CoChat
Sign Up
Cited by 85Obstructive Sleep Apnea ResearchSleep and related disordersChronic Obstructive Pulmonary Disease (COPD) Research

Home-based Diagnosis of Obstructive Sleep Apnea in an Urban Population

Open access
Garg, Natasha, Rolle, Andrew J., Lee, Todd A., Prasad, Bharati·2014·Journal of Clinical Sleep Medicine
DOI 10.5664/jcsm.3960PMC PMC4106942
Open this paper in CoChat — free account

Abstract

Study objectives Home-based diagnosis of obstructive sleep apnea (OSA) with portable monitoring (PM) is increasingly utilized, but remains understudied in underserved and minority populations. We tested the feasibility of home PM in an urban population at risk for OSA compared to in-laboratory polysomnography (PSG) and examined patient preference with respect to home PM versus PSG. Methods Randomized crossover study of home PM (WatchPAT200) and in-laboratory simultaneous PSG and PM in 75 urban African Americans with high pre-test probability of OSA, identified with the Berlin questionnaire. Results Fifty-seven of 75 participants were women, average age 45 ± 11 years (mean ± SD), 35% with ≤ high school education, and 76% with annual household income < $50,000. Technical failure rates were 5.3% for home vs. 3.1% for in-laboratory PM. There was good agreement between apnea hypopnea index on PSG; AHIPSG and AHI on home PM (mean ± 2 SD of the differences = 0.64 ± 46.5 and intraclass correlation coefficient; ICC = 0.73). The areas under the curve for the receiver-operator characteristic curves for home PM were 0.90 for AHIPSG ≥ 5, 0.95 for AHIPSG ≥ 10, and 0.92 for AHIPSG ≥ 15. 62/75 (82%) participants preferred home over in-laboratory testing. Conclusions Home PM for diagnosis of OSA in a high risk urban population is feasible, accurate, and preferred by patients. As home PM may improve access to care, the cost-effectiveness of this diagnostic strategy for OSA should be examined in underserved urban and rural populations. Clinical trials registration ClinicalTrials.gov, identifier: NCT01997723.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.5664/jcsm.3960

Cites

3 of 3 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Two cross-over studies randomized patients to home-based PAT, and in-laboratory simultaneous PSG and PAT.

    “Two cross-over studies randomized patients to home-based PAT, and in-laboratory simultaneous PSG and PAT.”

    From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [106]

    The Methods (Protocol) say participants were randomized to a home WatchPAT200 session or an in-laboratory session with simultaneous PSG and WatchPAT200. The Abstract identifies this as one randomized crossover study, so this source supports the study design but not the claim that there were two studies. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • A single study that evaluated the performance of the PAT device in the home against in-laboratory PSG using a cutoff of AHI ≥ 5 reported a specificity of 0.43 (95% CI: 0.22 to 0.66).

    “A single study that evaluated the performance of the PAT device in the home against in-laboratory PSG using a cutoff of AHI ≥ 5,106 reported a specificity of 0.43 (95% CI: 0.22 to 0.66).”

    From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [106]

    The Methods and Results report a comparison of home WatchPAT200 testing with in-laboratory PSG and a specificity of 0.43 at an AHI threshold of ≥5. The stated 95% confidence interval (0.22 to 0.66) is not available in our copy: Table 3 appears only as an image reference, and the accompanying Results text does not give that interval. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • When two studies evaluated the home-based PAT device against in-laboratory PSG at an AHI cutoff of ≥ 15, specificity ranged from 0.77 to 1.00 and sensitivity ranged from 0.92 to 0.96.

    “When two studies evaluated the home-based PAT device against in-laboratory PSG at an AHI cutoff of ≥ 15, specificity ranged from 0.77 to 1.00 and sensitivity ranged from 0.92 to 0.96.”

