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Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders

Authors Mayer P, Herrero Babiloni A, Aubé JL, Kaddaha Z, Marshansky S, Rompré PH, Jobin V, Lavigne GJ

Received 15 October 2019

Accepted for publication 4 December 2019

Published 19 December 2019 Volume 2019:11 Pages 423—431


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Steven A Shea

Pierre Mayer,1 Alberto Herrero Babiloni,1–4 Jean-Louis Aubé,1 Zeina Kaddaha,1 Serguei Marshansky,1 Pierre H Rompré,3 Vincent Jobin,1 Gilles J Lavigne1–4

1Centre Hospitalier de l’Universite de Montreal (CHUM), Faculty of Medicine, University of Montreal, Montreal, QC, Canada; 2Research Center, Sacre-Coeur Hospital, Montreal University, Montreal, QC, Canada; 3Faculty of Dentistry, University of Montreal, Montreal, QC, Canada; 4Division of Experimental Medicine, McGill University, Montreal, QC, Canada

Correspondence: Alberto Herrero Babiloni
Hopital du Sacre-Coeur de Montreal, CEAMS, 5400 Boul Gouin O, Montreal QC H4J 1C5, Canada
Tel +514-338-2222
Fax +514-238-2531

Introduction: Portable monitoring (PM) is an alternative to laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA). However, PM tends to underestimate the apnea-hypopnea index (AHI), as it does not identify non-desaturating events associated with electroencephalographic (EEG) arousal. The objectives were to explore heart rate acceleration (HRa) and decrease in pulse transit time (PTT) as surrogates to EEG arousal for non-desaturating hypopnea and respiratory effort-related arousal (RERA), and to estimate cut-off values for their use with both total sleep time (TST), the standard method for PSG, and total recording time (TRT), the usual method for PM.
Methods: Twenty-four consecutive individuals with suspected OSA were studied with PSG. Calculated outcomes were: AHI, respiratory disturbance index with EEG arousal (RDIe) and autonomic arousal by HRa (RDI-HRa) and PTT decreases (RDI-PTT) at different time cut-offs. Using RDIe as reference, Bland Altman and intraclass coefficient of correlation (ICC) were used to calculate agreement between indexes, and receiver operating curves (ROC) for sensitivity/specificity of the different cut-offs.
Results: Autonomic arousals, limited to respiratory events, were present in 36% of non-desaturating hypopneas and 29% of RERAs. Using TST, RDI-HRa of 10 bpm (ICC= 0.89) and RDI-PTT with a decrease of −15 msec (ICC=0.90) agreed better with RDIe. With TRT, the RDI-HRa of 5 bpm agreed better with the RDIe (ICC=0.89). Bland–Altman plots showed mean differences of 1.53 between RDI-HRa10-TST and RDIe and 0.89 between RDI-HRa5-TRT and RDIe.
Conclusion: Autonomic arousals (HRa and PTT) may be a suitable proxy of EEG arousals associated with respiratory events, using both TST and TRT. Therefore, they could potentially help to capture borderline symptomatic patients and to monitor treatment outcomes.

Keywords: sleep apnea, polysomnography, portable monitoring, autonomic nervous system, cardiovascular system, severity of illness index

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