Validation of the POLY-MESAM Seven-Channel Ambulatory Recording Unit

doi:10.1378/chest.117.6.1613

Chest

Volume 117, Issue 6, June 2000, Pages 1613-1618

https://doi.org/10.1378/chest.117.6.1613 Get rights and content

Study objectives

To determine the recording capabilities of the POLY-MESAM (PM) unit (MAP; Martinsried, Germany), an American Sleep Disorders Association level III system, and to compare it with simultaneous 12-channel polysomnography in the sleep laboratory.

Measurements and results

Fifty-three patients (49 men and 4 women) with obstructive sleep-related breathing disorders of varying severity were included. The apnea-hypopnea indexes (AHIs) obtained using the two methods differed significantly from each other, although the correlation was close. The PM unit produced false-negative results in patients with mild to moderate obstructive sleep apnea (OSA). The sensitivity of the PM unit in detecting patients with an AHI > 10 was 92%, while the specificity was 96.3%.

Conclusions

The correlation of AHIs obtained with polysomnography and with the PM unit is close. However, in some cases, the PM may underestimate OSA parameters. The PM unit produces false-negative results in patients with mild to moderate OSA. While inpatient polysomnography remains the “gold standard,” the PM unit may provide an inexpensive alternative in some special cases.

Section snippets

Materials and Methods

Patients who attended our clinic for sleep-related respiratory disorders and snoring were randomly selected. Those with chronic obstructive lung disease and cardiac insufficiency (New York Heart Association score > 2) were excluded. Fifty-three subjects were recruited and admitted to the hospital, were examined further, and underwent simultaneous polygraphy and polysomnography. For polygraphy, the PM unit was used, and for polysomnography the SIDAS GS system (Stimotron; Wendelstein, Germany)

Results

In general, values recorded by the PM unit were lower than those returned by standard polysomnography. This can be seen in Table 1, which presents data regarding the ODI, AHI, AI, HI, and arousal index (ie, the number of arousals per hour of sleep) in the complete patient group. Raw data for individual patients are presented in Table 2 .

The evaluation of data returned by polysomnography yielded AHI values between 0.2 and 75.9 (mean [± SD], 17.9 ± 18.1). In comparison, findings from polygraphy

Discussion

This study and previous studies comparing level III devices with the “gold standard” of polysomnography suffer from the inherent problem that for study purposes both types of measurement systems are used while being attended in the laboratory. Of course, by definition, level III devices are not designed to be used in this way. Laboratory use may give a false degree of reliability that is not found when used in the home.

In the present study, there was a high degree of correlation between the

Conclusion

The correlation of AHIs using polysomnography and the PM unit is close. However, in some cases, the use of the PM unit results in an underestimation of the AHI. The PM unit produces false-negative results in patients with mild to moderate OSA. Although inpatient polysomnography remains the “gold standard” because of that reason, the PM unit may provide an inexpensive alternative for the indications recommended by the ASDA.¹

