Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-22T17:51:38.550Z Has data issue: false hasContentIssue false
  • English
  • Français

The Assessment of a New Technology for Evaluating Respiratory Abnormalities in Sleep

A Comparison of the Polysomnogram and an Ambulatory Microprocessor

Published online by Cambridge University Press:  10 March 2009

German Nino-Murcia ,
Donald L. Bliwise ,
Sharon Keenan  and
William Dement
German Nino-Murcia
Affiliation:
Stanford University Medical School
Donald L. Bliwise
Affiliation:
Stanford University Medical School
Sharon Keenan
Affiliation:
Stanford University Medical School
William Dement
Affiliation:
Stanford University Medical School
Get access Rights & Permissions [Opens in a new window]

Abstract

This study assessed the diagnostic utility of two technologies for evaluating respiratory abnormalities in sleep. We compared conventional polysomnography with a new, ambulatory microprocessor technology. Two key features of the comparison involved: (a) the use of multiple, skilled interpreters of each system; and (b) inter-rater agreement within the systems as a crucial test for the diagnostic utility of each. Results indicated that general categories of respiratory abnormalities could be judged more reliably than more specific categories, regardless of technology. For certain categories of respiratory abnormalities, however, inter-rater agreement with the newer technology was extremely low (e.g., reliability coefficients of.12,.09, and –.06). Factors contributing to these low diagnostic reliabilities are discussed. Our data indicate that any assessment of new technology cannot be made apart from the clinical judgments to be rendered with that new technology. This approach may be generalizable to the assessment of other diagnostic technologies.

Type
General Essay
Information
International Journal of Technology Assessment in Health Care , Volume 3 , Issue 3 , July 1987 , pp. 427 - 445
Copyright
Copyright © Cambridge University Press 1987

