title: Accuracy of portable polygraphy for the diagnosis of sleep apnea in multiple system atrophy.
abstract: OBJECTIVE
  To assess the diagnostic accuracy of portable polygraphy (PG) for the detection of sleep apnea (SA) in multiple system atrophy (MSA).
  
  
  METHODS
  Thirty consecutive patients with probable MSA underwent PG (overnight recording of nasal flow, thoracic/abdominal movements and pulse oximetry), followed 4 weeks later by full polysomnography (PSG) (reference standard). The accuracy of PG was first assessed using the same threshold as for PSG (apnea-hypopnea index [AHI]≥5), then for all possible AHI thresholds using the area under the receiver operating characteristics (AUROC) curve. Inter-rater reliability of PG was assessed using the kappa coefficient.
  
  
  RESULTS
  Among 30 patients enrolled, seven were excluded for technical problems on PG or PSG and 23 were included in the main analysis. Eight out of 23 had an AHI≥5 on PSG. With the same threshold, sensitivity, specificity, positive and negative predictive values of PG for the diagnosis of SA were 87.5% (95% confidence interval: 47-99), 80% (52-96), 70% (35-93) and 92.3% (64-99), respectively. The kappa between PG raters was 0.75 (0.49-1.00) indicating good agreement. The AUROC was 0.93 (0.82-1.00). No association was found between sleep and excessive daytime sleepiness questionnaires and SA.
  
  
  CONCLUSIONS
  Portable PG seems to be valuable for ruling out SA in MSA.
authors.affiliation: Centre de référence atrophie multisystématisée, CHU de Bordeaux, Pessac, France; Service de Neurologie, CHU de Bordeaux, Pessac, France; Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France. Electronic address: wassilios.meissner@chu-bordeaux.fr.
authors.forename: Wassilios G
authors.initials: WG
authors.lastname: Meissner
authors.affiliation: Service de Neurologie, CHU de Bordeaux, Pessac, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Flabeau
authors.affiliation: CHU de Bordeaux, Unité de Soutien Méthodologique à la Recherche Clinique (USMR), Pôle de santé publique, Bordeaux, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Perez
authors.affiliation: Université Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France; CNRS, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Taillard
authors.affiliation: CHU de Bordeaux, Unité de Soutien Méthodologique à la Recherche Clinique (USMR), Pôle de santé publique, Bordeaux, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Marquant
authors.affiliation: Centre de référence atrophie multisystématisée, CHU de Bordeaux, Pessac, France; Service de Neurologie, CHU de Bordeaux, Pessac, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Dupouy
authors.affiliation: Centre de référence atrophie multisystématisée, CHU de Bordeaux, Pessac, France; Service de Neurologie, CHU de Bordeaux, Pessac, France; Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Tison
authors.affiliation: Université Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France; CNRS, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Philip
authors.affiliation: Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; Department of Clinical Neurophysiology, University Hospital Bordeaux, France.
authors.forename: Imad
authors.initials: I
authors.lastname: Ghorayeb
mesh_terms: D000368:Aged; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D019578:Multiple System Atrophy / Q000175:diagnosis*; D015588:Observer Variation; D017286:Polysomnography / Q000295:instrumentation*; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D011795:Surveys and Questionnaires
keywords: Atypical parkinsonism; Autonomic; Olivopontocerebellar atrophy; Polysomnography; Respiratory; Striatonigral degeneration