-1332.PubMedGoogle ScholarCrossref
Martin  SE, Engleman  HM, Kingshott  RN, Douglas  NJ.  Microarousals in patients with sleep apnoea/hypopnoea syndrome.  J Sleep Res. 1997;6(4):276-280.PubMedGoogle ScholarCrossref
Engleman  HM, Cheshire  KE, Deary  IJ, Douglas  NJ.  Daytime sleepiness, cognitive performance and mood after continuous positive airway pressure for the sleep apnoea/hypopnoea syndrome.  Thorax. 1993;48(9):911-914.PubMedGoogle ScholarCrossref
Epstein  L, Weiss  W.  Clinical consequences of obstructive sleep apnea.  Semin Respir Crit Care Med. 1998;19:123-132. doi:10.1055/s-2007-1009389.Google ScholarCrossref
Flemons  WW, Tsai  W.  Quality of life consequences of sleep-disordered breathing.  J Allergy Clin Immunol. 1997;99(2):S750-S756.PubMedGoogle ScholarCrossref
Shahar  E, Whitney  CW, Redline  S,  et al.  Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study.  Am J Respir Crit Care Med. 2001;163(1):19-25.PubMedGoogle Scholar
Young  T, Palta  M, Dempsey  J, Skatrud  J, Weber  S, Badr  S.  The occurrence of sleep-disordered breathing among middle-aged adults.  N Engl J Med. 1993;328(17):1230-1235.PubMedGoogle ScholarCrossref
Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee.  Practice parameters for the indications for polysomnography and related procedures.  Sleep. 1997;20(6):406-422.PubMedGoogle Scholar
Horner  RL, Brooks  D, Kozar  LF, Tse  S, Phillipson  EA.  Immediate effects of arousal from sleep on cardiac autonomic outflow in the absence of breathing in dogs.  J Appl Physiol. 1995;79(1):151-162.PubMedGoogle Scholar
Somers  VK, Dyken  ME, Mark  AL, Abboud  FM.  Sympathetic-nerve activity during sleep in normal subjects.  N Engl J Med. 1993;328(5):303-307.PubMedGoogle ScholarCrossref
Morgan  BJ, Crabtree  DC, Puleo  DS, Badr  MS, Toiber  F, Skatrud  JB.  Neurocirculatory consequences of abrupt change in sleep state in humans.  J Appl Physiol. 1996;80(5):1627-1636.PubMedGoogle Scholar
Hornyak  M, Cejnar  M, Elam  M, Matousek  M, Wallin  BG.  Sympathetic muscle nerve activity during sleep in man.  Brain. 1991;114(pt 3):1281-1295.PubMedGoogle ScholarCrossref
Okada  H, Iwase  S, Mano  T, Sugiyama  Y, Watanabe  T.  Changes in muscle sympathetic nerve activity during sleep in humans.  Neurology. 1991;41(12):1961-1966.PubMedGoogle ScholarCrossref
Schneider  H, Schaub  CD, Chen  CA,  et al.  Effects of arousal and sleep state on systemic and pulmonary hemodynamics in obstructive apnea.  J Appl Physiol. 2000;88(3):1084-1092.PubMedGoogle Scholar
Launois  SH, Averill  N, Abraham  JH, Kirby  DA, Weiss  JW.  Cardiovascular responses to nonrespiratory and respiratory arousals in a porcine model.  J Appl Physiol. 2001;90(1):114-120.PubMedGoogle Scholar
Pillar  G, Bar  A, Shlitner  A, Schnall  R, Shefy  J, Lavie  P.  Autonomic arousal index.  Sleep. 2002;25(5):543-549.PubMedGoogle Scholar
Penzel  T, Fricke  R, Jerrentrup  A, Peter  JH, Vogelmeier  C.  Peripheral arterial tonometry for the diagnosis of obstructive sleep apnea.  Biomed Tech (Berl). 2002;47(suppl 1)(pt 1):315-317.PubMedGoogle ScholarCrossref
Bar  A, Pillar  G, Dvir  I, Sheffy  J, Schnall  RP, Lavie  P.  Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies.  Chest. 2003;123(3):695-703.PubMedGoogle ScholarCrossref
Ayas  NT, Pittman  S, MacDonald  M, White  DP.  Assessment of a wrist-worn device in the detection of obstructive sleep apnea.  Sleep Med. 2003;4(5):435-442.PubMedGoogle ScholarCrossref
Pillar  G, Bar  A, Betito  M,  et al.  An automatic ambulatory device for detection of AASM defined arousals from sleep: the WP100.  Sleep Med. 2003;4(3):207-212.PubMedGoogle ScholarCrossref
Penzel  T, Kesper  K, Pinnow  I, Becker  HF, Vogelmeier  C.  Peripheral arterial tonometry, oximetry and actigraphy for ambulatory recording of sleep apnea.  Physiol Meas. 2004;25(4):1025-1036.PubMedGoogle ScholarCrossref
Pittman  SD, Ayas  NT, MacDonald  MM, Malhotra  A, Fogel  RB, White  DP.  Using a wrist-worn device based on peripheral arterial tonometry to diagnose obstructive sleep apnea: in-laboratory and ambulatory validation.  Sleep. 2004;27(5):923-933.PubMedGoogle Scholar
Zou  D, Grote  L, Peker  Y, Lindblad  U, Hedner  J.  Validation a portable monitoring device for sleep apnea diagnosis in a population based cohort using synchronized home polysomnography.  Sleep. 2006;29(3):367-374.PubMedGoogle Scholar
Pang  KP, Gourin  CG, Terris  DJ.  A comparison of polysomnography and the WatchPAT in the diagnosis of obstructive sleep apnea.  Otolaryngol Head Neck Surg. 2007;137(4):665-668.PubMedGoogle ScholarCrossref
Choi  JH, Kim  EJ, Kim  YS,  et al.  Validation study of portable device for the diagnosis of obstructive sleep apnea according to the new AASM scoring criteria: Watch-PAT 100.  Acta Otolaryngol. 2010;130(7):838-843.PubMedGoogle ScholarCrossref
Hedner  J, White  DP, Malhotra  A,  et al.  Sleep staging based on autonomic signals: a multi-center validation study.  J Clin Sleep Med. 2011;7(3):301-306.PubMedGoogle Scholar
Iber  C, Ancoli-Israel  S, Chesson  A, Quan  SF; American Academy of Sleep Medicine.  The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, IL: AASM; 2007.
Duval  S, Tweedie  R.  Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis.  Biometrics. 2000;56(2):455-463.PubMedGoogle ScholarCrossref
Onder  NS, Akpinar  ME, Yigit  O, Gor  AP.  Watch peripheral arterial tonometry in the diagnosis of obstructive sleep apnea: influence of aging.  Laryngoscope. 2012;122(6):1409-1414.PubMedGoogle ScholarCrossref
Yuceege  M, Firat  H, Demir  A, Ardic  S.  Reliability of the Watch-PAT 200 in detecting sleep apnea in highway bus drivers.  J Clin Sleep Med. 2013;9(4):339-344.PubMedGoogle Scholar
Weimin  L, Rongguang  W, Dongyan  H, Xiaoli  L, Wei  J, Shiming  Y.  Assessment of a portable monitoring device WatchPAT 200 in the diagnosis of obstructive sleep apnea [published online May 23, 2013].  Eur Arch Otorhinolaryngol. doi:10.1007/s00405-013-2555-4.PubMedGoogle Scholar
Original Investigation
December 2013