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Ancoli-Israel, S., Kripke, D. F., & Mason, W. J.Obstructive sleep apnea in a senior population. Sleep Research, 1986, 13, 130.Google Scholar
2.Ancoli-Israel, S., Kripke, D. F., Mason, W., & Kaplan, O. J.Sleep apnea and periodic movements in an aging sample. Journal of Gerontology, 1985, 40, 419–425.CrossRefGoogle Scholar
3.Bartko, J. J., & Carpenter, W.T.On the methods and theory of reliability. Journal of Nervous and Mental Disease, 1976, 163, 307–317.CrossRefGoogle ScholarPubMed
4.Berry, D. T. R., Webb, W. B., & Block, A. J.Sleep apnea syndrome: A critical review of the apnea index as a diagnostic criterion. Chest, 1984, 86, 529–531.CrossRefGoogle ScholarPubMed
5.Bixler, E. O., Kales, A., & Soldatos, C. R.Sleep disorders encountered in medical practice: A national survey of physicians. Behavioral Medicine, 1979, 6, 13–21.Google Scholar
6.Bixler, E. O., Kales, A., Soldatos, C. R., Kales, J. D., & Healey, S.Prevalence of sleep disorders in the Los Angeles Metropolitan Area. American Journal of Psychiatry, 1979, 136, 1257–1262.Google ScholarPubMed
7.Bliwise, D. L., Bliwise, N. G., Kraemer, H. C., & Dement, W. C.Measurement error in visually scored electrophysiological data: Respiration during sleep. Journal of Neuroscience Methods, 1984, 12, 49–56.CrossRefGoogle ScholarPubMed
8.Bliwise, D., Carey, E., & Dement, W. C.Nightly variation in sleep-related respiratory disturbances in older adults. Experimental Aging Resarch, 1983, 9, 77–81.CrossRefGoogle ScholarPubMed
9.Bliwise, D. L., Feldman, D. E., Bliwise, N. G., Carskadon, M. A., Kraemer, H. C., North, C. S., Petta, D. F., Seidel, W. F., & Dement, W. C.Risk factors for sleep disordered breathing in heterogeneous geriatric populations. Journal of the American Geriatrics Society, 1987, 35, 132–141.Google ScholarPubMed
10.Bliwise, D. L., Pursley, A. M., Bliwise, N. G., & Dement, W. C.Impaired respiration in sleep is associated with mortality in an ambulatory, non-institutionalized aged sample. Sleep Research, 1986, 15, 104.Google Scholar
11.Block, A. J.Polysomnography: Some difficult questions. Annals of Internal Medicine, 1981, 95, 644–645.CrossRefGoogle ScholarPubMed
12.Bornstein, S. K. Respiratory monitoring during sleep: Polysomnography. In Guilleminault, C. (ed.), Sleep and waking disorders: Indications and techniques. Menlo Park, CA: Addison-Wesley, 1982, 183–212.Google Scholar
13.Bradley, D., & Phillipson, E. A.American Review of Respiratory Diseases, 1983, 128, 583–586.Google Scholar
14.Carskadon, M. A. Basics for polygraphic monitoring of sleep. In Guilleminault, C. (ed.), Sleep and waking disorders: Indications and techniques. Menlo Park, CA: Addison-Wesley, 1982, 1–16.Google Scholar
15.Cartwright, R. D.Effect of sleep position on sleep apnea severity. Sleep, 1984, 7, 110–114.CrossRefGoogle ScholarPubMed
16.Catterall, J. R., Calverley, P. M. A., Shapiro, C. M., Flenley, D. C., – Douglas, N. J.Breathing and oxygenation during sleep are similar in normal men and women. American Review of Respiratory Disease, 1985, 132, 86–88.Google Scholar
17.Cohn, M. Respiratory monitoring during sleep: Respiratory inductive plethysmography. In Guilleminault, C. (ed.), Sleep and waking disorders: Indications and techniques. Menlo Park, CA: Addison-Wesley, 1982, 213–223.Google Scholar
18.Cohn, M. A., Watson, H. L., Weisshat, R., Scott, F., & Sackner, M. A. A transducer for non-invasive monitoring of respiration. In Scott, F. D., Raftery, E. G., Sleight, P., & Goulding, L. (eds.), ISAM-77: Proceedings of the Second International Symposium on Ambulatory Monitoring. London: Academic Press, 1978, 119–128.Google Scholar
19.Coleman, R. M., Miles, L. E., Guilleminault, C., Zarcone, V. P., van den Hoed, J., & Dement, W. C.Sleep-wake disorders in the elderly: A polysomnographic analysis. Journal of the American Geriatrics Society, 1981, 29, 289–296.CrossRefGoogle ScholarPubMed
20.Coleman, R. M., Roffwarg, H. P., Kennedy, S. J., Guilleminault, C., Cinque, J., Cohn, M., et al. Sleep-wake disorders based on a polysomnographic diagnosis: A national cooperative study. Journal of the American Medical Association, 1982, 247, 997–1003.CrossRefGoogle ScholarPubMed
21.Dolly, F. R., & Block, A. J.Effect of Flurazepam on sleep-disordered breathing and nocturnal oxygen desaturation in asymptomatic subjects. American Journal of Medicine, 1982, 73, 239–243.CrossRefGoogle ScholarPubMed
22.Findley, L. J., Wilhoit, S. C., & Suratt, P. M.Apnea duration and hypoxemia during REM sleep in patients with obstructive sleep apnea. Chest, 1985, 87, 432–436.CrossRefGoogle ScholarPubMed
23.Fletcher, E. C., Gray, B. A., & Levin, D. C.Nonapneic mechanisms of arterial oxygen desaturation during rapid-eye-movement sleep. Journal of Applied Physiology: Respiratory, Environmental, and Exercise Physiology, 1983, 54, 632–639.CrossRefGoogle ScholarPubMed
24.George, C. F., & Kryger, M. H.When is an apnea not an apnea? American Review of Respiratory Disease, 1985, 131, 485–486.CrossRefGoogle ScholarPubMed
25.Guilleminault, C. Natural history, cardiac impact, and long-term follow-up of sleep apnea syndrome. In Guilleminault, C. & Lugaresi, E. (eds.), Sleep/wake disorders: Natural history, epidemiology, and long-term evolution. New York: Raven Press, 1983, 107–125.Google Scholar
