{"id":{"repo_id":"dialnet","oai_identifier":"oai:dialnet.unirioja.es:TES0000023151"},"canonical_url":"https://search.dev.ndltd.org/etd/dialnet/oai:dialnet.unirioja.es:TES0000023151","repository":{"repo_id":"dialnet","name":"Dialnet","base_url":"https://dialnet.unirioja.es/oaites/OAIHandler"},"display":{"title":"Evaluación de la precisión diagnóstica del análisis automático de la poligrafía frente al análisis manual en la apnea obstructiva del sueño","abstract":"Introduction: Obstructive sleep apnea (OSA) is a chronic pathology that affects more than 20% of the adult population. It is one of the main sleep disorders with great clinical, economic and social repercussions. To evaluate the impact and severity of OSA, the number of apneas and hypopneas per hour (AHI) were counted. To define that a person has OSA, they must have an AHI ≥15/h, predominantly obstructive, in a sleep study, or the presence of an AHI ≥5/h accompanied by symptoms. The diagnosis of certainty or exclusion of OSA, as well as the severity, is established with a sleep study. Polysomnography (PSG) continues to be the reference standard for the diagnosis of OSA, it covers the recording of cardiorespiratory and neurophysiological variables, which allows the analysis of the time and structure of sleep, the presence of different respiratory episodes and their repercussions. Respiratory polygraphy (RP) includes the recording of a flow sensor, respiratory effort, oxygen saturation, heart rate and also position but not EEG. There are several studies that have explored the diagnostic agreement of PR versus PSG, being a validated, useful and necessary test for the diagnosis of OSA in different clinical situations. Being more economical and accessible. When we talk about the diagnosis of OSA, it refers to establishing whether or not there is, the severity and the therapeutic decision that will greatly affect the quality of life, prognosis and day-to-day life of the patient, since it is a chronic disease. It must be taken into account that the majority of studies are carried out in a field specialized in dream interpretation, so caution must be taken when interpreting results in another field. PR equipment incorporates increasingly better developed software that allows automatic analysis of records, but the technology and algorithms used vary depending on the device, and until now the AASM continues to recommend manual analysis based on the evidence that exists today. Several studies have analyzed the agreement between automatic and manual analysis of PR recording or between automatic analysis of PR and PSG. It seems that this agreement is reached above all at higher AHIs, above 25-30, which may limit its use in clinical practice. The PR studies previously carried out were not standardized, they were applied to a non-OSA population and using different softwares. Therefore, it is important to develop a study with a large number of patients to achieve statistical significance and strong conclusions that would support normal clinical practice, and to disable a study that does not meet the scientific requirements when it comes to interpretation and reading. Objetives: - Establish the diagnostic performance of AHI measured by automatic analysis with respect to manual analysis in polygraphy and depending on the severity of OSA. - Assess the degree of agreement between the automatic analysis with respect to the manual analysis in the calculation of the AHI, average SatO2 and CT90%. - Descriptive analysis of the demographic variables of patients who undergo polygraphy. Methodology: Descriptive, observational and retrospective study in which polygraphs performed at HUSP during the years 2014 to March 2020 are recruited with the sample size is 3144 subjects First, an automatic analysis of the polygraphy was performed to obtain the variables: AHI, supine AHI, non-supine AHI, average SatO2 and Ct90 and subsequently, according to usual clinical practice, the manual analysis was performed. Polygraphy analyzes are performed with the emletta MPR 3 model. Results: The polygraphies performed progressively increased during the study period: 169 in 2014, 695 in 2015, 502 in 2016, 417 in 2017, 530 in 2018, 723 in 2019 and 114 in 2020 (until March). The most prevalent type of patient who attended the consultation and underwent the test was male (67.6%) and with an average age of 56.63+/-14.6 years. However, according to sex, with similar ages in both groups, it is slightly higher in the group of women. This age difference was statistically significant. From the automatic analysis of the PR, a mean AHI of 17.7 +/- 14.6 (moderate OSA) was obtained, while in the manual analysis the mean AHI was 31.6 +/-36.24 (severe OSA). . When