Sleep Disorders

Review Article

Computer-Assisted Diagnosis of the Sleep Apnea-Hypopnea Syndrome: A Review

Table 2

Validation of SAHS screening approaches (see text for details). = number of participants/recordings; AHI = Apnea-Hypopnea Index; TR = training set; TS = testing set; H = hypopnea; PPV = positive predictive value; NPV = negative predictive value; AUC = areas under ROC curve; ACC = accuracy; ICC = intraclass correlation coefficient; = Pearson’s linear correlation coefficient; S = single validation set; CV = cross-validation; CSR-CSA = Cheyne-Stokes respiration.


Study source	Database	/ratio male	Age (mean ± std.)	AHI (mean ± std.)	Reference test	Event definition	AHI cut-off	Sensitivity (%)	Specificity (%)	Others	Validation

Daniels et al. [17]	Birmingham Heartlands Hospital, UK	21/—	—	—	Retrospective clinical diagnosis	—	—	100	66	PPV = 0.95 NPV = 1.00	S

Lévy et al. [18]	CHU de Grenoble, France	301/—	56 ± 12	30 ± 24	Same-night Level 1 PSG	H: >50% reduction + [3% desaturation or arousal]	15	90	75	PPV = 0.87 NPV = 0.81	S

Olson et al. [19]	Newcastle Sleep Disorders Center, Australia	793/—	—	—	Same-night Level 1 PSG	—	5	82.7	54.2	—	S

Magalang et al. [20]	Associated Sleep Center and the Buffalo Veterans Affairs Medical Center, USA	224/— (TR) 101/— (TS1) 191/— (TS2)	48.9 ± 12.3 (TR) 51.8 ± 11.5 (TS1) 56.0 ± 12.8 (TS2)	18.2 ± 20.0 (TR) 20.2 ± 19.5 (TS1) 18.2 ± 21.2 (TS2)	Same-night Level 1 PSG	H: discernible reduction + [4% desaturation or arousal]	15	90 (TR) — (TS1) — (TS2)	70 (TR) — (TS1) — (TS2)	—	TR/TS1/TS2

Zamarrón et al. [21]	Hospital General de Galicia, Spain	233/0.80	56.8 ± 13.1 (OSA) 56.1 ± 13.0 (Non-OSA)	40.1 ± 23.0 (OSA) 2.2 ± 2.7 (Non-OSA)	Same-night Level 1 PSG	H: >50% reduction + 4% desaturation	10	78	89	PPV = 0.89 NPV = 0.78	S

Zamarrón et al. [22]	Hospital General de Galicia, Spain	300/0.78	58.4 ± 12.1 (OSA) 56.6 ± 12.8 (Non-OSA)	40.2 ± 22.4 (OSA) 2.3 ± 2.7 (Non-OSA)	Same-night Level 1 PSG	H: >50% reduction + 4% desaturation	10	94	82	PPV = 0.87 NPV = 0.92	S

Hua and Yu [23]	Chang Gung Memorial Hospital, China	273/0.77 (TR) 206/0.81 (TS)	45.8 ± 16.5 (TR) 46.2 ± 13.4 (TS)	31.6 ± 27.1 (TR) 44.1 ± 29.8 (TS)	Same-night Level 1 PSG	AASM1999 H: >50% reduction or <50% reduction + [3% desaturation or arousal]	5	—	—	AUC = 0.96	TR/TS

Morillo et al. [24]	University Hospital Puerta del Mar de Cadiz, Spain	37/0.78 (TR) 78/0.74 (TS)	57.9 ± 9.8 (TR) 58.3 ± 12.5 (TS)	32.6 ± 29.24 (TR) 28.8 ± 28.3 (TS)	Same-night Level 1 PSG	H: >50% reduction + 4% desaturation	20	86.4	82.8	AUC = 0.92 ICC = 0.82	TR/TS

Álvarez et al. [25, 26]	Hospital Clinico Universitario in Santiago de Compostela, Spain	111/0.85 (OSA) 76/0.70 (Non-OSA)	58.3 ± 12.9 (OSA) 57.6 ± 12.9 (Non-OSA)	40.1 ± 19.6 (OSA) 2.04 ± 2.36 (Non-OSA)	Same-night Level 1 PSG	H: reduction (no cessation) + 4% desaturation	10	90.1	82.9	AUC = 0.92 ACC = 0.87	S

Hornero et al. [27]	Hospital Clinico Universitario in Santiago de Compostela, Spain	111/0.85 (OSA) 76/0.70 (Non-OSA)	58.3 ± 12.9 (OSA) 57.6 ± 12.9 (Non-OSA)	40.1 ± 19.6 (OSA) 2.04 ± 2.36 (Non-OSA)	Same-night Level 1 PSG	H: >50% reduction + 4% desaturation	10	82.1	87	—	TR/TS (113)

del Campo et al. [28]	Hospital Clinico Universitario in Santiago de Compostela, Spain	111/0.85 (OSA) 76/0.70 (Non-OSA)	58.3 ± 12.9 (OSA) 57.6 ± 12.9 (Non-OSA)	40.1 ± 19.6 (OSA) 2.03 ± 2.19 (Non-OSA)	Same-night Level 1 PSG	H: >50% reduction + 3% desaturation	10	88.3	82.9	AUC = 0.92 PPV = 0.88 NPV = 0.83	S

