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Clinical Use of a Home Sleep Apnea Test: An American Academy of Sleep Medicine Position Statement
Rosen, Ilene M; Kirsch, Douglas B; Chervin, Ronald D; Carden, Kelly A; Ramar, Kannan; Aurora, R Nisha; Kristo, David A; Malhotra, Raman K; Martin, Jennifer L; Olson, Eric J; Rosen, Carol L; Rowley, James A
The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent health priority. It is the position of the American Academy of Sleep Medicine (AASM) that only a physician can diagnose medical conditions such as OSA and primary snoring. Throughout this statement, the term "physician" refers to a medical provider who is licensed to practice medicine. A home sleep apnea test (HSAT) is an alternative to polysomnography for the diagnosis of OSA in uncomplicated adults presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. It is also the position of the AASM that: the need for, and appropriateness of, an HSAT must be based on the patient's medical history and a face-to-face examination by a physician, either in person or via telemedicine; an HSAT is a medical assessment that must be ordered by a physician to diagnose OSA or evaluate treatment efficacy; an HSAT should not be used for general screening of asymptomatic populations; diagnosis, assessment of treatment efficacy, and treatment decisions must not be based solely on automatically scored HSAT data, which could lead to sub-optimal care that jeopardizes patient health and safety; and the raw data from the HSAT device must be reviewed and interpreted by a physician who is either board-certified in sleep medicine or overseen by a board-certified sleep medicine physician.
PMID: 28942762
ISSN: 1550-9397
CID: 5400632
UTILITY OF TYPE 3 PORTABLE MONITORING FOR DIAGNOSIS OF SLEEP APNEA IN ACUTE DECOMPENSATED HEART FAILURE [Meeting Abstract]
Punjabi, N. M.; Patil, S.; Aurora, R. N.
ISI:000433175000490
ISSN: 0161-8105
CID: 5401042
The Association Between Nocturnal Hypoxemia, Subjective Sleepiness, And Glycemic Control In Patients With Type 2 Diabetes Mellitus [Meeting Abstract]
Aurora, R. N.; Punjabi, N. M.
ISI:000400372504169
ISSN: 1073-449x
CID: 5401002
Rem-Related Sleep Apnea And All-Cause Mortality [Meeting Abstract]
Aurora, R. N.; Kim, J.; Crainiceanu, C.; Punjabi, N. M.
ISI:000400372502247
ISSN: 1073-449x
CID: 5400992
Habitual Sleep Duration and All-Cause Mortality in a General Community Sample
Aurora, R Nisha; Kim, Ji Soo; Crainiceanu, Ciprian; O'Hearn, Daniel; Punjabi, Naresh M
STUDY OBJECTIVES:The current study sought to determine whether sleep duration and change in sleep duration are associated with all-cause mortality in a community sample of middle-aged and older adults while accounting for several confounding factors including prevalent sleep-disordered breathing (SDB). METHODS:Habitual sleep duration was assessed using self-report (< 7, 7-8, ≥ 9 h/night) at the baseline and at the follow-up visits of the Sleep Heart Health Study. Techniques of survival analysis were used to relate habitual sleep duration and change in sleep duration to all-cause mortality after adjusting for covariates such as age, sex, race, body mass index, smoking history, prevalent hypertension, diabetes, cardiovascular disease, antidepressant medication use, and SDB severity. RESULTS:Compared to a sleep duration of 7-8 h/night, habitually long sleep duration (≥ 9 h/night), but not short sleep duration (< 7 h/night), was associated with all-cause mortality with an adjusted hazards ratio of 1.25 (95% confidence interval [CI]: 1.05, 1.47). Participants who progressed from short or normal sleep duration to long sleep duration had increased risk for all-cause mortality with adjusted hazard ratios of 1.75 (95% CI: 1.08, 2.78) and 1.63 (95% CI: 1.26, 2.13), respectively. Finally, a change from long to short sleep duration was also associated with all-cause mortality. CONCLUSION:Long sleep duration or a shift from long to short sleep duration are independently associated with all-cause mortality.
PMCID:5070744
PMID: 27450684
ISSN: 1550-9109
CID: 5400612
Keep Calm and Debate On [Comment]
Aurora, R Nisha; Bista, Sabin R; Casey, Kenneth R; Chowdhuri, Susmita; Kristo, David A; Mallea, Jorge M; Ramar, Kannan; Rowley, James A; Zak, Rochelle S; Heald, Jonathan L
PMID: 27568903
ISSN: 1550-9397
CID: 5400622
Quality Measure for Screening for Adult Obstructive Sleep Apnea by Primary Care Physicians
Aurora, Rashmi N; Quan, Stuart F
Obstructive sleep apnea (OSA) is a highly prevalent condition which remains under-diagnosed and under-treated. Untreated OSA is associated with several chronic medical conditions, a reduction in quality of life and increases in health care costs. Therefore, early identification of undiagnosed cases is important. Implementation of a screening measure in a primary care environment for populations at high-risk for OSA could improve patient outcomes and reduce the health care burden of untreated OSA.
