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(Chest. 2005;128:2166-2175.)
© 2005 American College of Chest Physicians

Description and Validation of the Apnea Risk Evaluation System*

A Novel Method To Diagnose Sleep Apnea-Hypopnea in the Home

Philip R. Westbrook, MD; Daniel J. Levendowski, MBA; Milenko Cvetinovic, PhD; Timothy Zavora, BS; Vladislav Velimirovic, BS; Delmer Henninger, MD and Dennis Nicholson, MD

* From Advanced Brain Monitoring, Inc. (Drs. Westbrook and Cvetinovic, Mr. Levendowski, Mr. Tavora, and Mr. Velimirovic), Carlsbad; the Murrieta Sleep Medical Clinic (Dr. Henninger), Murietta; and the Sleep Disorders Center (Dr. Nicholson), Pomona Valley Hospital Medical Center, Pomona, CA.

Correspondence to: Philip Westbrook, MD, Advanced Brain Monitoring, Inc., 2850 Pio Pico Dr, Suite A, Carlsbad, CA 92008; e-mail: prw{at}b-alert.com

Study objectives: To evaluate the accuracy and practicality of the Apnea Risk Evaluation System (ARES; Advanced Brain Monitoring; Carlsbad, CA), a limited-channel system for diagnosing sleep apnea/hypopnea in the home.

Design: Prospective randomized study with blinded analysis.

Settings: Two independent, community-based, sleep-disorders centers and the participants’ homes.

Participants: Two hundred ninety-nine subjects were recruited, including 210 consecutive willing patients referred by community physicians to the centers because of suspected sleep apnea; 36 "general medical" patients recruited from community physicians’ offices; and 53 "presumably healthy" subjects recruited from community centers.

Measurements and results: Manual scoring of attended in-laboratory full-night or split-night polysomnography by trained technologists supervised by physicians board certified in sleep medicine, and automated scoring of the limited-channel system used attended in the laboratory and unattended at home. The definition of the polysomnography apnea-hypopnea index (AHI) and the ARES respiratory disturbance index was the total number of events divided by the study duration in hours. Two hundred eighty-four valid comparisons of in-laboratory simultaneous polysomnography and ARES and 187 valid comparisons of in-laboratory polysomnography with a separate 2 nights of unattended self-applied ARES Unicorder (Advanced Brain Monitoring) were obtained. A diagnostic AHI cutoff of > 10 was used to establish the accuracy and validity of the ARES. The concurrent in-laboratory comparison yielded a sensitivity of 97.4, a specificity of 85.6, a positive predictive value of 93.6, and a negative predictive value of 93.9; in-home comparison sensitivity, specificity, positive predictive value, and negative predictive value were 91.5, 85.7, 91.5, and 85.7, respectively.

Conclusions: The ARES demonstrated consistently high sensitivity and specificity for both in-laboratory and in-home recordings. In patients at risk for sleep apnea who do not a priori need an attended study, the ARES could provide a low-cost alternative to traditional polysomnography.

Key Words: apnea risk evaluation system • in-home monitoring • obstructive sleep apnea • polysomnography • pulse oximetry






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