Marcos et al. [29]	Hospital Clinico Universitario in Santiago de Compostela, Spain	111/0.85 (OSA) 76/0.70 (Non-OSA)	58.3 ± 12.9 (OSA) 57.6 ± 12.9 (Non-OSA)	40.1 ± 19.6 (OSA) 2.04 ± 2.36 (Non-OSA)	Same-night Level 1 PSG	H: >50% reduction + 4% desaturation	10	79.1	97.8	AUC = 0.92 ACC = 0.87	TR/TS (113)

Victor-Marcos et al. [30]	Hospital Universitario Pío del Río Hortega, Spain	166/0.84 (OSA) 48/0.67 (Non-OSA)	55 ± 13.5 (OSA) 47.7 ± 9.76 (Non-OSA)	37.1 ± 25.8 (OSA) 4.13 ± 2.39 (Non-OSA)	Same-night Level 1 PSG	H: >50% reduction + 4% desaturation	10	97.0	79.3	AUC = 0.95 ACC = 0.93	TR/TS (129)

Álvarez et al. [34]	Hospital Universitario Pío del Rio Hortega, Spain	100/0.84 (OSA) 48/0.67 (Non-OSA)	55.2 ± 14.6 (OSA) 48.3 ± 11.8 (Non-OSA)	40.9 ± 27.6 (OSA) 4.1 ± 2.4 (Non-OSA)	Same-night Level 1 PSG	H: >50% reduction + [3% desaturation or arousal]	10	92	85.4	AUC = 0.97 ACC = 0.90	CV (Leave-one-out)

Álvarez et al. [35]	Hospital Universitario Pío del Rio Hortega, Spain	160/0.84 (OSA) 80/0.65 (Non-OSA)	54.8 ± 13.8 (OSA) 47.2 ± 12.2 (Non-OSA)	36.6 ± 25.7 (OSA) 3.9 ± 2.4 (Non-OSA)	Same-night Level 1 PSG	AASM2007 H: >50% reduction + [3% desaturation or arousal]	10	90.6	81.3	ACC = 0.87	TR/TS (144)

El-Solh et al. [36]	Veterans Affairs Medical Center, USA	213/—	—	—	Same-night Level 1 PSG	H: discernible reduction + [3% desaturation or arousal]	5 (OSA) 10 (CSR-CSA)	97.7 (OSA) 100 (CSR-CSA)	100 (OSA) 99 (CSR-CSA)	ACC = 0.99 (OSA, CSR-CSA)	CV (5 K-fold)

Marcos et al. [31]	Hospital Clinico Universitario in Santiago de Compostela, Spain	111/0.85 (OSA) 76/0.70 (Non-OSA)	58.3 ± 12.9 (OSA) 57.6 ± 12.9 (Non-OSA)	40.1 ± 19.6 (OSA) 2.04 ± 2.36 (Non-OSA)	Same-night Level 1 PSG	H: >50% reduction + 4% desaturation	10	89.4 ± 1.6	81.4 ± 1.7	AUC = 0.91 ACC = 0.86	TR/TS1 (30)/TS2 (83)

Victor-Marcos et al. [32]	Hospital Clinico Universitario in Santiago de Compostela, Spain	111/0.85 (OSA) 76/0.70 (Non-OSA)	58.3 ± 12.9 (OSA) 57.6 ± 12.9 (Non-OSA)	40.1 ± 19.6 (OSA) 2.04 ± 2.36 (Non-OSA)	Same-night Level 1 PSG	H: >50% reduction + 4% desaturation	10	90.8 ± 4.2	79.1 ± 6.9	AUC = 0.91 ACC = 0.86	TR/TS1 (30)/TS2 (83)

Victor-Marcos et al. [33]	Hospital Universitario Pío del Rio Hortega, Spain	240/0.77	52.3 ± 13.8 (TR) 52.2 ± 13.7 (TS)	24.7 ± 25.2 (TR) 26.4 ± 26.7 (TS)	Same-night Level 1 PSG	—	15	94.9	90.9	ACC = 0.93 ICC = 0.91	TR/TS (144)

Gutierrez-Tobal et al. [37]	Hospital Universitario Pío del Rio Hortega, Spain	148/0.79	50.9 ± 11.7	23.5 ± 24.1	Same-night Level 1 PSG	H: >30% reduction + 4% desaturation	30	76.7	93.2	ACC = 0.88	TR/TS (89)

Gutiérrez-Tobal et al. [38]	Hospital Universitario Pío del Rio Hortega, Spain	148/0.79	50.9 ± 11.7	23.5 ± 24.1	Same-night Level 1 PSG	H: >30% reduction + 4% desaturation	10	88	70.8	AUC = 0.90 ACC = 0.82	CV (Leave-one-out)

Caseiro et al. [39]	Coimbra Sleep Disorders Clinic, Portugal	21/0.52 (OSA) 20/0.35 (Non-OSA)	59.9 ± 13.9 (OSA) 40.8 ± 12 (Non-OSA)	47.4 ± 32.8 (OSA) 2.17 ± 1.56 (Non-OSA)	Same-night Level 1 PSG	—	5	81	95	AUC = 0.88	S

Salisbury and Sun [40]	Vanguard Technologies	18/— (TR1) 16/— (TR2)	—	— (TR1) 33.2 ± 35.7 (TR2)	Retrospective clinical diagnosis (TR1) Different-night Level 1 PSG (TR2)	H: >50% reduction + 5% desaturation	5	100 (TR1) 85.7 (TR2)	100 (TR1) 100 (TR2)	= 0.30	S