title: Diagnosis of Obstructive Sleep Apnea in Parkinson's Disease Patients: Is Unattended Portable Monitoring a Suitable Tool?
abstract: Purpose. Obstructive sleep apnea (OSA) is frequent in Parkinson's disease (PD) and may contribute to nonmotor symptoms. Polysomnography (PSG) is the gold standard for OSA diagnosis. Unattended portable monitoring (PM) may improve access to diagnosis but has not been studied in PD. We assessed feasibility and diagnostic accuracy in PD. Methods. Selected PD patients without known OSA underwent home PM and laboratory PSG. The quality of PM signals (n = 28) was compared with matched controls. PM accuracy was calculated compared with PSG for standard apnea hypopnea index (AHI) thresholds. Results. Technical failure rate was 27.0% and airflow signal quality was lower than in controls. Sensitivity of PM was 84.0%, 36.4%, and 50.0% for AHI cut-offs of 5/h, 15/h, and 30/h, respectively, using the same cut-offs on PM. Specificity was 66.7%, 83.3%, and 100%, respectively. PM underestimated the AHI with a mean bias of 12.4/h. Discrepancy between PM and PSG was greater in those with more motor dysfunction. Conclusion. PM was adequate to "rule in" moderate or severe OSA in PD patients, but the failure rate was relatively high and signal quality poorer than in controls. PM overall underestimated the severity of OSA in PD patients, especially those with greater motor dysfunction.
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada H4A 3J1.
authors.forename: Priti
authors.initials: P
authors.lastname: Gros
authors.affiliation: Clinica Alemana de Santiago, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile.
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Mery
authors.affiliation: Montreal Neurological Hospital, McGill University Centre, Montreal, QC, Canada H3A 2B4.
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Lafontaine
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada H4A 3J1.
authors.forename: Ann
authors.initials: A
authors.lastname: Robinson
authors.affiliation: Department of Medicine and Department of Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, QC, Canada H4A 3J1 ; Respiratory & Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada H4A 3J1.
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada H4A 3J1.
authors.forename: R John
authors.initials: RJ
authors.lastname: Kimoff
authors.affiliation: Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada H4A 3J1 ; Respiratory & Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada H4A 3J1.
authors.forename: Marta
authors.initials: M
authors.lastname: Kaminska