title: Autonomic arousal index: an automated detection based on peripheral arterial tonometry.
abstract: Arousals from sleep are associated with increased sympathetic activation and are therefore associated with peripheral vasoconstriction. We hypothesized that digital vasoconstrictions as measured by peripheral arterial tonometery (PAT), combined with an increase in pulse rate, would accurately reflect arousals from sleep, and can provide an autonomic arousal index (AAI). Based on a previously studied group of 40 sleep apnea patients simultaneously recorded by both polysomnography (PSG) and PAT systems, an automated algorithm using the PAT signal (and pulse rate derived from it) was developed for detection of arousals from sleep. This was further validated in a separate group of 96 subjects (85 patients referred with suspected obstructive sleep apnea and 11 healthy volunteers mean age 46.2+/-14.4 years, BMI 28.5+/-5.4 kg/m2). All underwent a whole night PSG with simultaneous PAT recording. The PSG recordings were blindly manually analyzed for arousals based on American Academy of Sleep Medicine (AASM) criteria, while PAT was scored automatically. There was a significant correlation between PSG and PAT arousals (R=0.82, p<0.0001) with a good agreement across a wide range of values, with a ROC curve having an area under the curve (AUC) of 0.88. We conclude that automated analysis of the peripheral arterial tonometry signal can detect EEG arousals from sleep, in a relatively quick and reproducible fashion.
authors.affiliation: Sleep Laboratory, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
authors.forename: Giora
authors.initials: G
authors.lastname: Pillar
authors.forename: Amir
authors.initials: A
authors.lastname: Bar
authors.forename: Arie
authors.initials: A
authors.lastname: Shlitner
authors.forename: Robert
authors.initials: R
authors.lastname: Schnall
authors.forename: Jacob
authors.initials: J
authors.lastname: Shefy
authors.forename: Peretz
authors.initials: P
authors.lastname: Lavie
mesh_terms: D001143:Arousal / Q000502:physiology*; D001158:Arteries / Q000502:physiology; D001341:Autonomic Nervous System / Q000502:physiology*; D004569:Electroencephalography; D004576:Electromyography / Q000379:methods; D001330:Electronic Data Processing; D006801:Humans; D008875:Middle Aged; D017933:Peripheral Nervous System / Q000098:blood supply*; D011674:Pulse / Q000379:methods; D012372:ROC Curve; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D012895:Sleep, REM / Q000502:physiology