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2023, Sleep Medicine Reviews
Obstructive sleep apnea (OSA) is a significant healthcare burden affecting approximately one billion people worldwide. The prevalence of OSA is rising with the ongoing obesity epidemic, a key risk factor for its development. While in-laboratory polysomnography (PSG) is the gold standard for diagnosing OSA, it has significant drawbacks that prevent widespread use. Portable devices with different levels of monitoring are available to allow remote assessment for OSA. To better inform clinical practice and research, this comprehensive systematic review evaluated diagnostic performances, study cost and patients’ experience of different levels of portable sleep studies (type 2, 3, and 4), as well as wearable devices and non-contact systems, in adults. Despite varying study designs and devices used, portable diagnostic tests are found to be sufficient for initial screening of patients at risk of OSA. Future studies are needed to evaluate cost effectiveness with the incorporation of portable diagnostic tests into the diagnostic pathway for OSA, as well as their application in patients with chronic respiratory diseases and other comorbidities that may affect test performance.
OSA, Short Sleep Duration, and Their Interactions With Sleepiness and Cardiometabolic Risk Factors in Adults: The ELSA-Brasil Study
2019, Chest
OSA and short sleep duration (SSD) are frequently associated with daytime symptoms and cardiometabolic deregulation. However, the vast majority of studies addressing OSA have not evaluated SSD, and vice versa. Our aim was to evaluate the association of OSA, SSD, and their interactions with sleepiness and cardiometabolic risk factors in a large cohort of adults.
Consecutive subjects from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participated in clinical evaluations, sleep questionnaires, home sleep monitoring, and actigraphy. OSA was defined as an apnea-hypopnea index ≥ 15 events/hour. SSD was defined by a mean sleep duration < 6 h.
Data from 2,064 participants were used in the final analysis (42.8% male; mean age, 49 ± 8 years). The overall frequency of OSA and SSD were 32.9% and 27.2%, respectively. Following an adjustment for multiple confounding factors, excessive daytime sleepiness was independently associated with SSD (OR, 1.448; 95% CI, 1.172-1.790) but not with OSA (OR, 1.107; 95% CI, 0.888-1.380). The SSD interaction with OSA was not significant. Prevalent obesity (OR, 3.894; 95% CI, 3.077-4.928), hypertension (OR, 1.314; 95% CI, 1.035-1.667), and dyslipidemia (OR, 1.251; 95% CI, 1.006-1.555) were independently associated with OSA but not with SSD. Similarly, the interactions of OSA with SSD were not significant. An additional analysis using < 5 h for SSD or continuous sleep duration did not change the lack of association with the cardiometabolic risk factors.
Objective SSD but not OSA was independently associated with daytime sleepiness. By contrast, OSA, but not SSD, was independently associated with obesity, hypertension, and dyslipidemia.
Optimal Body Mass Index Cut-offs for Identification of Patients with Coronary Artery Disease at High Risk of Obstructive Sleep Apnoea
2016, Heart Lung and Circulation
Citation Excerpt :
The device has been validated against in-laboratory polysomnography for diagnosis of OSA [19]. Although limited by the lack of objective measurement of sleep duration and the inability to examine sleep-staging, the reported sensitivity and specificity of the Embletta Gold diagnostic device were from 92-97% and 64-96% respectively [20–22]. Output measures recorded were airflow (nasal cannula), oxygen saturation (pulse oximetry), thoraco-abdominal movements (inductive respiratory bands), snoring episodes (integrated pressure transducer), electrocardiography, and body position (continuous actigraphy).
We sought to evaluate the relationship between Body Mass Index (BMI) and obstructive sleep apnoea (OSA) in Chinese patients hospitalised with coronary artery disease, and to determine the optimal BMI cut-off for prediction of OSA.
Consecutive Chinese patients who were hospitalised with symptomatic coronary artery disease were recruited to undergo an in-hospital sleep study.
A total of 587 patients were recruited. Using cut-off for Asians, 81.2% of the cohort was overweight (BMI ≥23 kg/m²) and 31.6% was obese (≥27 kg/m²). A total of 59.5% was diagnosed with OSA, defined as apnoea-hypopnoea index ≥15. Body mass index, hypertension and smoking were predictors of OSA. Multiple logistic regression analysis showed that BMI remains an independent predictor of OSA (odds ratio: 1.11 [95% confidence interval: 1.06 to 1.17], p < 0.001) after adjusting for smoking and hypertension. Further analysis using BMI and Apnoea-Hypopnoea Index (AHI) as continuous variables showed significant correlation between BMI and AHI (Pearson's r =0.25, P<0.001). In adjusted models, optimal BMI cut-offs to screen for OSA were 27.3 kg/m², 23.0-23.9 kg/m², and 20 kg/m² for patients with neither, either, or both predictors (smoking and hypertension) respectively. The area under the curve for the adjusted and unadjusted models were similar (0.6013 vs 0.6262, p = 0.118).
Body mass index represents a convenient and readily available tool for bedside identification of patients at high risk of OSA. Body mass index cut-offs to predict risks of OSA in Chinese patients with symptomatic coronary artery disease are defined in this study.
Snoring analysis methods
2011, Medicina Clinica
El ronquido es un sonido respiratorio que se produce durante el sueño, ya sea nocturno o diurno. El ronquido puede ser inspiratorio, espiratorio o puede ocupar todo el ciclo respiratorio. Tiene su origen en la vibración de los diferentes tejidos de la vía aérea superior. Se han descrito numerosos métodos para analizarlo, desde el simple interrogatorio, pasando por cuestionarios estándares, hasta llegar a los métodos acústicos más sofisticados, que se han desarrollado gracias al gran avance de las técnicas biomédicas en los últimos años. El presente trabajo describe el estado del arte actual en los procedimientos de análisis del ronquido.
