Sleep Disorders / 2015 / Article / Tab 4

Review Article

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

Table 4

Validation of SAHS detection approaches (see text for details). = number of participants/recordings; AHI = Apnea-Hypopnea Index; TR = training set; TS = testing set; A = apnea; H = hypopnea; N = normal breathing; PPV = positive predictive value; NPV = negative predictive value; AUC = areas under ROC curve; ACC = accuracy; ICC = intraclass correlation coefficient; = weighted Kappa coefficient; = Pearson’s linear correlation coefficient; DU = detection unit; C = continuous; S = single validation set; CV = cross-validation.

Study sourceDatabase/ratio maleAge (mean ± std.)AHI 
(mean ± std.)
Reference testEvent definitionNumber of eventsDUSensitivity (%)Specificity (%)OthersValidation

Burgos et al. [43]Apnea-ECG [68] (Physionet [69])8/0.8743.2 ± 8.3431.9 ± 35.9Same-night Level 1 PSGH: >50% reduction + 4% desaturation + compensatory hyperventilation2465 (TR) 
1498 (TS)
60 s92.393.5AUC = 0.98TR/TS

Gil et al. [44]Apnea-ECG [68] (Physionet [69]) (TR1) 
Miguel Servet Children’s Hospital, Spain (TR2)
8/0.87 (TR1) 
26/—
(TR2)
43.2 ± 8.34 
(TR1) 
Children (TR2)
32 ± 35.9 (TR1) 
— (TR2)
Same-night Level 1 PSGH: discernible reduction + 3% desaturation1609 (TR1) 
207 (TR2)
C95.3 (TR1) 
74 (TR2)
PPV = 0.94 (TR1)S

Macey et al. [45]Christchurch Hospital, New Zealand10/—
(TR) 
85/—
(TS1) 
57/—
(TS2)
InfantsSame-night Level 1 PSG (TR) 
Same-night Level 2 PSG (TS1, TS2)
Only apneas scored: flat region > 5 s619 (TR) 
28339 (TS1) 
32222 (TS2)
C94.1 (TS1) 
96.1 (TS2)
60.9 (TS1) 
59.2 (TS2)
TR/TS1/TS2

Reisch et al. [46]Ambrock Hospital, Germany51/0.9051.29.1Same-night Level 1 PSGSee [46]500C25–9487–100TR/TS (250)

Várady et al. [48]MIT-BIH [70] (Physionet [69])16/—Same-night Level 1 PSG8000 epochs16 s98.4 (N) 
78.7 (H) 
97.0 (A)
94.0 (N) 
91.0 (H) 
88.7 (A)
TR/TS

Han et al. [49]Center for Sleep and Chronobiology of Seoul National University Hospital, South Korea24/1.0050.2 ± 11.137.7 ± 20.5Same-night Level 1 PSG195.5 ± 94.3 (A)1 s92.4 ± 5.588.3 ± 5.8ACC = 0.92TR/TS (21 P)

Pépin et al. [47]Grenoble University Hospital, France29/0.6947 ± 15 (TR) 
47 ± 12 (TS)
21.6 ± 18.5 (TR) 
20.4 ± 18.8 (TS)
Same-night Level 1 PSGH: >50% reduction or 30–50% reduction + [3% desaturation or arousal]CTR/TS (19 P)

Nakano et al. [50]Fukuoka National Hospital, Japan100/0.79 (TR) 
299/0.85 (TS1) 
119/—
(TS2)
51.1 ± 13.7 (TR) 
48.6 ± 13.9 (TS1) 
— (TS2)
24.4 ± —
(TR)  
25.6 ± —
(TS1) 
— (TS2)
Same-night Level 1 PSGH: >50% reduction or  
<30–50% reduction + [3% desaturation or arousal]
2744 (TS1) 
2420 (TS2)
C77 (TS1) 
89 (TS2)
91 (TS1) 
86 (TS2)
TR/TS1/TS2

Shin et al. [51]13/1.0056.8 ± 1.9Same-night Level 1 PSGH: >50% reductionC = 0.86S

