Improving the Diagnostic Ability of the Sleep Apnea Screening System Based on Oximetry by Using Physical Activity Data
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ORIGINAL ARTICLE
Improving the Diagnostic Ability of the Sleep Apnea Screening System Based on Oximetry by Using Physical Activity Data Cheng‑Han Wu1,2 · Jui‑Hsuan Lee1,2 · Terry B. J. Kuo1,2,3,4,5 · Chun‑Ting Lai1,2 · Lieber P. H. Li4,6,7 · Cheryl C. H. Yang1,2,3,5 Received: 15 April 2020 / Accepted: 8 September 2020 / Published online: 8 October 2020 © Taiwanese Society of Biomedical Engineering 2020
Abstract Purpose Polysomnography (PSG) is the gold standard for diagnosing sleep apnea (SA), but it is costly and time-consuming. An oximeter as alternative diagnostic tool is small in size and user friendly. However, using an oximeter alone can easily underestimate SA severity. Therefore, we aimed to develop a SA screening system to solve the problem of underestimating SA severity. Methods We developed a wireless oximetry system to record peripheral oxygen saturation, heart rate, and physical activity. Physical activity was used to remove artifacts and derive total sleep time. After artifact removal, an algorithm estimated the apnea–hypopnea index (AHI). Results 56 participants with different severities of SA underwent overnight inspection using home-based PSG and wireless oximetry for more than 6 h. In the four SA severity groups, the overall accuracy, sensitivity, and specificity of AHI estimated by our system (AHIEsti) were 81.25%, 69.64%, and 92.86%, respectively. AHIEsti was positively related to AHI of PSG. Receiver operating characteristic curves were plotted based on the threshold of AHI of PSG being greater than 5, 10, 15, and 30, and the corresponding areas under the curve were 0.910, 0.800, 0.794, and 0.970. Conclusion This SA screening system can determine whether a patient has SA but cannot evaluate SA severity precisely. Our system is a potential screening tool for SA, supporting PSG at a lower cost. Keywords Oximeter · Sleep apnea · Screening system · Accelerometer · Physical activity
1 Introduction Cheng-Han Wu and Jui-Hsuan Lee contributed equally to the writing of this article. * Cheryl C. H. Yang [email protected] 1
Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
2
Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
3
Brain Research Center, National Yang-Ming University, Taipei, Taiwan
4
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
5
Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
6
Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
7
Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
13
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Sleep apnea (SA) is a sleep-related breathing disorder characterized by recurrent interruptions of breathing during sleep. Sleep apneic events lead to oxygen desaturation and an increase in the carbon dioxide level in blood. Arousal is generated to reactivate all peripheral systems and restore respiration [1]. These events may occur up to hundreds of times during sleep time
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