the degree of OSA was analyzed with the automatic analysis, OSA was ruled out in 29.2% of the subjects, 29.4% were diagnosed with mild OSA, 20.1% moderate, 13.5% severe, and 7.8% very serious. With manual analysis the results were different. OSA was ruled out in 13.9% of subjects, and mild OSA was diagnosed in 22.7%, moderate in 22.5%, severe in 18.1%, and very severe in 19.2%. Therefore, although the automatic analysis ruled out false positives, it undervalued and consequently undertreated patients with OSA. 86.1% of the polygraphs performed by manual analysis were diagnosed with OSA, so only 1 in 8 of the polygraphs performed was not diagnostic of OSA, of which 40.0% were serious or very serious. The diagnostic frequency of OSA analyzed by sex was 87.8% in men (42.4% severe or very severe). On the other hand, it was 81.8% in women (28.4% is serious or very serious). Therefore, in women the severity of OSA was less than in men and more frequent of a moderate nature. The linear correlation coefficient between both types of analysis was high (p<0.001) when studying the AHI (supine and non-supine). The highest correlation was obtained with SatO2 (0.969) and to a lesser extent with CT90 (0.77). The agreement in the severity of OSA between both PR evaluations was 44.52% and the kappa index was 0.3068, indicating low/moderate agreement. When the ability to rule out or not rule out OSA and to diagnose its degree was analyzed with the automatic analysis compared to the manual analysis, the automatic analysis was sensitive (0.94), but not very specific (0.51). The positive predictive value was also low (0.46), and on the other hand, the negative predictive value was high (0.95). The sensitivity to diagnose OSA was moderate (0.78) and with very low specificity (0.46). The positive predictive value was high (0.98), and on the other hand, the negative predictive value was very low (0.49). The sensitivity to diagnose mild OSA was very low (0.31) with a specificity of 0.82, which although higher, was not adequate (0.82) either. The positive predictive value was also very low (0.55) and the negative predictive value is high (0.86). The sensitivity for diagnosing moderate OSA was very low (0.29), with a specificity of 0.88. The positive predictive value was very low (0.36, and on the other hand the negative predictive value was higher (0.84). The sensitivity to diagnose severe OSA is very low (0.29) with a specificity of 0.89. The positive predictive value was very low (0.37) and the negative predictive value was, on the other hand, higher (0.84).And finally, the sensitivity to diagnose very severe OSA was very low (0.39) with a specificity of 0.99, while the positive predictive value was very high (0.97) and the negative predictive value was also high, although to a lesser extent (0.87). Conclusions: Compared the automatic PR analysis with the manual analysis, the automatic analysis is not valid in the diagnosis of OSA, it only has diagnostic capacity in the case of no OSA or in the case of very severe OSA, but not in intermediates OSA diagnoses. Automatic analysis of PR is not recommended in the definitive diagnosis of OSA. It is only recommended as a screening method to later demonstrate the diagnosis with a polygraph analysis with the manual method performed by healthcare personnel expert in sleep.","abstract_html":"Introduction: Obstructive sleep apnea (OSA) is a chronic pathology that affects more than 20% of the adult population. It is one of the main sleep disorders with great clinical, economic and social repercussions. To evaluate the impact and severity of OSA, the number of apneas and hypopneas per hour (AHI) were counted. To define that a person has OSA, they must have an AHI ≥15/h, predominantly obstructive, in a sleep study, or the presence of an AHI ≥5/h accompanied by symptoms. The diagnosis of certainty or exclusion of OSA, as well as the severity, is established with a sleep study. Polysomnography (PSG) continues to be the reference standard for the diagnosis of OSA, it covers the recording of cardiorespiratory and neurophysiological variables, which allows the analysis of the time and structure of sleep, the presence of different respiratory episodes and their repercussions. Respiratory polygraphy (RP) includes the recording of a flow sensor, respiratory effort, oxygen saturation, heart rate and also position but not EEG. There are several studies that have explored the diagnostic agreement of PR versus PSG, being a validated, useful and necessary test for the diagnosis of OSA in different clinical situations. Being more economical and accessible. When we talk about the diagnosis of OSA, it refers to establishing whether or not there is, the severity