A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies

Dec 9, 2021Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

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Abstract

A pooled mean apnea-hypopnea index (AHI) bias of 0.30 was found in a meta-analysis involving 1,318 participants.

The WatchPAT device showed a percentage error of 230% in AHI determination compared to polysomnography (PSG).
Cohen's kappa values indicated moderate to poor agreement for classifying sleep apnea severity between PSG and WatchPAT: 0.45 for no apnea, 0.29 for mild, 0.25 for moderate, and 0.64 for severe apnea.
Sensitivity and specificity of WatchPAT at AHI thresholds of 5, 15, and 30 events/hour were 94.11% and 43.47%, 92.21% and 72.39%, and 74.11% and 87.10%, respectively.
Likelihood ratios for diagnostic accuracy were not significant at any AHI threshold.
The results suggest notable discrepancies in AHI measurements and misclassification of sleep apnea severity using the WatchPAT compared to PSG.

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STUDY OBJECTIVES: The objective of this meta-analysis was to analyze agreement in apnea-hypopnea index (AHI) determination between peripheral arterial tonometry (PAT) and polysomnography (PSG) studies.

METHODS: Mean AHI bias and standard deviation extracted from Bland-Altman plots reported in studies were pooled in a meta-analysis, which was then used to calculate percentage errors of limit agreement in AHI determination by PAT using PSG AHI as the reference. Individual participant data (where reported in studies) were used to compute Cohen's kappa to assess agreement between PSG and PAT on sleep apnea severity and for computing the sensitivity and specificity of PAT at different AHI thresholds using PSG AHI as the reference.

RESULTS: From 17 studies and 1,318 participants (all underwent simultaneous PSG and use of the WatchPAT device), a pooled mean AHI bias of 0.30 (standard error [SE], 0.74) and a WatchPAT AHI percentage error of 230% was calculated. The meta-analysis of Cohen's kappa for agreement between PSG and WatchPAT studies for classifying patients with no sleep apnea, mild, moderate, or severe sleep apnea severity was 0.45 (SE, 0.06), 0.29 (SE, 0.05), 0.25 (SE, 0.07), and 0.64 (SE, 0.05), respectively. At AHI thresholds of 5, 15 and 30 events/h, WatchPAT studies showed pooled sensitivities and specificities of 94.11% and 43.47%, 92.21% and 72.39%, and 74.11% and 87.10%, respectively. Likelihood ratios were not significant at any AHI threshold.

CONCLUSIONS: The results of this meta-analysis suggest clinically significant discordance between WatchPAT and PSG measurements of AHI, significant sleep apnea severity misclassification by PAT studies, and poor diagnostic test performance.

CITATION: Iftikhar IH, Finch CE, Shah AS, Augunstein CA, Ioachimescu OC. A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies.2022;18(4):1093-1102. J Clin Sleep Med.

A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies

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