    From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [106]

    The Results report that home WatchPAT200 was compared with in-laboratory PSG at an AHI cutoff of ≥15 and had specificity of 0.77, with sensitivity of at least 0.90. Our copy does not give the claimed sensitivity range of 0.92–0.96 or report a second study with specificity of 1.00, so it supports only part of the two-study range. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 45

  1. [1]Kuna ST. Portable-monitor testing: an alternative strategy for managing patients with obstructive sleep apnea. Respir Care. 2010;55:1196–215. [PubMed] [Google Scholar]
  2. [2]Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007;3:737–47. [PMC free article] [PubMed] [Google Scholar]
  3. [3]Mohsenin V. Portable monitoring for obstructive sleep apnea: the horse is out of the barn-avoiding pitfalls. Am J Med. 2013;126:e1–3. doi: 10.1016/j.amjmed.2012.05.016. [DOI] [PubMed] [Google Scholar] · DOI
  4. [4]Kuna ST, Badr MS, Kimoff RJ, et al. An official ATS/AASM/ACCP/ERS workshop report: Research priorities in ambulatory management of adults with obstructive sleep apnea. Proc Am Thorac Soc. 2011;8:1–16. doi: 10.1513/pats.2009-042WS. [DOI] [PubMed] [Google Scholar] · DOI
  5. [5]Fleetham J, Ayas N, Bradley D, et al. Canadian Thoracic Society 2011 guideline update: diagnosis and treatment of sleep disordered breathing. Can Respir J. 2011;18:25–47. doi: 10.1155/2011/506189. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  6. [6]McNicholas WT, Levy P. Portable monitoring in sleep apnoea: the way forward? Eur Respir J. 2011;37:749–51. doi: 10.1183/09031936.00180410. [DOI] [PubMed] [Google Scholar] · DOI
  7. [7]Flemons WW, Littner MR, Rowley JA, et al. Home diagnosis of sleep apnea: a systematic review of the literature. An evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society. Chest. 2003;124:1543–79. doi: 10.1378/chest.124.4.1543. [DOI] [PubMed] [Google Scholar] · DOI
  8. [8]Chesson AL, Jr., Berry RB, Pack A American Academy of Sleep Medicine, American Thoracic Society, American College of Chest Physicians. Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. Sleep. 2003;26:907–13. doi: 10.1093/sleep/26.7.907. [DOI] [PubMed] [Google Scholar] · DOI
  9. [9]Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131:485–91. doi: 10.7326/0003-4819-131-7-199910050-00002. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  10. [10]Fulop T, Hickson DA, Wyatt SB, et al. Sleep-disordered breathing symptoms among African-Americans in the Jackson Heart Study. Sleep Med. 2012;13:1039–49. doi: 10.1016/j.sleep.2012.06.005. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  11. [11]Yalamanchali S, Farajian V, Hamilton C, Pott TR, Samuelson CG, Friedman M. Diagnosis of obstructive sleep apnea by peripheral arterial tonometry: meta-analysis. JAMA Otolaryngol Head Neck Surg. 2013;139:1343–50. doi: 10.1001/jamaoto.2013.5338. [DOI] [PubMed] [Google Scholar] · DOI
  12. [12]Iber C, Ancoli-Israel S, Chesson AL, Jr., Quan SF. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine; 2007. [Google Scholar]
  13. [13]White DP. Monitoring peripheral arterial tone (PAT) to diagnose sleep apnea in the home. J Clin Sleep Med. 2008;4:73. [PMC free article] [PubMed] [Google Scholar]
  14. [14]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;27:923–33. doi: 10.1093/sleep/27.5.923. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  15. [15]Ayas NT, Pittman S, MacDonald M, White DP. Assessment of a wrist-worn device in the detection of obstructive sleep apnea. Sleep Med. 2003;4:435–42. doi: 10.1016/s1389-9457(03)00111-4. [DOI] [PubMed] [Google Scholar] · DOI
  16. [16]Kapur VK, Rapoport DM, Sanders MH, et al. Rates of sensor loss in unattended home polysomnography: the influence of age, gender, obesity, and sleep-disordered breathing. Sleep. 2000;23:682–8. [PubMed] [Google Scholar]
  17. [17]Obuchowski NA, McClish DK. Sample size determination for diagnostic accuracy studies involving binormal ROC curve indices. Stat Med. 1997;16:1529–42. doi: 10.1002/(sici)1097-0258(19970715)16:13<1529::aid-sim565>3.0.co;2-h. [DOI] [PubMed] [Google Scholar] · DOI
  18. [18]Ayas NT, Fox J, Epstein L, Ryan CF, Fleetham JA. Initial use of portable monitoring versus polysomnography to confirm obstructive sleep apnea in symptomatic patients: an economic decision model. Sleep Med. 2010;11:320–4. doi: 10.1016/j.sleep.2009.08.015. [DOI] [PubMed] [Google Scholar] · DOI
  19. [19]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;29:367–74. doi: 10.1093/sleep/29.3.367. [DOI] [PubMed] [Google Scholar] · DOI
  20. [20]Flemons WW, Littner MR. Measuring agreement between diagnostic devices. Chest. 2003;124:1535–42. doi: 10.1378/chest.124.4.1535. [DOI] [PubMed] [Google Scholar] · DOI
  21. [21]Prasad B, Carley DW, Herdegen JJ. Continuous positive airway pressure device-based automated detection of obstructive sleep apnea compared to standard laboratory polysomnography. Sleep Breath. 2010;14:101–7. doi: 10.1007/s11325-009-0285-z. [DOI] [PubMed] [Google Scholar] · DOI