and the therapeutic decision that will greatly affect the quality of life, prognosis and day-to-day life of the patient, since it is a chronic disease. It must be taken into account that the majority of studies are carried out in a field specialized in dream interpretation, so caution must be taken when interpreting results in another field. PR equipment incorporates increasingly better developed software that allows automatic analysis of records, but the technology and algorithms used vary depending on the device, and until now the AASM continues to recommend manual analysis based on the evidence that exists today. Several studies have analyzed the agreement between automatic and manual analysis of PR recording or between automatic analysis of PR and PSG. It seems that this agreement is reached above all at higher AHIs, above 25-30, which may limit its use in clinical practice. The PR studies previously carried out were not standardized, they were applied to a non-OSA population and using different softwares. Therefore, it is important to develop a study with a large number of patients to achieve statistical significance and strong conclusions that would support normal clinical practice, and to disable a study that does not meet the scientific requirements when it comes to interpretation and reading. Objetives: - Establish the diagnostic performance of AHI measured by automatic analysis with respect to manual analysis in polygraphy and depending on the severity of OSA. - Assess the degree of agreement between the automatic analysis with respect to the manual analysis in the calculation of the AHI, average SatO2 and CT90%. - Descriptive analysis of the demographic variables of patients who undergo polygraphy. Methodology: Descriptive, observational and retrospective study in which polygraphs performed at HUSP during the years 2014 to March 2020 are recruited with the sample size is 3144 subjects First, an automatic analysis of the polygraphy was performed to obtain the variables: AHI, supine AHI, non-supine AHI, average SatO2 and Ct90 and subsequently, according to usual clinical practice, the manual analysis was performed. Polygraphy analyzes are performed with the emletta MPR 3 model. Results: The polygraphies performed progressively increased during the study period: 169 in 2014, 695 in 2015, 502 in 2016, 417 in 2017, 530 in 2018, 723 in 2019 and 114 in 2020 (until March). The most prevalent type of patient who attended the consultation and underwent the test was male (67.6%) and with an average age of 56.63+/-14.6 years. However, according to sex, with similar ages in both groups, it is slightly higher in the group of women. This age difference was statistically significant. From the automatic analysis of the PR, a mean AHI of 17.7 +/- 14.6 (moderate OSA) was obtained, while in the manual analysis the mean AHI was 31.6 +/-36.24 (severe OSA). . When the degree of OSA was analyzed with the automatic analysis, OSA was ruled out in 29.2% of the subjects, 29.4% were diagnosed with mild OSA, 20.1% moderate, 13.5% severe, and 7.8% very serious. With manual analysis the results were different. OSA was ruled out in 13.9% of subjects, and mild OSA was diagnosed in 22.7%, moderate in 22.5%, severe in 18.1%, and very severe in 19.2%. Therefore, although the automatic analysis ruled out false positives, it undervalued and consequently undertreated patients with OSA. 86.1% of the polygraphs performed by manual analysis were diagnosed with OSA, so only 1 in 8 of the polygraphs performed was not diagnostic of OSA, of which 40.0% were serious or very serious. The diagnostic frequency of OSA analyzed by sex was 87.8% in men (42.4% severe or very severe). On the other hand, it was 81.8% in women (28.4% is serious or very serious). Therefore, in women the severity of OSA was less than in men and more frequent of a moderate nature. The linear correlation coefficient between both types of analysis was high (p&lt;0.001) when studying the AHI (supine and non-supine). The highest correlation was obtained with SatO2 (0.969) and to a lesser extent with CT90 (0.77). The agreement in the severity of OSA between both PR evaluations was 44.52% and the kappa index was 0.3068, indicating low/moderate agreement. When the ability to rule out or not rule out OSA and to diagnose its degree was analyzed with the automatic analysis compared to the manual analysis, the automatic analysis was sensitive (0.94), but not very specific (0.51). The positive predictive value was also low (0.46), and on the other hand, the negative predictive value was high (0.95). The sensitivity to diagnose OSA was moderate (0.78) and with very low specificity (0.46). The positive predictive value was high (0.98), and