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 source

Database

/ratio male

Age (mean ± std.)

AHI; (mean ± std.)

Reference test

Event definition

Number of events

DU

Sensitivity (%)

Specificity (%)

Others

Validation

Burgos et al. [43]

Apnea-ECG [68] (Physionet [69])

8/0.87

43.2 ± 8.34

31.9 ± 35.9

Same-night Level 1 PSG

H: >50% reduction + 4% desaturation + compensatory hyperventilation

2465 (TR); 1498 (TS)

60 s

92.3

93.5

AUC = 0.98

TR/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 PSG

H: discernible reduction + 3% desaturation

1609 (TR1); 207 (TR2)

C

95.3 (TR1); 74 (TR2)

—

PPV = 0.94 (TR1)

S

Macey et al. [45]

Christchurch Hospital, New Zealand

10/—; (TR); 85/—; (TS1); 57/—; (TS2)

Infants

—

Same-night Level 1 PSG (TR); Same-night Level 2 PSG (TS1, TS2)

Only apneas scored: flat region > 5 s

619 (TR); 28339 (TS1); 32222 (TS2)

C

94.1 (TS1); 96.1 (TS2)

60.9 (TS1); 59.2 (TS2)

—

TR/TS1/TS2

Reisch et al. [46]

Ambrock Hospital, Germany

51/0.90

51.2

9.1

Same-night Level 1 PSG

See [46]

500

C

25–94

87–100

—

TR/TS (250)

Várady et al. [48]

MIT-BIH [70] (Physionet [69])

16/—

—

—

Same-night Level 1 PSG

—

8000 epochs

16 s

98.4 (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 Korea

24/1.00

50.2 ± 11.1

37.7 ± 20.5

Same-night Level 1 PSG

—

195.5 ± 94.3 (A)

1 s

92.4 ± 5.5

88.3 ± 5.8

ACC = 0.92

TR/TS (21 P)

Pépin et al. [47]

Grenoble University Hospital, France

29/0.69

47 ± 15 (TR); 47 ± 12 (TS)

21.6 ± 18.5 (TR); 20.4 ± 18.8 (TS)

Same-night Level 1 PSG

H: >50% reduction or 30–50% reduction + [3% desaturation or arousal]

—

C

—

—

—

TR/TS (19 P)

Nakano et al. [50]

Fukuoka National Hospital, Japan

100/0.79 (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 PSG

H: >50% reduction or; <30–50% reduction + [3% desaturation or arousal]

2744 (TS1); 2420 (TS2)

C

77 (TS1); 89 (TS2)

91 (TS1); 86 (TS2)

—

TR/TS1/TS2

Shin et al. [51]

—

13/1.00

56.8 ± 1.9

—

Same-night Level 1 PSG

H: >50% reduction

—

C

—

—

= 0.86

S

Nazeran et al. [52]

Texas Southwestern Medical Center, USA

9/0.78

48 ± 15

39 ± 29

Same-night Level 1 PSG

—

808 (A)

C

83

—

ACC = 0.83

S

Morsy and Al-Ashmouny [53]

—

10/—

—

—

—

—

—

C

99.9 ± 0.0

96.6 ± 0.04

—

TR/TS

Al-Ashmouny et al. [54]

—

30/—

—

—

—

—

3626

C

—

—

—

S

Taha et al. [55]

Wisconsin Sleep Cohort Study [71]

10/—

51.8 ± 7.17

18.2 ± 16.2

Same-night Level 1 PSG

H: discernible reduction + 2% desaturation

1804 (SDB)

C

93.1

—

PPV = 0.97

S

Tian and Liu [56]

—

30/—

—

—

Same-night Level 1 PSG

H: >50% reduction; + 3% desaturation

302 (A); 728 (H)

1 s

90.7 (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, Germany

66/0.63

54 ± 14

19.3 ± 18.5

Same-night Level 3 PG

H: >50% reduction; + 3% desaturation

4715 (A); 4089 (H)

C

—

—

= 0.95

S

Steltner et al. [58]

Freiburg University Hospital, Germany

19/1.00

59.9 ± 10.6

16.5 ± 13.29

Same-night Level 1 PSG

H: >50% reduction or; discernible reduction + [3% desaturation or arousal]

3957 (scorer 1); 2966 (scorer 2)

C

75.1 (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)

—

189

C, val = 5 min

—

—

ACC = 0.91

S

Houdt et al. [60]

Sleep Medicine Center, Kempenhaeghe, The Netherlands

11/0.91

49.1 ± 11.4

16.5 ± 13.3

Same-night Level 1 PSG

AASM2007; H: >50% reduction + [3% desaturation or arousal]

299 (A); 504 (H) (scorer 1); 293 (A); 540 (H) (scorer 2)

30 s

89.2 (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 PSG

H: >30% reduction or discernible reduction + 2% desaturation; (see [4])

22908

60 s

69.9

91.4

ACC = 0.82

S

Waxman et al. [62, 63]

Sleep Center University of Illinois, USA

74/0.72

48.1 ± 10.8

36.8 ± 30.5

Same-night Level 1 PSG

AASM1999; H: >50% reduction or; <50% reduction + [3% desaturation or arousal]

6371 (A); 1167 (H)

30 s

88.6 ± 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 PSG

H: >30% reduction or discernible reduction + 2% desaturation; (see [4])

4866

C, val = 30 s

87; 92 (A); 85 (H)

89; 85 (A); 92 (H)

—

S

Maali and Al-Jumaily [65]

—

2/—

—

—

—

—

959

C

—

—

ACC = 0.95

S

Otero et al. [66]

Hospital Clinico Universitario in Santiago de Compostela, Spain

12/—

—

—

Same-night Level 1 PSG

—

5796

C

95.7

98.4

ACC = 0.89

S

Otero et al. [67]

Hospital Clinico Universitario in Santiago de Compostela, Spain

10/—

—

—

Same-night Level 1 PSG

—

1706 (A)

C

90 (A)

96.8 (A)

—

S