title: Diagnosis of obstructive sleep apnea syndrome and its outcomes with home portable monitoring.
abstract: BACKGROUND
  The use of portable respiratory monitoring (PM) has been proposed for the diagnosis of obstructive sleep apnea syndrome (OSAS), but most studies that validate PM accuracy have not followed the best standards for diagnostic test validation. The objective of the present study was to evaluate the accuracy of PM performed at home to diagnose OSAS and its outcomes after first validating PM in the laboratory setting by comparing it to polysomnography (PSG).
  
  
  METHODS
  Patients with suspected OSAS were submitted, in random order, to PM at the sleep laboratory concurrently with PSG (lab-PM) or at home-PM. The diagnostic performance was assessed by sensitivity, specificity, positive and negative predictive values, positive likelihood ratio (+LR), negative likelihood ratio (-LR), intraclass correlation coefficients, kappa statistic, and Bland-Altman plot.
  
  
  RESULTS
  One hundred fifty-seven subjects (73% men, mean age +/- SD, 45 +/- 12 yr) with an apnea-hypopnea index (AHI) of 31 (SD +/- 29) events/h were studied. Excluding inadequate recordings, 149 valid comparisons with lab-PM and 121 with unattended home-PM were obtained. Compared to PSG for detecting AHI > 5, the lab-PM demonstrated sensitivity of 95.3%, specificity of 75%, +LR of 3.8, and -LR of 0.11; the home-PM exhibited sensitivity of 96%, specificity of 64%, +LR of 2.7, and -LR of 0.05. Kappa statistics indicated substantial correlation between PSG and PM results. Bland-Altman plot showed smaller dispersion for lab-PM than for home-PM. Pearson product moment correlation coefficients among the three AHIs and clinical outcomes were similar, denoting comparable diagnostic ability.
  
  
  CONCLUSIONS
  This study used all available comparison methods to demonstrate accuracy of PM in-home recordings similar to that of repeated PSGs. PM increases the possibility of correctly diagnosing and effectively treating OSAS in populations worldwide.
authors.affiliation: Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Ana Claudia Tonelli
authors.initials: ACT
authors.lastname: de Oliveira
authors.affiliation: Clinica do Sono Sleep Clinic, Porto Alegre, RS, Brazil; Cardiology Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil; Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Electronic address: dm@ufrgs.br.
authors.forename: Denis
authors.initials: D
authors.lastname: Martinez
authors.affiliation: Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Luiz Felipe T
authors.initials: LFT
authors.lastname: Vasconcelos
authors.affiliation: Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Sandro
authors.initials: S
authors.lastname: Cadaval Gonçalves
authors.affiliation: Clinica do Sono Sleep Clinic, Porto Alegre, RS, Brazil.
authors.forename: Maria
authors.initials: M
authors.lastname: do Carmo Lenz
authors.affiliation: Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Porto Alegre, RS, Brazil; Cardiology Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Sandra
authors.initials: S
authors.lastname: Costa Fuchs
authors.affiliation: Cardiology Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil; Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Gus
authors.affiliation: Cardiology Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Erlon Oliveira
authors.initials: EO
authors.lastname: de Abreu-Silva
authors.affiliation: Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Cardiology Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Leila
authors.initials: L
authors.lastname: Beltrami Moreira
authors.affiliation: Cardiology Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil; Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Flávio
authors.initials: F
authors.lastname: Danni Fuchs
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D008991:Monitoring, Physiologic / Q000379:methods*; D017286:Polysomnography / Q000295:instrumentation / Q000379:methods*; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*