on the other hand, the negative predictive value was very low (0.49). The sensitivity to diagnose mild OSA was very low (0.31) with a specificity of 0.82, which although higher, was not adequate (0.82) either. The positive predictive value was also very low (0.55) and the negative predictive value is high (0.86). The sensitivity for diagnosing moderate OSA was very low (0.29), with a specificity of 0.88. The positive predictive value was very low (0.36, and on the other hand the negative predictive value was higher (0.84). The sensitivity to diagnose severe OSA is very low (0.29) with a specificity of 0.89. The positive predictive value was very low (0.37) and the negative predictive value was, on the other hand, higher (0.84).And finally, the sensitivity to diagnose very severe OSA was very low (0.39) with a specificity of 0.99, while the positive predictive value was very high (0.97) and the negative predictive value was also high, although to a lesser extent (0.87). Conclusions: Compared the automatic PR analysis with the manual analysis, the automatic analysis is not valid in the diagnosis of OSA, it only has diagnostic capacity in the case of no OSA or in the case of very severe OSA, but not in intermediates OSA diagnoses. Automatic analysis of PR is not recommended in the definitive diagnosis of OSA. It is only recommended as a screening method to later demonstrate the diagnosis with a polygraph analysis with the manual method performed by healthcare personnel expert in sleep.","abstract_has_math":false,"creators":["Roncero Lázaro, Alejandra"],"institution":"Universidad de La Rioja (España)","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["García Pichel, José Manuel (Universidad de La Rioja)","Ruiz Martínez, Carlos (Universidad de La Rioja)"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2024,"date_issued":"2024","date_published":"2024","updated_at":"2026-07-24T06:27:07Z","subjects":[],"languages":["spa"],"rights":["LICENCIA DE USO: Los documentos a texto completo incluidos en Dialnet son de acceso libre y propiedad de sus autores y/o editores. Por tanto, cualquier acto de reproducción, distribución, comunicación pública y/o transformación total o parcial requiere el consentimiento expreso y escrito de aquéllos. Cualquier enlace al texto completo de estos documentos deberá hacerse a través de la URL oficial de éstos en Dialnet. Más información: https://dialnet.unirioja.es/info/derechosOAI | INTELLECTUAL PROPERTY RIGHTS STATEMENT: Full text documents hosted by Dialnet are protected by copyright and/or related rights. This digital object is accessible without charge, but its use is subject to the licensing conditions set by its authors or editors. Unless expressly stated otherwise in the licensing conditions, you are free to linking, browsing, printing and making a copy for your own personal purposes. All other acts of reproduction and communication to the public are subject to the licensing conditions expressed by editors and authors and require consent from them. Any link to this document should be made using its official URL in Dialnet. More info: https://dialnet.unirioja.es/info/derechosOAI"],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://dialnet.unirioja.es/servlet/oaites?codigo=342207","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["García Pichel, José Manuel (Universidad de La Rioja)","Ruiz Martínez, Carlos (Universidad de La Rioja)"]},{"key":"dc:creator","label":"Author","values":["Roncero Lázaro, Alejandra"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2024"]},{"key":"dc:publisher","label":"Institution","values":["Universidad de La Rioja (España)"]},{"key":"dc:type","label":"Dc Type","values":["text (thesis)"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["spa"]},{"key":"dc:rights","label":"Dc Rights","values":["LICENCIA DE USO: Los documentos a texto completo incluidos en Dialnet son de acceso libre y propiedad de sus autores y/o editores. Por tanto, cualquier acto de reproducción, distribución, comunicación pública y/o transformación total o parcial requiere el consentimiento expreso y escrito de aquéllos. Cualquier enlace al texto completo de estos documentos deberá hacerse a través de la URL oficial de éstos en Dialnet. Más información: https://dialnet.unirioja.es/info/derechosOAI | INTELLECTUAL PROPERTY RIGHTS STATEMENT: Full text documents hosted by Dialnet are protected by copyright and/or related rights. This digital object is accessible without charge, but its use is subject to the licensing conditions set by its authors or editors. Unless expressly stated otherwise in the licensing conditions, you are free to linking, browsing, printing and making a copy for your own personal purposes. All