Obstructive sleep apnea — everything you need to know
Prevalence in the UK (age 30-65y) 13.5 v 6%. 10mill USA 14.5%. 24
mill.
1 in 8
? >Billion worldwide
80-90% are undiagnosed.
Increased incidence associated with obesity
Sleepy snorer Witnessed apneas +/- comorbidities (BP, T2DM etc)
? High / low threshold (light or deep sleep)
UA calibre (soft /hard tissue)/ nose
Cpap is the gold standard treatment for moderate or severe OSA and is successful in 80%, but dropout rates are reduced by careful attention to trouble shooting, encouragement and adjustments of device pressures and mask adequacy.
Other options like Mandibular advancement splints, tongue stimulators and surgery (ENT or maxillo-mandibular ) are potential options in those intolerant of CPAP depending on the severity and circumstances.
Studies have shown that reducing weight can effectively reduce OSA severity. One study in particular showed that loss of 10% body weight reduced the value on the AHI scale by 26%. For example, this would be the same as going from an AHI value of 15 (moderate) to 11 (mild). Most recently the SURMOUNT - OSA trials have demonstrated that the subcutaneous weight loss injectable drug tirzepatide used weekly for a year can reduce severe sleep apnoea to mild in those without or currently using CPAP (Malhotra A et al, NEJM 2024)
There are also more complex conditions like Comorbid Insomnia with
OSA.
CBTi and CPAP can improve quality of sleep and daytime function
How accurate at diagnosing sleep apnoea are smart phone devices compared with medical sleep diagnostic equipment?
Smartphone devices, while increasingly sophisticated, cannot match the accuracy and comprehensiveness of medical sleep diagnostic equipment when it comes to diagnosing sleep apnea. Medical equipment used in sleep studies, like polysomnography (PSG), is considered the gold standard for diagnosing sleep apnea. This equipment measures numerous parameters including:
- Airflow
- Blood Oxygen Levels
- Heart Rate
- Brain Waves
- Eye Movements
- Muscle Activity
PSG provides a comprehensive evaluation of the sleep cycle and can identify various sleep disorders, including sleep apnea, with a high degree of accuracy.
On the other hand, smartphone apps and devices typically use microphones and accelerometers to detect snoring and movement during sleep. They may also use peripheral devices like pulse oximeters for blood oxygen levels. While these can offer indications of potential sleep disruptions or apnea events, they are not as thorough or accurate as a full sleep study. The accuracy can also be affected by factors such as the smartphone's position, ambient noise, and the quality of any peripheral sensor used.
Some consumer-grade devices, such as wearables and bed-based sensors, can track various metrics related to sleep, but they still fall short of a full polysomnography in terms of diagnostic capability.
Therefore, if sleep apnea is suspected, it's recommended to seek a professional diagnosis from a healthcare provider, who may recommend a sleep study for accurate assessment. Smartphone apps can play a role in initial awareness or as adjuncts for monitoring known conditions but are not substitutes for professional medical equipment and diagnosis.
I think I might have sleep apnea, should I use a smartphone app to diagnose it?
If you suspect you have sleep apnea, it is advisable to consult with a healthcare professional instead of relying solely on a smartphone app for diagnosis. While smartphone apps can be a useful tool for initial screening or for monitoring your sleep patterns once you have been diagnosed, they are not a substitute for a professional medical evaluation.
A healthcare provider can evaluate your symptoms and, if necessary, refer you for a sleep study. A sleep study, such as polysomnography, is conducted in a specialized sleep laboratory and is designed to detect and measure sleep disturbances, breathing irregularities, oxygen levels, and other critical physiological functions throughout the night. This is the most reliable and accurate method to diagnose sleep apnea.
In some cases, if you are unable to undergo a sleep study in a clinical setting, a healthcare provider might prescribe a home sleep apnea test (HSAT). This is a simpler version of polysomnography that can measure several important parameters while you sleep in your own bed.
While awaiting a professional consultation or as part of ongoing self-care, you may use a smartphone app to gather information about your sleep patterns and any potential apnea events. However, it is crucial to understand that data collected from smartphone apps should be used as a complementary source of information and not for a definitive diagnosis.
Always seek guidance from a doctor or a sleep specialist when dealing with potential sleep apnea. It's a condition that can be effectively managed once properly diagnosed, and treatment options can greatly improve your sleep quality, overall health, and well-being.
I'm considering a home sleep apnea test as an initial step.
A home sleep apnea test (HSAT) is a more accessible and convenient option for many people who suspect they might have sleep apnea. It allows you to stay in the comfort of your own home while the device monitors aspects of your sleep. Here's what to consider when taking an HSAT:
1. Consultation with a Healthcare Provider: Before you decide on a home sleep apnea test, it’s essential to discuss your symptoms with a healthcare provider. They can determine if an HSAT is appropriate for your situation based on the severity of your symptoms and health history.
2. Insurance and Cost: Check if your insurance covers an HSAT, or if you'll need to pay out-of-pocket. Home tests tend to be less expensive than in-lab sleep studies.
