Valeur diagnostique des micro-éveils autonomiques comme substitut aux éveils cérébraux dans l'apnée du sommeil
The general adult population has a high prevalence of sleep breathing disorders, of which obstructive sleep apnea is the most common, yet many cases remain undiagnosed. Although overnight laboratory polysomnography, called type 1 recording, is the most effective diagnostic tool, it is expensive and time-consuming. To overcome these disadvantages, several portable home (type 3) recording devices have been developed. However, they do not measure brain activity (with EEG). This study presents a comparison between type 1 and type 3 recordings. All apnea, hypopnea, and RERA respiratory events were analyzed, as well as cerebral arousals (EEG arousals) and autonomic arousals. Autonomic arousals are defined by increased heart rate following a respiratory event. To enrich the analysis, the following respiratory outcome measures were included: 4% oxygen saturation index (ODI), apnea-hypopnea index (AHI), respiratory disturbance index with apneas + hypopneas + RERAs including EEG arousals (RDIe), and RDI including autonomic arousals scored as an increase of 5 bpm (RDIa5). The objective of this study was to determine the proportion of respiratory events associated with autonomic arousals and the impact on RDI detected with type 1 compared to type 3 recordings. The hypothesis is that respiratory events with autonomic arousals will have a greater impact on RDI using type 3 compared to type 1 recordings. This study included 72 subjects who underwent type 1 full polysomnography recording and 79 different subjects underwent type 3 ambulatory recording. The following analyses were performed: 1) percentage of events associated with only autonomic arousals in type 1 and type 3 studies; 2) frequency of migration from lower to higher AHI severity category when accounting events associated with only autonomic arousals; 3) Bland-Altman (B-A) for agreement between AHI, RDIe, and RDIa5 (type 1) and AHI and RDIa5 (type 3) and; 4) Pearson correlations and intraclass coefficient correlation (ICC) for agreement between AHI, RDIe and RDIa5 (type 1) and between AHI and RDIa5 (type 3). The use of the RDIa5 criterion increased the number of AHI scoring events by 49% for type 1 recordings and by 51% for type 3 recordings. These results show that autonomic arousals have a similar impact on RDI data using both type 3 and type 1 recordings. We conclude that RDIa5 is a suitable and reliable criterion for type 3 recordings.
RDI sleep apnea hypopneas autonomic arousals EEG arousals AHI