other acts of reproduction and communication to the public are subject to the licensing conditions expressed by editors and authors and require consent from them. Any link to this document should be made using its official URL in Dialnet. More info: https://dialnet.unirioja.es/info/derechosOAI"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://dialnet.unirioja.es/servlet/oaites?codigo=342207"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Introduction: Obstructive sleep apnea (OSA) is a chronic pathology that affects more than 20% of the adult population. It is one of the main sleep disorders with great clinical, economic and social repercussions. To evaluate the impact and severity of OSA, the number of apneas and hypopneas per hour (AHI) were counted. To define that a person has OSA, they must have an AHI ≥15/h, predominantly obstructive, in a sleep study, or the presence of an AHI ≥5/h accompanied by symptoms. The diagnosis of certainty or exclusion of OSA, as well as the severity, is established with a sleep study. Polysomnography (PSG) continues to be the reference standard for the diagnosis of OSA, it covers the recording of cardiorespiratory and neurophysiological variables, which allows the analysis of the time and structure of sleep, the presence of different respiratory episodes and their repercussions. Respiratory polygraphy (RP) includes the recording of a flow sensor, respiratory effort, oxygen saturation, heart rate and also position but not EEG. There are several studies that have explored the diagnostic agreement of PR versus PSG, being a validated, useful and necessary test for the diagnosis of OSA in different clinical situations. Being more economical and accessible. When we talk about the diagnosis of OSA, it refers to establishing whether or not there is, the severity and the therapeutic decision that will greatly affect the quality of life, prognosis and day-to-day life of the patient, since it is a chronic disease. It must be taken into account that the majority of studies are carried out in a field specialized in dream interpretation, so caution must be taken when interpreting results in another field. PR equipment incorporates increasingly better developed software that allows automatic analysis of records, but the technology and algorithms used vary depending on the device, and until now the AASM continues to recommend manual analysis based on the evidence that exists today. Several studies have analyzed the agreement between automatic and manual analysis of PR recording or between automatic analysis of PR and PSG. It seems that this agreement is reached above all at higher AHIs, above 25-30, which may limit its use in clinical practice. The PR studies previously carried out were not standardized, they were applied to a non-OSA population and using different softwares. Therefore, it is important to develop a study with a large number of patients to achieve statistical significance and strong conclusions that would support normal clinical practice, and to disable a study that does not meet the scientific requirements when it comes to interpretation and reading. Objetives: - Establish the diagnostic performance of AHI measured by automatic analysis with respect to manual analysis in polygraphy and depending on the severity of OSA. - Assess the degree of agreement between the automatic analysis with respect to the manual analysis in the calculation of the AHI, average SatO2 and CT90%. - Descriptive analysis of the demographic variables of patients who undergo polygraphy. Methodology: Descriptive, observational and retrospective study in which polygraphs performed at HUSP during the years 2014 to March 2020 are recruited with the sample size is 3144 subjects First, an automatic analysis of the polygraphy was performed to obtain the variables: AHI, supine AHI, non-supine AHI, average SatO2 and Ct90 and subsequently, according to usual clinical practice, the manual analysis was performed. Polygraphy analyzes are performed with the emletta MPR 3 model. Results: The polygraphies performed progressively increased during the study period: 169 in 2014, 695 in 2015, 502 in 2016, 417 in 2017, 530 in 2018, 723 in 2019 and 114 in 2020 (until March). The most prevalent type of patient who attended the consultation and underwent the test was male (67.6%) and with an average age of 56.63+/-14.6 years. However, according to sex, with similar ages in both groups, it is slightly higher in the group of women. This age difference was statistically significant. From the automatic analysis of the PR, a mean AHI of 17.7 +/- 14.6 (moderate OSA) was obtained, while in the manual analysis the mean AHI was 31.6 +/-36.24 (severe OSA). . When the degree