Universität zu Köln

Parekh, Ankit ORCID: 0000-0002-5396-0553, Tolbert, Thomas M., Mooney, Anne M., Ramos-Cejudo, Jaime, Osorio, Ricardo S., Treml, Marcel, Herkenrath, Simon-Dominik, Randerath, Winfried J., Ayappa, Indu and Rapoport, David M. (2021). Endotyping Sleep Apnea One Breath at a Time An Automated Approach for Separating Obstructive from Central Sleep-disordered Breathing. Am. J. Respir. Crit. Care Med., 204 (12). S. 1452 - 1463. NEW YORK: AMER THORACIC SOC. ISSN 1535-4970

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Abstract

Rationale: Determining whether an individual has obstructive or central sleep apnea is fundamental to selecting the appropriate treatment. Objectives: Here we derive an automated breath-by-breath probability of obstruction, as a surrogate of gold-standard upper airway resistance, using hallmarks of upper airway obstruction visible on clinical sleep studies. Methods: From five nocturnal polysomnography signals (airflow, thoracic and abdominal effort, oxygen saturation, and snore), nine features were extracted and weighted to derive the breath-by-breath probability of obstruction (P-obs). A development and initial test set of 29 subjects (development = 6, test = 23) (New York, NY) and a second test set of 39 subjects (Solingen, Germany), both with esophageal manometry, were used to develop P-obs and validate it against gold-standard upper airway resistance. A separate dataset of 114 subjects with 2 consecutive nocturnal polysomnographies (New York, NY) without esophageal manometry was used to assess the night-to-night variability of P-obs. Measurements and Main Results: A total of 1,962,229 breaths were analyzed. On a breath-by-breath level, P-obs was strongly correlated with normalized upper airway resistance in both test sets (set 1: cubic adjusted [adj.] R-2 = 0.87, P < 0.001, area under the receiver operating characteristic curve = 0.74; set 2: cubic adj. R-2 = 0.83, P < 0.001, area under the receiver operating characteristic curve = 0.7). On a subject level, median P-obs was associated with the median normalized upper airway resistance (set 1: linear adj. R-2 = 0.59, P < 0.001; set 2: linear adj. R-2 = 0.45, P < 0.001). Median P-obs exhibited low night-to-night variability [intraclass correlation(2, 1) = 0.93]. Conclusions: Using nearly 2 million breaths from 182 subjects, we show that breath-by-breath probability of obstruction can reliably predict the overall burden of obstructed breaths in individual subjects and can aid in determining the type of sleep apnea.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Parekh, Ankit UNSPECIFIED orcid.org/0000-0002-5396-0553 UNSPECIFIED Tolbert, Thomas M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mooney, Anne M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ramos-Cejudo, Jaime UNSPECIFIED UNSPECIFIED UNSPECIFIED Osorio, Ricardo S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Treml, Marcel UNSPECIFIED UNSPECIFIED UNSPECIFIED Herkenrath, Simon-Dominik UNSPECIFIED UNSPECIFIED UNSPECIFIED Randerath, Winfried J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ayappa, Indu UNSPECIFIED UNSPECIFIED UNSPECIFIED Rapoport, David M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-579712
DOI:	10.1164/rccm.202011-4055OC
Journal or Publication Title:	Am. J. Respir. Crit. Care Med.
Volume:	204
Number:	12
Page Range:	S. 1452 - 1463
Date:	2021
Publisher:	AMER THORACIC SOC
Place of Publication:	NEW YORK
ISSN:	1535-4970
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language UPPER-AIRWAY-RESISTANCE Multiple languages Critical Care Medicine; Respiratory System Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/57971