Open AccessEndotyping Sleep Apnea One Breath at a Time: An Automated Approach for Separating Obstructive from Central Sleep-disordered Breathing
Author(s) -
Ankit Parekh,
Thomas Tolbert,
Anne M. Mooney,
Jaime RamosCejudo,
Ricardo S. Osorio,
Marcel Treml,
Simon-Dominik Herkenrath,
Winfried Randerath,
Indu Ayappa,
David M. Rapoport
Publication year - 2021
Publication title -
american journal of respiratory and critical care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.272
H-Index - 374
eISSN - 1535-4970
pISSN - 1073-449X
DOI - 10.1164/rccm.202011-4055oc
Subject(s) - medicine , polysomnography , obstructive sleep apnea , receiver operating characteristic , airway resistance , gold standard (test) , airway , airway obstruction , sleep apnea , apnea , anesthesia
Rationale: Determining whether an individual has obstructive or central sleep apnea is fundamental to selecting the appropriate treatment. Objectives: Here we derive an automated breath-by-breath probability of obstruction, as a surrogate of gold-standard upper airway resistance, using hallmarks of upper airway obstruction visible on clinical sleep studies. Methods: From five nocturnal polysomnography signals (airflow, thoracic and abdominal effort, oxygen saturation, and snore), nine features were extracted and weighted to derive the breath-by-breath probability of obstruction (P obs ). A development and initial test set of 29 subjects (development = 6, test = 23) (New York, NY) and a second test set of 39 subjects (Solingen, Germany), both with esophageal manometry, were used to develop P obs and validate it against gold-standard upper airway resistance. A separate dataset of 114 subjects with 2 consecutive nocturnal polysomnographies (New York, NY) without esophageal manometry was used to assess the night-to-night variability of P obs . Measurements and Main Results: A total of 1,962,229 breaths were analyzed. On a breath-by-breath level, P obs was strongly correlated with normalized upper airway resistance in both test sets (set 1: cubic adjusted [adj.] R 2 = 0.87, P < 0.001, area under the receiver operating characteristic curve = 0.74; set 2: cubic adj. R 2 = 0.83, P < 0.001, area under the receiver operating characteristic curve = 0.7). On a subject level, median P obs was associated with the median normalized upper airway resistance (set 1: linear adj. R 2 = 0.59, P < 0.001; set 2: linear adj. R 2 = 0.45, P < 0.001). Median P obs exhibited low night-to-night variability [intraclass correlation(2, 1) = 0.93]. Conclusions: Using nearly 2 million breaths from 182 subjects, we show that breath-by-breath probability of obstruction can reliably predict the overall burden of obstructed breaths in individual subjects and can aid in determining the type of sleep apnea.