of OSA was analyzed with the automatic analysis, OSA was ruled out in 29.2% of the subjects, 29.4% were diagnosed with mild OSA, 20.1% moderate, 13.5% severe, and 7.8% very serious. With manual analysis the results were different. OSA was ruled out in 13.9% of subjects, and mild OSA was diagnosed in 22.7%, moderate in 22.5%, severe in 18.1%, and very severe in 19.2%. Therefore, although the automatic analysis ruled out false positives, it undervalued and consequently undertreated patients with OSA. 86.1% of the polygraphs performed by manual analysis were diagnosed with OSA, so only 1 in 8 of the polygraphs performed was not diagnostic of OSA, of which 40.0% were serious or very serious. The diagnostic frequency of OSA analyzed by sex was 87.8% in men (42.4% severe or very severe). On the other hand, it was 81.8% in women (28.4% is serious or very serious). Therefore, in women the severity of OSA was less than in men and more frequent of a moderate nature. The linear correlation coefficient between both types of analysis was high (p<0.001) when studying the AHI (supine and non-supine). The highest correlation was obtained with SatO2 (0.969) and to a lesser extent with CT90 (0.77). The agreement in the severity of OSA between both PR evaluations was 44.52% and the kappa index was 0.3068, indicating low/moderate agreement. When the ability to rule out or not rule out OSA and to diagnose its degree was analyzed with the automatic analysis compared to the manual analysis, the automatic analysis was sensitive (0.94), but not very specific (0.51). The positive predictive value was also low (0.46), and on the other hand, the negative predictive value was high (0.95). The sensitivity to diagnose OSA was moderate (0.78) and with very low specificity (0.46). The positive predictive value was high (0.98), and on the other hand, the negative predictive value was very low (0.49). The sensitivity to diagnose mild OSA was very low (0.31) with a specificity of 0.82, which although higher, was not adequate (0.82) either. The positive predictive value was also very low (0.55) and the negative predictive value is high (0.86). The sensitivity for diagnosing moderate OSA was very low (0.29), with a specificity of 0.88. The positive predictive value was very low (0.36, and on the other hand the negative predictive value was higher (0.84). The sensitivity to diagnose severe OSA is very low (0.29) with a specificity of 0.89. The positive predictive value was very low (0.37) and the negative predictive value was, on the other hand, higher (0.84).And finally, the sensitivity to diagnose very severe OSA was very low (0.39) with a specificity of 0.99, while the positive predictive value was very high (0.97) and the negative predictive value was also high, although to a lesser extent (0.87). Conclusions: Compared the automatic PR analysis with the manual analysis, the automatic analysis is not valid in the diagnosis of OSA, it only has diagnostic capacity in the case of no OSA or in the case of very severe OSA, but not in intermediates OSA diagnoses. Automatic analysis of PR is not recommended in the definitive diagnosis of OSA. It is only recommended as a screening method to later demonstrate the diagnosis with a polygraph analysis with the manual method performed by healthcare personnel expert in sleep.","Introducción: La apnea obstructiva del sueño (AOS) es una patología crónica que afecta a más del 20% de la población adulta. Se trata de uno de los principales trastornos del sueño con gran repercusión clínica, económica y social. Para evaluar la repercusión y gravedad de la apnea obstructiva del sueño se contabiliza el número apneas e hipopneas por hora (IAH). Una persona se diagnostica de AOS cuando en un estudio de sueño presenta IAH ≥15/h, predominantemente de tipo obstructivo, o bien con IAH≥5/h acompañado de sintomatología. El diagnóstico de certeza o la exclusión de la AOS, así como la gravedad, se establecen con un estudio de sueño. La polisomnografía (PSG) sigue siendo el patrón de referencia para el diagnósticoy abarca el registro de variables cardiorrespiratorias y neurofisiológicas, lo cual permite analizar el tiempo y la estructura del sueño, la presencia de diferentes episodios respiratorios y sus repercusiones. La poligrafía respiratoria (PR), incluye el registro de un sensor de flujo, esfuerzo respiratorio, saturación de oxígeno, frecuencia cardíaca y también posición, pero no EEG. Hay varios estudios que han explorado el acuerdo diagnóstico de la PR frente a la PSG, siendo la PR una prueba validada, útil y necesaria para el diagnóstico de AOS sólo en algunas circunstancias clínicas, y también más económica y accesible. Con el diagnóstico de AOStambién se valorasu