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Obstructive Sleep Apnea
Home Sleep Testing
Sleep Disordered Breathing
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Watermark Medical (ARES™)
Abstracts:

Comparing the ARES Questionnaire to the Berlin for identifying OSA patients
Reyes Enciso & Glenn T. Clark. 3 September 2009 / Accepted: 9 January 2010

Purpose The aim of this study was to compare the sensitivity and specificity of two questionnaires to identify patients with obstructive sleep apnea (OSA).

Accuracy of Automated Sleep Staging using Signals from a Single Forehead Site.
Popovic D, Ayappa I, Hauri P, et al. Sleep .2008 31:332

Using actigraphy acquired from the forehead to detect sleep/wake provided an overall agreement of 91% with a sensitivity of detecting wave of 0.76. There was good agreement in estimating sleep latency, total sleep time and sleep efficiency and within clinically acceptable ranges.

Sleep/wake Classification using Head Actigraphy, Snoring and Airflow Signals.
Popovic D, Velimirovic V, Ayappa I, et al. Sleep 2008 32:379.

One-hundred and nine subjects wore the ARES UnicorderTM concurrent during laboratory polysomnography. The PSG records were staged for sleep according to the AASM criteria. Behavioral sleep/wake was derived using an algorithm that combined changes in actigraphy, snoring and airflow. On average there was an 85% agreement between the EEG and behavioral sleep/wake with mean Kappa scores of 0.52. The sensitivity and specificity of sleep/wake was consistent across RDI severities; the concordance between total sleep time and sleep efficiency improved when short/split-night PSG studies were excluded from analysis.

Feasibility of Portable Monitoring to Detect Obstructive Sleep Apnea In-home in Adolescents: A Pilot study.
Daniel J. Levendowski, Carol L. Rosen, Timothy Zavora, et al. Sleep 2008 31:62.

There was a 0.96 correlation between the AHI values obtained from PSG and concurrently acquired ARES in 28 habitually snoring teens, and a 0.74 correlation between PSG and the in-home AHI values acquired with ARES. The ARES provided a sensitivity and specificity of 100% and 83% when worn concurrently during PSG using a clinical cut-offs of > 2 events/hour, and 91% and 77% using a cut-off of > 5 events/hr. The in-home ARES provided a sensitivity and specificity of 94% and 93% vs. PSG with a cut-off > 2 events/hour and 82% and 94% using a cut-off > 5 events/hour.

Impact of Age and Position on Severity of Gender-Specific Sleep Disordered Breathing.
Levendowski D, Berka C, Popovic D et al. Sleep 2009 32:203

A retrospective analysis of 529 males and 203 females stratified into a young (age 30-45) and old (age 55 – 70) patients, by gender differences in the percent time snoring and AHI and RDI were evaluated by and across positions were evaluated. There were no differences in neck size or BMI between gender specific groups. In males, the AHI and RDI severity increased with age across all positions. In females, the impact of age was only apparent in the increase in supine AHI and RDI severity. There was no difference in the percent time snoring between young and old males; older females snored significantly louder than younger females and equivalent to older males. This study suggests that the length of the pharyngeal airway may impact changes in OSA severity but not snoring as one ages.

Night to Night Variability in In-home Sleep Studies.
Westbrook P, Levendowski D, Zavora T, et al. Sleep 2007 30:184.

A study of 476 subjects with at least 4 hours of valid recording time in two separate nights acquired with the ARES Unicorder showed strong correlations in the AHI (0.90). A exponential equation used to identify clinically important differences in AHI revealed that there is substantial night to night variability in AHI in the range of 11 – 30 events/hour.

Comparison of Subjective Sleep Position Preference vs. Objective Ambulatory Data.
Rosenthal L, Dolan D. Sleep 2009 32:387.

Forty-nine subjects wore the WM ARES in-home for two nights to compare the subject’s favored sleep position to an objective measure based on head position. The study confirmed that the preferred position during sleep reflected the differential time spent in the supine position during ambulatory recordings.