Diagnosis of Obstructive Sleep Apnea by Peripheral Arterial Tonometry: Meta-analysis

Author Affiliations
  • 1Chicago ENT Advanced Center for Specialty Care, Department of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago
  • 2Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center, Chicago, Illinois
JAMA Otolaryngol Head Neck Surg. 2013;139(12):1343-1350. doi:10.1001/jamaoto.2013.5338

Importance  Efficient diagnosis and early treatment of obstructive sleep apnea may help prevent the development of related morbidity and mortality. Compared with polysomnography (PSG), ambulatory sleep study devices offer the possibility of an accurate diagnosis with convenience and low cost.

Objective  To assess the correlation between sleep indexes measured by a portable sleep-testing device (peripheral arterial tonometry [PAT]) and those measured by PSG.

Data Sources  We searched PubMed, MEDLINE, the Cochrane Trial Registry (through May 2013), and relevant article bibliographies.

Study Selection  Systematic review and meta-analysis of studies assessing correlation of sleep indexes between PAT devices and PSG in adults (aged >18 years). Included studies provided a bivariate correlation coefficient for sleep indexes, specifically the respiratory disturbance index (RDI), apnea-hypopnea index (AHI), and oxygen desaturation index (ODI).

Data Extraction and Synthesis  Included studies were reviewed by 2 independent reviewers. Reported correlation values for the RDI, AHI, and ODI between a commercially available PAT device (WatchPAT) and PSG were systematically reviewed. A comprehensive meta-analysis software package was used for statistical analysis.

Main Outcomes and Measures  Assessment of the correlation between PAT and PSG as measured by AHI, RDI, and ODI.

Results  Fourteen studies met inclusion criteria and had data suitable for pooling (909 patients). Of these, 13 studies had blinded study designs, with PAT and PSG conducted simultaneously in the home or the laboratory setting. One study contained 2 trial phases for the same patient group (n = 29), one laboratory based and the other home based, which were analyzed separately. One study contained 2 different study groups based on age. Overall, correlation of the RDI and AHI was high (r = 0.889 [95% CI, 0.862-0.911]; P < .001). Studies comparing the RDI between PAT and PSG had a combined correlation of 0.879 (95% CI, 0.849-0.904; P < .001); those comparing the AHI, 0.893 (0.857-0.920; P < .001); and those comparing the ODI, 0.942 (0.894-0.969; P < .001). Analysis of publication bias revealed a nonsignificant Egger regression intercept.

Conclusions and Relevance  Respiratory indexes calculated using PAT-based portable devices positively correlated with those calculated from the scoring of PSG. Strengthened by the blinded design of most of the included studies, this technology represents a viable alternative to PSG for confirmation of clinically suspected sleep apnea.