Nazeran et al. [52]Texas Southwestern Medical Center, USA9/0.7848 ± 1539 ± 29Same-night Level 1 PSG808 (A)C83ACC = 0.83S

Morsy and Al-Ashmouny [53]10/—C99.9 ± 0.096.6 ± 0.04TR/TS

Al-Ashmouny et al. [54]30/—3626CS

Taha et al. [55]Wisconsin Sleep Cohort Study [71]10/—51.8 ± 7.1718.2 ± 16.2Same-night Level 1 PSGH: discernible reduction + 2% desaturation1804 (SDB)C93.1PPV = 0.97S

Tian and Liu [56]30/—Same-night Level 1 PSGH: >50% reduction  
+ 3% desaturation
302 (A) 
728 (H)
1 s90.7 (A) 
80.8 (H)
86.4 (A) 
81.4 (H)
TR/TS (15 P)

Sommermeyer et al. [57]Sahlgrenska University Hospital, Sweden, and sleep centers in Ulm, Berlin, and Nuremberg, Germany66/0.6354 ± 1419.3 ± 18.5Same-night Level 3 PGH: >50% reduction  
+ 3% desaturation
4715 (A) 
4089 (H)
C = 0.95S

Steltner et al. [58]Freiburg University Hospital, Germany19/1.0059.9 ± 10.616.5 ± 13.29Same-night Level 1 PSGH: >50% reduction or  
discernible reduction + [3% desaturation or arousal]
3957 (scorer 1) 
2966 (scorer 2)
C75.1 (scorer 1) 
85.5 (scorer 2)
= 0.45 ± 0.15 (scorer 1) 0.40 ± 0.19 (scorer 2)CV (Leave-one-out P)

Várady et al. [59]6/—PSG (unknown level or timing)189C, val = 5 minACC = 0.91S

Houdt et al. [60]Sleep Medicine Center, Kempenhaeghe, The Netherlands11/0.9149.1 ± 11.416.5 ± 13.3Same-night Level 1 PSGAASM2007 
H: >50% reduction + [3% desaturation or arousal]
299 (A) 
504 (H) (scorer 1) 
293 (A) 
540 (H) (scorer 2)
30 s89.2 (scorer 1) 
88.9 (scorer 2)
PPV = 0.54 (scorer 1) 
0.59 (scorer 2)
TR/TS (6 P)

Al-Angari and Sahakian [61]Sleep Heart Health Study [72]50/—
(OSA) 
20/— (Non-OSA)
36.9 ± 24.3 (OSA) 
1.1 ± 1.48 (Non-OSA)
Same-night Level 2 PSGH: >30% reduction or discernible reduction + 2% desaturation 
(see [4])
2290860 s69.991.4ACC = 0.82S

Waxman et al. [62, 63]Sleep Center University of Illinois, USA74/0.7248.1 ± 10.836.8 ± 30.5Same-night Level 1 PSGAASM1999 
H: >50% reduction or  
<50% reduction + [3% desaturation or arousal]
6371 (A) 
1167 (H)
30 s88.6 ± 1.2 (A in NREM) 
82.8 ± 3.5 (H in NREM)
85.3 ± 1.2 (A in NREM) 
77.2 ± 5.2 (H in NREM)
TR/TS

Álvarez-Estévez and Moret-Bonillo [64]Sleep Heart Health Study [72]12/—Same-night Level 2 PSGH: >30% reduction or discernible reduction + 2% desaturation 
(see [4])
4866C, val = 30 s87 
92 (A) 
85 (H)
89 
85 (A) 
92 (H)
S

Maali and Al-Jumaily [65]2/—959CACC = 0.95S

Otero et al. [66]Hospital Clinico Universitario in Santiago de Compostela, Spain12/—Same-night Level 1 PSG5796C95.798.4ACC = 0.89S

Otero et al. [67]Hospital Clinico Universitario in Santiago de Compostela, Spain10/—Same-night Level 1 PSG1706 (A)C90 (A)96.8 (A)S

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