title: Diagnosis of obstructive sleep apnea by peripheral arterial tonometry: meta-analysis.
abstract: OBJECTIVE
  Efficient diagnosis and early treatment of obstructive sleep apnea may help prevent the development of related morbidity and mortality. Compared with polysomnography (PSG), ambulatory sleep study devices offer the possibility of an accurate diagnosis with convenience and low cost.
  
  
  OBJECTIVE
  To assess the correlation between sleep indexes measured by a portable sleep-testing device (peripheral arterial tonometry [PAT]) and those measured by PSG.
  
  
  METHODS
  We searched PubMed, MEDLINE, the Cochrane Trial Registry (through May 2013), and relevant article bibliographies.
  
  
  METHODS
  Systematic review and meta-analysis of studies assessing correlation of sleep indexes between PAT devices and PSG in adults (aged >18 years). Included studies provided a bivariate correlation coefficient for sleep indexes, specifically the respiratory disturbance index (RDI), apnea-hypopnea index (AHI), and oxygen desaturation index (ODI).
  
  
  METHODS
  Included studies were reviewed by 2 independent reviewers. Reported correlation values for the RDI, AHI, and ODI between a commercially available PAT device (WatchPAT) and PSG were systematically reviewed. A comprehensive meta-analysis software package was used for statistical analysis.
  
  
  METHODS
  Assessment of the correlation between PAT and PSG as measured by AHI, RDI, and ODI.
  
  
  RESULTS
  Fourteen studies met inclusion criteria and had data suitable for pooling (909 patients). Of these, 13 studies had blinded study designs, with PAT and PSG conducted simultaneously in the home or the laboratory setting. One study contained 2 trial phases for the same patient group (n = 29), one laboratory based and the other home based, which were analyzed separately. One study contained 2 different study groups based on age. Overall, correlation of the RDI and AHI was high (r = 0.889 [95% CI, 0.862-0.911]; P < .001). Studies comparing the RDI between PAT and PSG had a combined correlation of 0.879 (95% CI, 0.849-0.904; P < .001); those comparing the AHI, 0.893 (0.857-0.920; P < .001); and those comparing the ODI, 0.942 (0.894-0.969; P < .001). Analysis of publication bias revealed a nonsignificant Egger regression intercept.
  
  
  CONCLUSIONS
  Respiratory indexes calculated using PAT-based portable devices positively correlated with those calculated from the scoring of PSG. Strengthened by the blinded design of most of the included studies, this technology represents a viable alternative to PSG for confirmation of clinically suspected sleep apnea.
authors.affiliation: Chicago ENT Advanced Center for Specialty Care, Department of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago.
authors.forename: Sreeya
authors.initials: S
authors.lastname: Yalamanchali
authors.affiliation: Chicago ENT Advanced Center for Specialty Care, Department of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago.
authors.forename: Viken
authors.initials: V
authors.lastname: Farajian
authors.affiliation: Chicago ENT Advanced Center for Specialty Care, Department of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago.
authors.forename: Craig
authors.initials: C
authors.lastname: Hamilton
authors.affiliation: Chicago ENT Advanced Center for Specialty Care, Department of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Pott
authors.affiliation: Chicago ENT Advanced Center for Specialty Care, Department of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Samuelson
authors.affiliation: Chicago ENT Advanced Center for Specialty Care, Department of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago2Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Michael
authors.initials: M
authors.lastname: Friedman
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D017286:Polysomnography / Q000295:instrumentation* / Q000379:methods; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*