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doi:10.1378/chest.06-1604
(Chest. 2007; 131:725-732)
© 2007 American College of Chest Physicians
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Respiratory Polygraphy With Actigraphy in the Diagnosis of Sleep Apnea-Hypopnea Syndrome*

Emilio García-Díaz, MD; Esther Quintana-Gallego, MD; Aránzazu Ruiz, MD; Carmen Carmona-Bernal, MD; Ángeles Sánchez-Armengol, MD; Georgina Botebol-Benhamou, MD and Francisco Capote, MD

* From the Departments of Critical Care and Emergency (Dr. García-Díaz), Pneumology (Drs. Ruiz, Carmona-Bernal, Sánchez-Armengol, and Capote), and Neurophysiology (Dr. Botebol-Benhamou), Hospitales Universitarios Virgen del Rocío, Sevilla, Spain; and the Department of Pneumology (Dr. Quintana-Gallego), Hospital San Juan de Dios, Sevilla, Spain.

Correspondence to: Emilio García-Díaz, MD, Department of Critical Care and Emergency, Hospitales Universitarios Virgen del Rocío, Manuel Siurot s/n, E-41013 Sevilla, Spain: e-mail: emil800{at}separ.es

Abstract

Objective: To determine the utility and reliability of a respiratory polygraphy (RP) device with actigraphy (Apnoescreen II; Erich Jaeger GMBH & CoKg; Wuerzburg, Germany) in the diagnosis of sleep apnea-hypopnea syndrome (SAHS).

Design: A prospective randomized study with blinded analysis.

Patients: Sixty-two patients with suspected SAHS.

Measurements: the following two RP studies were performed: one in the sleep laboratory (sleep laboratory RP [LRP]), simultaneously with polysomnography; and the other at home (home RP [HRP]). To study the interobserver reliability of RP, two manual analyses were carried out by two different researchers.

Results: In LRP, when the respiratory disturbance index was calculated using the total sleep time estimated by actigraphy (RDI) as a denominator, the sensitivity ranged between 94.6% and 100%, and the specificity between 88% and 96.7% for the different cutoff points of the apnea-hypopnea indexes studied. When the respiratory disturbance index was calculated according to the total recording time (RDITRT), the sensitivity was slightly lower (91.6 to 96.9%) and the specificity was similar (92 to 96.7%). In HRP, the sensitivity of the RDI ranged between 83.8% and 95.8%, and the specificity between 92% and 100%, whereas, when the RDITRT was used, the sensitivity was between 83.8% and 87.5%, and the specificity was between 94.7% and 100%. With regard to interobserver reliability, the intraclass correlation coefficient for the RDI of the two analyses of the RP was 0.99 for both LPR and HPR.

Conclusion: HPR is an effective and reliable technique for the diagnosis of SAHS, although it is less sensitive than LRP. Wrist actigraphy improves the results of HRP only slightly.

Key Words: actigraphy • diagnosis • home sleep study • polysomnography • portable devices • sleep apnea-hypopnea syndrome






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