Snore is a breathing sound that is originated during sleep, either nocturnal or diurnal. Snoring may be inspiratory, expiratory or it may occupy the whole breathing cycle. It is caused by the vibrations of the different tissues of the upper airway. Many procedures have been used to analyze it, from simple interrogation, to standardized questionnaires, to more sophisticated acoustic methods developed thanks to the advance of biomedical techniques in the last years. The present work describes the current state of the art of snoring analysis procedures.
Restless Legs Syndrome (RLS) in anemic patients with congestive heart failure and chronic renal failure: Lack of effect of anemia treatment
2010, International Journal of Cardiology
To assess the prevalence of Restless Legs Syndrome (RLS) in anemic patients with Congestive Heart Failure (CHF) and Chronic Renal Failure (CRF) and to evaluate the effect of anemia treatment on RLS.
38 anemic CHF–CRF patients were treated with subcutaneous Erythropoietin (EPO) and intravenous (IV) iron over 1 year. They were questioned initially and at 3 months post treatment about symptoms of RLS according to standard criteria. They were also contacted by telephone about RLS symptoms 12 months after onset of anemia treatment.
RLS was found in 15 (39.5%) of the 38 patients. In 10 (66.7%) patients it was present at least 6 days a week. The prevalence of the RLS initially was not related to Hb, to serum iron or % Transferrin Saturation. Diabetes and lower serum ferritin were more common in the RLS group (p < 0.05). After 3 months of treatment, Hb increased from 10.4 ± 0.8 to12.3 ± 1.2 g/dl, but RLS symptoms did not change. By 12 months the prevalence and frequency of RLS complaints was similar to what it had been initially.
RLS is common and often undiagnosed and untreated in anemic CHF–CRF patients. Unfortunately, successful treatment of anemia with EPO and IV iron did not improve this condition.
Reliability of home respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome: Analysis of costs
2008, Archivos de Bronconeumologia
To evaluate the reliability of home respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome (SAHS) and to compare the cost of this technique with that of nighttime polysomnography performed in a sleep laboratory.
This was a prospective study of a random sample of patients with clinically suspected SAHS in which the participants who underwent both home respiratory polygraphy and nighttime polysomnography were blinded as to the results of their first test. Costs were calculated based on a theoretical population of 1000 individuals. A t test for paired samples, the Pearson correlation coefficient, and a receiver operator characteristic curve were used for the statistical analysis.
The study population was composed of 45 patients with a mean (SD) age of 52.3 (11) years of whom 21 (46.6%) were diagnosed with SAHS, defined by an apneahypopnea index greater than 10 in nighttime polysomnography. Comparison of the results obtained in both recordings revealed statistically significant correlations for all comparisons. The optimal cutoff in this population was a respiratory disturbance index of 13.7 or more, for which the area under the receiver operating characteristic curve was 87.5% (95% confidence interval, 74.2%-95.4%). The mean cost of home respiratory polygraphy in a patient with suspected SAHS was € 69, whereas that of polysomnography was € 179.
Home respiratory polygraphy is a reliable technique for the diagnosis of SAHS. Using this technique routinely in patients suspected of SAHS will be more economical than using nighttime polysomnography. Uncertain results must be verified by nighttime polysomnography.
El presente estudio se realizó con siguientes objetivos: a) valorar la fiabilidad de la poligrafía respiratoria domiciliara (PRD) para el diagnóstico de síndrome de apneashipopneas durante el sueño (SAHS), y b) comparar los costes derivados de la realización de PRD con los de la polisomnografía nocturna (PSG) efectuada en el laboratorio de sueño.
Se trata de un estudio prospectivo y ciego. La población de estudio estuvo constituida por una selección aleatoria de pacientes con sospecha clínica de SAHS. A todo paciente incluido en el estudio se le realizaron PRD y PSG sin conocer el resultado de primera. Para el cálculo de costes se utilizó una población teórica de 1.000 personas. Para el análisis estadístico se emplearon la prueba de la t de Student para muestras emparejadas, el coeficiente de correlación de Pearson y el cálculo de las curvas de eficacia diagnóstica.
Se estudió a 45 pacientes, con una edad media (± desviación estándar) de 52,3 ± 11 años, de los que se diagnosticó de SAHS (índice de apneas-hipopneas α 10 en la PSG) a 21 (46,6%). Al comparar los valores obtenidos en la PRD y la PSG, las correlaciones fueron significativas para todos los pares relacionados. El punto de corte óptimo en nuestra población fue un índice de acontecimientos respiratorios de 13,7 o mayor, con un área bajo la curva de eficacia diagnóstica del 87,5% (intervalo de confianza del 95%, 74,2-95,4%). La realización de una PRD en un paciente con sospecha de SAHS supone un coste medio de 69 €, mientras que el de una PSG es de 179 €.
La PRD es un método fiable para el diagnóstico de SAHS. Su realización de forma protocolizada supone un ahorro respecto a la realización de PSG a todos los pacientes con sospecha de SAHS. Por último, los resultados dudosos de la PRD requieren la realización de PSG.

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: The POLY-MESAM unit was loaned to the authors by the MAP Company (16 Fraunhoferstrasse, 82152 Martinsried, Germany). No person at MAP has read the manuscript or has been involved in any of the research, which is the sole responsibility of the authors.

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Chest

Clinical InvestigationsSLEEPValidation of the POLY-MESAM Seven-Channel Ambulatory Recording Unit

Study objectives

Measurements and results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Conclusion

Chest

ASDA standards of practice: practice parameters for the use of portable recording in the assessment of obstructive sleep apnea

Sleep

First results of a prospective study validating the method of ambulatory polysomnography using the POLY-MESAM unit

Sleep Breathing

A manual of standardized terminology techniques and scoring system for sleep stages in human subjects

Validierung eines ambulanten Screeninggera¨tes fu¨r schlafbezogene Atmungssto¨rungen: APNOESCREEN I

Somnologie

Clinical Investigations
SLEEP
Validation of the POLY-MESAM Seven-Channel Ambulatory Recording Unit