3. Test Components: An HSAT typically includes devices that measure your airflow, breathing efforts, blood oxygen levels, and heart rate. You'll receive instructions on how to use the equipment properly.
4. Sleeping in Your Environment: An advantage of an HSAT is that you sleep in your usual environment, which may result in a more representative assessment of your typical sleep behaviour.
5. Understanding Limitations: Home sleep apnea tests are generally used for diagnosing obstructive sleep apnea and may not be suitable for detecting other types of sleep disorders. They are also less comprehensive than in-lab sleep studies.
6. Following Instructions: Make sure to follow all the instructions that come with the HSAT to ensure accurate results. This includes where and how to place the sensors, when to start the test, and any preparatory steps such as avoiding caffeine or alcohol.
7. After the Test: Once the test is completed, you return the device to the clinic or mail it back for analysis. A sleep specialist interprets the data and consults with you about the results.
8. Potential Next Steps: If the HSAT indicates that you have sleep apnea, your healthcare provider might recommend lifestyle changes, continuous positive airway pressure (CPAP) therapy, an oral appliance, or, in some cases, surgery. If your HSAT results are inconclusive or your symptoms suggest another sleep disorder, an in-lab sleep study may be recommended.
9. Ongoing Evaluation: If diagnosed with sleep apnea, your treatment's effectiveness should be regularly evaluated by your healthcare provider, which may involve follow-up sleep studies or monitoring.
Always ensure that any HSAT you undertake is with the approval and follow-up of a healthcare provider to correctly interpret the results and guide you through the appropriate treatment, if necessary.
What is new in the diagnosis of obstructive sleep apnoea
In the field of medicine, diagnostic methods are constantly evolving with advancements in technology and medical research. As of the latest knowledge update in April 2023, new developments in the diagnosis of obstructive sleep apnea (OSA) may include:
1. Home Sleep Apnea Testing (HSAT): There has been a push for more convenient and accessible diagnostic options, such as HSAT. This allows patients to be tested in the comfort of their home using portable devices that measure breathing, oxygen levels, and other physiological parameters during sleep.
2. Wearable Technology: Wearables like smartwatches with advanced sensors have been studied for their potential to screen for OSA by monitoring biometrics such as heart rate variability, oxygen saturation, and sleep patterns.
3. Machine Learning and Artificial Intelligence: AI algorithms are being developed to analyze data from sleep studies more efficiently and possibly predict OSA risk or severity using various inputs including demographic data, patient questionnaires, and physiological signals.
4. Nocturnal Oximetry: Improved pulse oximetry algorithms that are better able to distinguish between central and obstructive events could refine the diagnostic process for OSA without the need for full polysomnography.
5. Drug-Induced Sleep Endoscopy (DISE): While not entirely new, enhancements in DISE involve better visualization techniques to observe the physical blockages that occur in the airway during sedated sleep, which can be important for planning treatment, especially surgery.
6. Genetic and Biomarker Research: Studies are exploring genetic markers and biomarkers in blood or saliva that may be indicative of OSA risk and severity, which could lead to more personalized and predictive diagnostic methods.
7. High-Resolution Pulse Oximetry (HRPO): This technique has gained attention as a potential single-channel screening tool for OSA, providing high-resolution data on oxygen saturation throughout the night.
8. Pharyngeal Electrical Stimulation: While primarily a treatment, this method may also be used diagnostically to assess the neuromuscular responsiveness of the pharynx, which has implications for OSA severity.
9. Phenotyping: As our understanding of the pathophysiology of OSA improves, efforts are being made to classify patients into specific phenotypes (categorizations based on clinical characteristics) for more targeted diagnostic and treatment approaches.
10. Telemedicine and e-Health: The use of telemedicine platforms for the evaluation and diagnosis of sleep disorders, including OSA, has increased, especially after the COVID-19 pandemic.
These advancements aim to make diagnosis of OSA more accurate, accessible, and personalized, although not all may be available or widely implemented in clinical practice yet. You should consult the latest medical literature or professional medical societies for the most current practices in OSA diagnosis.
What are the outcome measures used to compare new wearable devices v established HSATs ?
As of my knowledge cutoff date in April 2023, numerous research studies have been conducted to explore the diagnostic accuracy of new wearable devices compared to traditional medical home sleep apnea tests. However, it's important to note that the field of wearable technology and sleep medicine is continually evolving, and new studies are regularly published.
Clinical studies that compare wearable devices and home sleep apnea tests often focus on several key endpoints, including:
1. Sensitivity and Specificity: These measures indicate how well the wearable device can correctly identify individuals with sleep apnea (sensitive) and how well it can confirm the absence of the condition in those who do not have it (specific).
2. Positive and Negative Predictive Values: These values help to determine the likelihood that a positive or negative test result is accurate.
3. Comparison of Apnea-Hypopnea Index (AHI): This is a score used to indicate the severity of sleep apnea, and studies often compare the AHI recorded by wearable devices with that of home sleep tests.