  22. [22]Pepe M. The statistical evaluation of medical tests for classification and prediction. Oxford Univeristy Press; 2003. [Google Scholar]
  23. [23]DeLong E, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45. [PubMed] [Google Scholar]
  24. [24]Ross SD, Sheinhait IA, Harrison KJ, et al. Systematic review and meta-analysis of the literature regarding the diagnosis of sleep apnea. Sleep. 2000;23:519–32. [PubMed] [Google Scholar]
  25. [25]Tosteson AN, Begg CB. A general regression methodology for ROC curve estimation. Med Decis Making. 1988;8:204–15. doi: 10.1177/0272989X8800800309. [DOI] [PubMed] [Google Scholar] · DOI
  26. [26]Mediano O, Barcelo A, de la Pena M, Gozal D, Agusti A, Barbe F. Daytime sleepiness and polysomnographic variables in sleep apnoea patients. Eur Respir J. 2007;30:110–13. doi: 10.1183/09031936.00009506. [DOI] [PubMed] [Google Scholar] · DOI
  27. [27]Chasens ER, Ratcliffe SJ, Weaver TE. Development of the FOSQ-10: a short version of the Functional Outcomes of Sleep Questionnaire. Sleep. 2009;32:915–9. doi: 10.1093/sleep/32.7.915. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  28. [29]Kuna ST, Gurubhagavatula I, Maislin G, et al. Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med. 2011;183:1238–44. doi: 10.1164/rccm.201011-1770OC. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  29. [30]Pittman SD, Pillar G, Berry RB, Malhotra A, MacDonald MM, White DP. Follow-up assessment of CPAP efficacy in patients with obstructive sleep apnea using an ambulatory device based on peripheral arterial tonometry. Sleep Breath. 2006;10:123–31. doi: 10.1007/s11325-006-0058-x. [DOI] [PubMed] [Google Scholar] · DOI
  30. [31]Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med. 2004;169:668–72. doi: 10.1164/rccm.200308-1124PP. [DOI] [PubMed] [Google Scholar] · DOI
  31. [32]Jean-Louis G, von Gizycki H, Zizi F, Dharawat A, Lazar JM, Brown CD. Evaluation of sleep apnea in a sample of black patients. J Clin Sleep Med. 2008;4:421–5. [PMC free article] [PubMed] [Google Scholar]
  32. [33]Shaw R, McKenzie S, Taylor T, et al. Beliefs and attitudes toward obstructive sleep apnea evaluation and treatment among blacks. J Natl Med Assoc. 2012;104:510–9. doi: 10.1016/s0027-9684(15)30217-0. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  33. [34]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;9:339–44. doi: 10.5664/jcsm.2584. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  34. [35]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. Eur Arch Otorhinolaryngol. 2013;270:3099–105. doi: 10.1007/s00405-013-2555-4. [DOI] [PubMed] [Google Scholar] · DOI
  35. [36]Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8:597–619. doi: 10.5664/jcsm.2172. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  36. [37]Thornton AT, Singh P, Ruehland WR, Rochford PD. AASM criteria for scoring respiratory events: interaction between apnea sensor and hypopnea definition. Sleep. 2012;35:425–32. doi: 10.5665/sleep.1710. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  37. [38]El Shayeb M, Topfer LA, Stafinski T, Pawluk L, Menon D. Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ. 2014;186:E25–51. doi: 10.1503/cmaj.130952. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  38. [39]Quan SF, Griswold ME, Iber C, et al. Short-term variability of respiration and sleep during unattended nonlaboratory polysomnography–the Sleep Heart Health Study. [corrected] Sleep. 2002;25:843–9. [PubMed] [Google Scholar]
  39. [40]Levendowski DJ, Zack N, Rao S, et al. Assessment of the test-retest reliability of laboratory polysomnography. Sleep Breath. 2009;13:163–7. doi: 10.1007/s11325-008-0214-6. [DOI] [PubMed] [Google Scholar] · DOI
  40. [42]Collop NA, Tracy SL, Kapur V, et al. Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med. 2011;7:531–48. doi: 10.5664/JCSM.1328. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  41. [44]Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth. 2010;57:423–38. doi: 10.1007/s12630-010-9280-x. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  42. [45]Ceylan T, Firat H, Kuran G, Ardic S, Bilgin E, Celenk F. Quick diagnosis in obstructive sleep apnea syndrome: WatchPAT-200. Iran Red Crescent Med J. 2012;14:475–8. [PMC free article] [PubMed] [Google Scholar]
  43. [46]Johnson NL, Kirchner HL, Rosen CL, et al. Sleep estimation using wrist actigraphy in adolescents with and without sleep disordered breathing: a comparison of three data modes. Sleep. 2007;30:899–905. doi: 10.1093/sleep/30.7.899. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  44. [47]Hedner J, White DP, Malhotra A, et al. Sleep staging based on autonomic signals: a multi-center validation study. J Clin Sleep Med. 2011;7:301–6. doi: 10.5664/JCSM.1078. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  45. [48]Campbell AJ, Neill AM. Home set-up polysomnography in the assessment of suspected obstructive sleep apnea. J Sleep Res. 2011;20:207–13. doi: 10.1111/j.1365-2869.2010.00854.x. [DOI] [PubMed] [Google Scholar] · DOI · Paper page