26.Guilleminault, C., Connoly, S. J., & Winkle, R. A.Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. American Journal of Cardiology, 1983, 52, 490–494.CrossRefGoogle ScholarPubMed
27.Guilleminault, C., & Dement, W. C. (eds.), Sleep apnea syndromes. New York: Alan R. Liss, 1978.Google Scholar
28.Guilleminault, C., Pool, P., Motta, J., & Gillis, A. M.Sinus arrest during REM sleep in young adults. New England Journal of Medicine, 1984, 311, 1006–1010.CrossRefGoogle ScholarPubMed
29.Hudgel, D. W., “Apnea Index”: need for improving the description of respiratory variability during sleep. American Review of Respiratory Disease, 1986, 133, 708–709.Google ScholarPubMed
30.Kales, A., Bixler, E. O., Cadieux, R. J., Schneck, D. W., Shaw, L. C. III, Locke, T. W., Vela-Bueno, A., & Soldatos, C. R.Sleep apnea in a hypertensive population. Lancet, 1984, 2(8410), 1005–1008.CrossRefGoogle Scholar
31.Konno, K., & Mead, J.Measurement of the separate volume changes of rib cage and abdomen during breathing. Journal of Applied Physiology, 1967, 22, 407–422.CrossRefGoogle ScholarPubMed
32.Koran, L. M.The reliability of clinical methods, data, and judgments I. New England Journal of Medicine, 1975, 293, 642–646.CrossRefGoogle Scholar
33.Koran, L. M.The reliability of clinical methods, data, and judgments II. New England Journal of Medicine, 1975, 293, 695–701.CrossRefGoogle Scholar
34.Kripke, D. F., Mullaney, D. J., Messin, S., & Wyborney, V. G.Wrist actigraphic measures of sleep and rhythms. Electroencephalography and Clinical Neurophysiology, 1978, 44, 674–676.CrossRefGoogle ScholarPubMed
35.Kupfer, D. J., & Crook, T. (eds.). Physician's guide to the recognition and treatment of sleep disorders in the elderly. New Canaan, CT: Mark Powley, 1984.Google Scholar
36.Lavie, P.Sleep habits and sleep disturbances in industrial workers in Israel: Main findings and some characteristics of workers' complaints of excessive daytime somnolence. Sleep, 1981, 4, 147–158.CrossRefGoogle Scholar
37.Lavie, P., Ben-Yosef, R., & Rubin, A. E.Prevalence of sleep apnea syndrome among patients with essential hypertension. American Heart Journal, 1985, 55, 1019–1022.Google Scholar
38.Levine, B., Moyles, T., Roehrs, T., Fortier, J., & Roth, T.Actigraphic monitoring and polygraphic recording in determination of sleep and wake. Sleep Research, 1986, 15, 247.Google Scholar
39.Littner, M., & McGinty, D.Asymptomatic disordered breathing during sleep in older persons: disease or not? Archives of Internal Medicine, 1985, 145, 233–234.CrossRefGoogle ScholarPubMed
40.Milledge, J. S., & Stott, F. D.Inductive plethysmography: A new respiratory transducer. Journal of Physiology, 1977, 267, 48.Google ScholarPubMed
41.Mullaney, D. J., Kripke, D. F., & Messin, S.Wrist-actigraphic estimation of sleep time. Sleep, 1980, 3, 83–92.CrossRefGoogle ScholarPubMed
42.Muller, N. L., Francis, P. W., Gurwitz, D., Levison, H., & Bryan, A. C.Mechanisms of hemoglobin desaturation during rapid-eye movement sleep in normal subjects and in patients with cystic fibrosis. American Review of Respiratory Disease, 1980, 121, 463–469.CrossRefGoogle ScholarPubMed
43.Rechtschaffen, A., & Kales, A. (eds.). A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: Brain Information Service/Brain Research Institute, 1968.Google Scholar
44. Society of Actuaries and Association of Life Insurance Medical Directors of America. Build study, 1979. Recording and Statistical Corporation, 1980.Google Scholar
45.Taasan, V. C., Block, A. J., Boysen, P. G., & Wynne, J. W.Alcohol increases sleep apnea and oxygen desaturation in asymptomatic men. American Journal of Medicine, 1981, 71, 240–245.Google ScholarPubMed
46.Walker, L. E., Walker, J. M., Farney, R. J., & Kramer, J.A comparison of polysomnography with a portable home monitoring system in the detection of sleep apnea. Sleep Research, 1986, 15, 262.Google Scholar
47.Watson, H., Schneider, A., Birch, S., Chadha, T., Abraham, W. M., Cohn, M., & Sackner, M. A. Calibration techniques for the respiratory inductive plethysmograph. In Scott, F. D., Raftery, E. G., Sleight, P., & Goulding, L. (eds.), ISAM-77: Proceedings of the Second International Symposium on Ambulatory Monitoring. London: Academic Press, 1978, 269–284.Google Scholar
48.Williams, A. J., Houston, D., Finberg, S., Lam, C., Kinney, J. L., & Santiago, S.Sleep apnea syndrome and essential hypertension. American Journal of Cardiology, 1985, 55, 1019–1022.CrossRefGoogle ScholarPubMed
49.Wittig, R. M., Romaker, A., Zorick, F. J., Roehrs, T. A., Conway, W. A., & Roth, T.Night-to-night consistency of apneas during sleep. American Review of Respiratory Disease, 1984, 129, 244–246.Google ScholarPubMed
50.Zepelin, Z.Letter to the editor. Journal of Gerontology, 1983, 38, 384.CrossRefGoogle Scholar
51.Zimmerman, P. V., Connellan, S. J., Middleton, H. C., Tabona, M. V., Goldman, M. D., & Pride, N.Postural changes in rib cage and abdominal volume-motion coefficients and their effect on the calibration of a respiratory inductance plethysmograph. American Review of Respiratory Disease, 1983, 127, 209–214.Google ScholarPubMed