4. Usability and Patient Compliance: Studies might also look at how easy the devices are for patients to use by themselves at home and how likely patients are to use the devices correctly and consistently.
5. Cost Effectiveness: The economic impact of using new wearable devices versus traditional tests may also be examined.
Some types of wearable technology used for sleep apnea diagnosis include wrist-worn pulse oximeters, devices with heart rate monitors, and even contactless devices that can measure breathing patterns.
To find specific studies, you can check biomedical databases such as PubMed, Google Scholar, or the Cochrane Library. Look for systematic reviews, meta-analyses, and randomized controlled trials (RCTs) which provide high levels of evidence. Key terms to use in your search could include "wearable technology," "sleep apnea," "home sleep testing," "diagnostic accuracy," and "comparative study."
Please note that the availability of studies might be different now, and new findings could have emerged after my last update. Always consult the latest literature for up-to-date information.
How accurate is the RING (oura) device for monitoring sleep ?
The "RING" device, commonly known by brands like the Oura Ring, is a piece of wearable technology that has gained attention for its ability to monitor sleep, among other health-related metrics. These smart rings are designed to continuously track physiological parameters such as heart rate, heart rate variability (HRV), body temperature, and movement throughout the night.
The accuracy of the Oura Ring and other similar devices for sleep monitoring is typically assessed using a few key metrics:
1. Sleep Stages: It should accurately differentiate between light sleep, deep sleep, REM sleep, and wakefulness. Studies have shown mixed results, with some finding reasonable correlations with polysomnography (PSG) data for sleep stages, while others suggest that wearables may not be as accurate in breaking down sleep into these individual stages.
2. Total Sleep Time: The device should correctly estimate how long the user is asleep.
3. Sleep Onset Latency: This is the time it takes for a person to transition from full wakefulness to sleep.
4. Waking After Sleep Onset (WASO): These are periods of wakefulness occurring after sleep onset.
Clinical studies have shown that while wearables like the Oura Ring offer reasonably accurate data on total sleep time and sleep-wake classification, they may be less accurate in differentiating between sleep stages when compared to the gold standard PSG. However, they can still be valuable for tracking sleep patterns and potential disturbances over time.
Consumer wearables are generally considered a useful tool for self-monitoring and lifestyle tracking but should not be solely relied upon for medical diagnosis or treatment decisions. For those with concerns about sleep disorders such as sleep apnea, it's important to consult with a healthcare provider who may recommend a more comprehensive sleep study using medical-grade equipment.
Keep in mind that the technology is constantly being updated, so newer versions of the device may offer improved accuracy. Always refer to the most recent reviews and studies for the latest insights into the accuracy and reliability of specific devices like the Oura Ring for sleep monitoring.
Is WatchPAT as accurate as other HSATs?
The WatchPAT is one of the devices approved for home sleep apnea testing (HSAT) and is used for the diagnosis of obstructive sleep apnea (OSA). Unlike traditional HSAT devices which can include nasal airflow sensors, chest belts, and oxygen saturation probes, the WatchPAT uses peripheral arterial tonometry to measure changes in peripheral arterial volume and pulse rate, among other metrics. These changes are correlated with respiratory effort and thus can be indicative of apnea events.
The accuracy of the WatchPAT device has been a subject of clinical research, and studies generally indicate that it has good concordance with the gold standard polysomnography (PSG), especially for the diagnosis of moderate to severe obstructive sleep apnea. Some advantages associated with the WatchPAT include:
Ease of Use: It is worn like a watch, which may be more comfortable and user-friendly compared to traditional HSAT devices with multiple sensors.
Comprehensive Data: It measures several physiological parameters, including oxygen saturation, heart rate, sleep time, body position, and more, by analyzing the PAT signal along with actigraphy and oxygen saturation.
Validation: Clinical studies have validated its use and found it to be a reliable alternative to in-lab PSG, particularly when identifying OSA.
However, it's also worth noting that the accuracy of the WatchPAT—and indeed any HSAT device—can vary depending on:
- The range of apnea severity (it may be less sensitive in cases of mild OSA).
- User compliance and proper use of the device.
- The presence of comorbidities or other sleep disorders that might affect readings.
- The specific algorithms used by the device for interpretation of the data.
While the WatchPAT has shown to have a high level of accuracy for diagnosing OSA, especially moderate to severe cases, any HSAT device may have limitations in certain patient populations or in the detection of central sleep apnea (CSA), which has different pathophysiology than OSA.
Healthcare providers typically choose an HSAT device like the WatchPAT based on the patient's specific circumstances, suitability for home testing, and the provider's confidence in the technology to detect sleep apnea. Despite the demonstrated accuracy of devices like WatchPAT, in-person consultation with a healthcare provider and consideration of an individual's overall health status and symptoms remain crucial in determining the most appropriate diagnostic tool and interpreting results within the broader context of the patient's health.
For a definitive diagnosis and customized treatment plan, it's best to seek advice from a board-certified sleep medicine physician or a healthcare provider with expertise in sleep disorders.
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