TY - JOUR
T1 - A comparison of 2 visual methods for classifying obstructive vs central hypopneas
AU - Dupuy-McCauley, Kara L.
AU - Mudrakola, Harsha V.
AU - Colaco, Brendon
AU - Arunthari, Vichaya
AU - Slota, Katarzyna A.
AU - Morgenthaler, Timothy I.
N1 - Publisher Copyright:
© 2021 American Academy of Sleep Medicine. All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Study Objectives: Rules for classifying apneas as obstructive, central, or mixed are well established. Although hypopneas are given equal weight when calculating the apnea-hypopnea index, classification is not standardized. Visualmethods for classifying hypopneas have been proposed by the American Academy of Sleep Medicine and by Randerath et al (Sleep. 2013;36[3]:363-368) but never compared. We evaluated the clinical suitability of the 2 visual methods for classifying hypopneas as central or obstructive. Methods: Fifty hypopnea-containing polysomnographic segments were selected from patients with clear obstructive or clear central physiology to serve as standard obstructive or central hypopneas. These 100 hypopnea-containing polysomnographic segments were deidentified, randomized, and scored by 2 groups. We assigned 1 group to use the American Academy of Sleep Medicine criteria and the other the Randerath algorithm. After a washout period, re-randomized hypopnea-containing polysomnographic segments were scored using the alternativemethod.We determined the accuracy (agreement with standard), interrater (Fleiss's κ), and intrarater agreement (Cohen's κ) for obtained scores. Results: Accuracy of the 2 methods was similar: 67% vs 69.3% for Randerath et al and the American Academy of Sleep Medicine, respectively. Cohen's κ was 0.01-0.75, showing that some raters scored similarly using the 2 methods, while others scored them markedly differently. Fleiss's κ for the American Academy of Sleep Medicine algorithm was 0.32 (95% confidence interval, 0.29-0.36) and for the Randerath algorithm was 0.27 (95% confidence interval, 0.23-0.30). Conclusions: More work is needed to discover a noninvasive way to accurately characterize hypopneas. Studies like oursmay lay the foundation for discovering the full spectrum of physiologic consequences of obstructive sleep apnea and central sleep apnea.
AB - Study Objectives: Rules for classifying apneas as obstructive, central, or mixed are well established. Although hypopneas are given equal weight when calculating the apnea-hypopnea index, classification is not standardized. Visualmethods for classifying hypopneas have been proposed by the American Academy of Sleep Medicine and by Randerath et al (Sleep. 2013;36[3]:363-368) but never compared. We evaluated the clinical suitability of the 2 visual methods for classifying hypopneas as central or obstructive. Methods: Fifty hypopnea-containing polysomnographic segments were selected from patients with clear obstructive or clear central physiology to serve as standard obstructive or central hypopneas. These 100 hypopnea-containing polysomnographic segments were deidentified, randomized, and scored by 2 groups. We assigned 1 group to use the American Academy of Sleep Medicine criteria and the other the Randerath algorithm. After a washout period, re-randomized hypopnea-containing polysomnographic segments were scored using the alternativemethod.We determined the accuracy (agreement with standard), interrater (Fleiss's κ), and intrarater agreement (Cohen's κ) for obtained scores. Results: Accuracy of the 2 methods was similar: 67% vs 69.3% for Randerath et al and the American Academy of Sleep Medicine, respectively. Cohen's κ was 0.01-0.75, showing that some raters scored similarly using the 2 methods, while others scored them markedly differently. Fleiss's κ for the American Academy of Sleep Medicine algorithm was 0.32 (95% confidence interval, 0.29-0.36) and for the Randerath algorithm was 0.27 (95% confidence interval, 0.23-0.30). Conclusions: More work is needed to discover a noninvasive way to accurately characterize hypopneas. Studies like oursmay lay the foundation for discovering the full spectrum of physiologic consequences of obstructive sleep apnea and central sleep apnea.
KW - Central sleep apnea
KW - Hypopnea
KW - Obstructive sleep apnea
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U2 - 10.5664/jcsm.9140
DO - 10.5664/jcsm.9140
M3 - Article
C2 - 33583493
AN - SCOPUS:85107428258
SN - 1550-9389
VL - 17
SP - 1157
EP - 1165
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
IS - 6
ER -