Timing of Changes in Oxyhemoglobin Saturation Resulting from Breath Holding.
Sasse S, Westbrook, P, Levendowski D, et al. Sleep Medicine 2006 7(2):261.

Co-oximetry results from arterial draws taken at 5-sec increments from 20 subjects were used to assess difference s in desaturation during 30-sec breath-holding at FRC. FRC was positively correlation with SaO2 level and negatively correlate with the maximum depth of desaturation. The percent change in SaO2 as a result of a 30-sec breath hold can be explained in part by FRC and FRC is related to BMI.

Predicting Effective Continuous Positive Airway Pressure (CPAP) based on Laboratory Titration and Auto-titrating CPAP.
Westbrook P, Levendowski D, Henninger D, et al. Sleep Medicine 2006 7(2):217.

The correlation between CPAP pressure obtained during laboratory titration vs. auto-CPAP over 30 days was only 0.65 with 21% of patients having a different in CPAP pressure > 3 cm H2O. 96% of patients had an auto-PAP pressure within 2 cm H2O after 3-nights vs. 30-nights. 85% of patients had a predicted CPAP pressure (derived using ARES sleep study data combined with anthropomorphic measures) within 3 cm H2O vs. 3-nights of auto-PAP.

Impact of Clinical Assessment on the Difference Between Unattended Limited Monitoring and Full In-Lab PSG.
Sleep, 2008; 31:151.

Four sleep trained pulmonologists reviewed clinical history & physical information and full disclosure tracings from 85 subjects with the PSG and ARES studies reviewed > two-week apart. The goal was to assess agreement as to the primary diagnosis and treatment recommendations. The agreement between PSG and ARES-1% with a clinical cut-off of >15 was sensitivity = 80%, specificity = 92%, overall agreement for sleep disordered breathing = 86%. The overall diagnostic agreement across clinicians for PSG vs. ARES was 78%. Agreement for treatment recommendations was 75%.

Using the ARES Screener and the Berlin Questionnaire to Predict OSA.
Enciso R, Clark. Sleep Breath 2009, in-press.

Thirty-nine subjects completed both the Berlin and ARES questionnaires and subsequently compared an ARES sleep study. Using a clinical cut-off AHI > 10, the ARES provided a sensitivity of 89%, a specificity of 53%, a positive predictive value (PPV) of 83% and a negative predictive value (NPV) of 64%. The Berlin provided a sensitivity of 71%, a specificity of 65%, a positive predictive value (PPV) of 84% and a negative predictive value (NPV) of 46%. The ARES questionnaire is a better choice than the Berlin Questionnaire in most of the situations, but further research is necessary to generalize these results.

Patient Preferences Comparing Use of Two Home Sleep Testing Devices.
Simmons M. Sleep Breath 2009, in-press.

Twenty subjects were trained to first apply the WM ARES Unicorder™ (Model 600) and then apply the Watch-Pat (Model 100) prior to wearing both for one night in the home. Questionnaire responses pertaining to device preferences and ease of use were acquired when the devices were returned. Approximately 50% of subjects had a preference between the systems, but overall satisfaction was almost the same. While subjects preferred the report format of the Watch-Pat 5:1, in the remaining six categories showed subjects preferred WM ARES on average 2:1.

Accuracy of Pulse Oximetry During Breath Holding.
ATS, San Diego, 2005

Arterial blood was extracted at 5-sec intervals in 20 subjects during breath hold to FRC. The ARES and Nellcor forehead oximters were more accurate than the Nonin finger oximeter in terms of the root mean squared error and detection of the depth of desaturation vs co-oximetry. The SaO2 nadir point was significantly delayed using the finger oximeter relative to CoOx and forehead oximeters.

WM ARES VALIDATION

WM ARES AND TREATMENT

WM DENTAL DOCUMENTATION

OSA AND CO-MORBIDITIES