PMCID:4957197
PMID: 27397659
ISSN: 1550-9397
CID: 5400512
Agreement Between Results of Home Sleep Testing for Obstructive Sleep Apnea with and Without a Sleep Specialist
Aurora, R Nisha; Putcha, Nirupama; Swartz, Rachel; Punjabi, Naresh M
BACKGROUND:Obstructive sleep apnea is a prevalent yet underdiagnosed condition associated with cardiovascular morbidity and mortality. Home sleep testing offers an efficient means for diagnosing obstructive sleep apnea but has been deployed primarily in clinical samples with a high pretest probability. The present study sought to assess whether obstructive sleep apnea can be diagnosed with home sleep testing in a nonreferred sample without involvement of a sleep medicine specialist. METHODS:A study of community-based adults with untreated obstructive sleep apnea was undertaken. Misclassification of disease severity according to home sleep testing with and without involvement of a sleep medicine specialist was assessed, and agreement was characterized using scatter plots, Pearson's correlation coefficient, Bland-Altman analysis, and the κ statistic. Analyses were also conducted to assess whether any observed differences varied as a function of pretest probability of obstructive sleep apnea or subjective sleepiness. RESULTS:The sample consisted of 191 subjects, with more than half (56.5%) having obstructive sleep apnea. Without involvement of a sleep medicine specialist, obstructive sleep apnea was not identified in only 5.8% of the sample. Analyses comparing the categorical assessment of disease severity with and without a sleep medicine specialist showed that in total, 32 subjects (16.8%) were misclassified. Agreement in the disease severity with and without a sleep medicine specialist was not influenced by the pretest probability or daytime sleep tendency. CONCLUSION:Obstructive sleep apnea can be reliably identified with home sleep testing in a nonreferred sample, irrespective of the pretest probability of the disease.
PMCID:4930550
PMID: 26968467
ISSN: 1555-7162
CID: 5400592
Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: "The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses"
Aurora, R Nisha; Bista, Sabin R; Casey, Kenneth R; Chowdhuri, Susmita; Kristo, David A; Mallea, Jorge M; Ramar, Kannan; Rowley, James A; Zak, Rochelle S; Heald, Jonathan L
An update of the 2012 systematic review and meta-analyses were performed and a modified-GRADE approach was used to update the recommendation for the use of adaptive servo-ventilation (ASV) for the treatment of central sleep apnea syndrome (CSAS) related to congestive heart failure (CHF). Meta-analyses demonstrated an improvement in LVEF and a normalization of AHI in all patients. Analyses also demonstrated an increased risk of cardiac mortality in patients with an LVEF of ≤ 45% and moderate or severe CSA predominant sleep-disordered breathing. These data support a Standard level recommendation against the use of ASV to treat CHF-associated CSAS in patients with an LVEF of ≤ 45% and moderate or severe CSAS, and an Option level recommendation for the use of ASV in the treatment CHF-associated CSAS in patients with an LVEF > 45% or mild CHF-related CSAS. The application of these recommendations is limited to the target patient populations; the ultimate judgment regarding propriety of any specific care must be made by the clinician.
PMID: 27092695
ISSN: 1550-9397
CID: 5400602
Computer-Assisted Automated Scoring of Polysomnograms Using the Somnolyzer System
Punjabi, Naresh M; Shifa, Naima; Dorffner, Georg; Patil, Susheel; Pien, Grace; Aurora, Rashmi N
STUDY OBJECTIVES/OBJECTIVE:Manual scoring of polysomnograms is a time-consuming and tedious process. To expedite the scoring of polysomnograms, several computerized algorithms for automated scoring have been developed. The overarching goal of this study was to determine the validity of the Somnolyzer system, an automated system for scoring polysomnograms. DESIGN/METHODS:The analysis sample comprised of 97 sleep studies. Each polysomnogram was manually scored by certified technologists from four sleep laboratories and concurrently subjected to automated scoring by the Somnolyzer system. Agreement between manual and automated scoring was examined. Sleep staging and scoring of disordered breathing events was conducted using the 2007 American Academy of Sleep Medicine criteria. SETTING/METHODS:Clinical sleep laboratories. MEASUREMENTS AND RESULTS/RESULTS:A high degree of agreement was noted between manual and automated scoring of the apnea-hypopnea index (AHI). The average correlation between the manually scored AHI across the four clinical sites was 0.92 (95% confidence interval: 0.90-0.93). Similarly, the average correlation between the manual and Somnolyzer-scored AHI values was 0.93 (95% confidence interval: 0.91-0.96). Thus, interscorer correlation between the manually scored results was no different than that derived from manual and automated scoring. Substantial concordance in the arousal index, total sleep time, and sleep efficiency between manual and automated scoring was also observed. In contrast, differences were noted between manually and automated scored percentages of sleep stages N1, N2, and N3. CONCLUSION/CONCLUSIONS:Automated analysis of polysomnograms using the Somnolyzer system provides results that are comparable to manual scoring for commonly used metrics in sleep medicine. Although differences exist between manual versus automated scoring for specific sleep stages, the level of agreement between manual and automated scoring is not significantly different than that between any two human scorers. In light of the burden associated with manual scoring, automated scoring platforms provide a viable complement of tools in the diagnostic armamentarium of sleep medicine.
PMCID:4576329
PMID: 25902809
ISSN: 1550-9109
CID: 5400502