Cited by

Sorted by citations

Authors
Garg, N., Rolle, A. J., Lee, T. A., & Prasad, B.
Affiliations
University of Illinois Chicago (US)
Corresponding author
Prasad, Bharati
ORCID
Venue
Journal of Clinical Sleep Medicine
Publisher
Springer Science and Business Media LLC
Published
2014-08-15
Volume
10
Issue
8
Pages
879-885
ISSN
  • 1550-9389 (ISSN-L)
  • 1550-9397
DOI
10.5664/jcsm.3960
PMC
PMC4106942
OpenAlex
W2332543859
Cited by
85
References
3
Citations by year
2026: 6 · 2025: 8 · 2024: 7 · 2023: 11 · 2022: 7 · 2021: 15 · 2020: 7 · 2019: 4 · 2018: 6 · 2017: 8 · 2016: 2 · 2015: 4
FWCI
2.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Sleep Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Cancer Institute (KM1CA156717)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Keywords
obstructive sleep apnea, home-based diagnosis, portable monitoring, polysomnography, African Americans, urban population, underserved populations, patient preferences, apnea-hypopnea index, diagnostic accuracy, Berlin questionnaire
MeSH terms
Female, Humans, Male, Middle Aged, Monitoring, Physiologic, Self Care, Urban Population, Polysomnography, Cross-Over Studies, Sleep Apnea, Obstructive

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review