Faculty Collaboration Database

A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies. J Clin Sleep Med 2022 Apr 01;18(4):1093-1102

Date

12/10/2021

Pubmed ID

34879903

Pubmed Central ID

PMC8974372

DOI

10.5664/jcsm.9808

Scopus ID

2-s2.0-85128159936 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

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. J Clin Sleep Med. 2022;18(4):1093-1102.

Author List

Iftikhar IH, Finch CE, Shah AS, Augunstein CA, Ioachimescu OC

Author

Octavian C. Ioachimescu MD, PhD Vice Chair, Director, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Diagnostic Tests, Routine
Humans
Manometry
Polysomnography
Sensitivity and Specificity
Sleep Apnea Syndromes
Sleep Apnea, Obstructive