ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title For Adult Patients with High Suspicion of Obstructive Sleep Apnea (OSA), Home-Based Testing Gave Similar Results, As In-Laboratory Testing in Diagnosing for The OSA
Clinical Question For an adult patient who is highly suspected of sleep disorder, will home-based, unattended portable monitoring system (PM), as compared to in-laboratory polysomnography (PSG), be as effective and useful in diagnosing obstructive sleep apnea?
Clinical Bottom Line For adult patients with high suspicion of obstructive sleep apnea (OSA), home-based testing gave a similar result to in-laboratory testing in diagnosing for the OSA.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19480230Santos-Silva/200970 patients with suspected OSA & 10 patients wihout suspected OSAComparative Test
Key resultsStardust, which is a Portable-Measuring device (PM), is accurate in confirming diagnosis of the OSA if there is a suspicion. There is better agreement during simultaneous recording of PM and PSG. AUC (Area Under Curve) values for PSG lab vs. PM home for different AHI cut-offs (5, 15, and 30) were 0.90, 0.92, and 0.95, respectively. This indicates that there is an excellent agreement between PSG lab and PM home in making diagnosis.
#2) 21897775Oktay/201153; 55% female and mean age of 45.1 yrsComparative Test
Key resultsAL (ApneaLINK) home test is a good diagnostic alternative to PSG for patients at risk for moderate to severe OSA. AL home test showed the highest specificity (92.5) and sensitivity (100) at AHI greater than or equal to 20 events per hour. At that level, PPV was 81.3 and NPV was 100.0.
Evidence Search portable monitor, OSA AND ("last 5 years"[PDat])
Comments on
The Evidence
Validity: AUC values comparing PSG lab and STD home gave high specificity and sensitivity between two diagnostic methods. Gold standard (polysomnography) was compared to the home-based test. The groups were not randomized. The Oktay study is also a comparative study. In both studies, possible conflict of interest is indicated. Santos-Silva received free PMs from “Respironics” and financial supports from “Associacao Fundo de Incentivo a Psicofarmacologia (AFIP)” and “Respironics,” which is a manufacturer of the Stardust. Oktay’s disclosure statement indicates that this study was funded by ResMed Corporation, which is a global manufacturer for diagnosis and treatment of sleep disorders. ResMed manufactures ApneaLINK. Four authors for Oktay have received research funds from various manufacturing companies including Vapotherm, Respironics, Medcare, Cephalon, Itamar Medical, and Philips-Respironics. Therefore, reader has to be suspicious about the validity of these studies.
Applicability Home-based testing can be applied to adult patients (18 years or older) who are suspected of high risk of obstructive sleep apnea when PSG is not available due to geography, economics, and time constraint. Testing can be used by average general dentists to diagnose the suspected patients.
Specialty/Discipline (General Dentistry)
Keywords obstructive sleep apnea, diagnosis, home monitoring
ID# 2351
Date of submission: 03/09/2013spacer
E-mail hurj@livemail.uthscsa.edu
Author Ju Ri Hur
Co-author(s) Stephen R. Matteson, DDS
Co-author(s) e-mail MATTESON@uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Ryushiro Sugita, DDS (San Antonio, Texas) on 11/17/2015
A PubMed search on the home-based testing diagnosing obstructive sleep apnea was performed Oct 2015. A more recent publication was found: Yalamanchali 2015, PubMed: 24158564. The meta-analysis revealed that studies comparing the RDI between peripheral arterial tonometry (PAT) and PSG had a combined correlation of 0.879 (95% CI, 0.849-0.904; P < .001); those comparing the AHI, 0.893 (0.857-0.920; P < .001); and those comparing the ODI, 0.942 (0.894-0.969; P < .001). Respiratory indexes calculated using PAT-based portable devices positively correlated with those calculated from the scoring of PSG. This technology represents a viable alternative to PSG for confirmation of clinically suspected sleep apnea.
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