gravedad. Al tratarse de una enfermedad crónica, la decisión terapéutica va a afectar en gran medida la calidad de vida, el pronóstico y el día a día del paciente. La mayoría de estudios de AOS se desarrollan en un ámbito especializado de interpretación del sueño, por lo que hay que tener cautela en la interpretación de resultados en otro ámbito. Los equipos de PR incorporan softwares cada vez mejor desarrollados que permiten el análisis automático de los registros, pero la tecnología y algoritmos utilizados varían según el dispositivo. Sin embargo, hasta ahora y según la evidencia, la American Academy of Sleep Medicine (AASM) sigue recomendando el análisis manual de las PR. Varios estudios han analizado el acuerdo de diagnóstico de AOS entre el análisis automático y manual del registro de PR o entre el análisis automático de la PR y la PSG, aunque estos estudios se han realizado en cohortes de pacientes muy limitadas y con métodos no estandarizados. El acuerdo de diagnóstico se alcanza principalmente en los pacientes con IAH elevados, por encima de 25-30, lo cual limitaría su uso en la práctica clínica. Para alcanzar una significación estadística y conclusiones fuertes que nos avalen la práctica clínica habitual del análisis automático de la PR frente al análisis manual en el diagnóstico certero de AOS es importante desarrollar un estudio sistemático que incluya un gran número de pacientes para que cumpla los requisitos científicos a la hora de su interpretación y lectura. Objetivos: - Establecer el rendimiento diagnóstico del IAH medido mediante el análisis automático de la PR con respecto al análisis manual de la PR y en función de la gravedad de la AOS. - Valorar el grado de concordancia entre el análisis automático por PR con respecto al análisis manual por PR en el cálculo del IAH, SatO2 media y CT90%. - Análisis descriptivo de las variables demográficas de los pacientes a los que se les ha realizado una PR. Metodología: Estudio descriptivo, observacional y retrospectivo en el que se han reclutado las PR realizadas en el HUSP desde enero de 2014 a marzo del 2020 con un tamaño muestral de 3144 sujetos. En primer lugar a los sujetos se les ha realizado un análisis automático de la PR para obtener las variables: IAH, IAH en supino, IAH en no supino, SatO2 media y CT90, y posteriormente el análisis manual, según la práctica clínica habitual. Los registros de la PR se han realizado con un equipo polígrafo del modelo Embletta MPR 3. Resultados: Las poligrafías realizadas aumentaron progresivamente en el período del estudio: 169 en el año 2014, 695 en 2015, 502 en 2016, 417 en 2017, 530 en 2018, 723 en 2019 y 114 en 2020 (hasta el mes de marzo). El tipo de paciente más prevalente que asistió a la consulta y se efectuó la prueba fue del sexo masculino (67,6%) y con una edad media de 56,63+/-14,6 años. Sin embargo, según el sexo, tratándose de edades similares en ambos grupos, es ligeramente mayor en el grupo de mujeres. Dicha diferencia etaria fue estadísticamente significativa. Del análisis automático de la PR se obtuvo un IAH medio de 17,7 +/- 14,6 (AOS moderado), mientras que en el análisis manual el IAH medio fue de 31,6+/-36,24 (AOS grave). Cuando se analizó el grado de AOS con el análisis automático se descartó AOS en un 29,2% de los sujetos, el 29,4% se diagnosticó con AOS leve, el 20,1 % moderado, el 13,5% grave, y el 7,8% muy grave. Con el análisis manual los resultados fueron diferentes. Se descartó AOS en el 13,9% de los sujetos, y se diagnoticó AOS leve en el 22,7%, moderado en el 22,5%, grave en el 18,1% y muy grave en el 19,2%. Por lo tanto, aunque el análisis automático descartó falsos positivos, infravaloró y consecuentemente infratrató a los pacientes con AOS. Un 86,1% de las poligrafías realizadas por análisis manual fueron diagnósticados de AOS, por lo que sólo 1 de cada 8 de las poligrafías realizadas no fue diagnóstica de AOS, de las que un 40,0 % fuero graves o muy graves. La frecuencia diagnóstica de AOS analizada por sexo, fue del 87,8% en hombres (42,4% de carácter grave o muy grave). En cambio, fue del 81.8% en mujeres (28,4% es grave o muy grave). Por lo que en las mujeres la gravedad de la AOS fue menor que en hombres y más frecuente de carácter moderado. El coeficiente de correlación lineal entre ambos tipos de análisis fue alto (p<0.001) al estudiar el IAH (en supino y no supino). La mayor correlación se obtuvo con la SatO2 (0,969) y en menor medida con el CT90 (0,77). La concordancia en la gravedad de la AOS entre ambas evaluaciones de las PR fue de un 44,52% y el valor del índice kappa fue de 0,3068, indicando una concordancia baja/moderada. Cuando se analizó la capacidad para descartar o no descartar AOS y para diagnosticar su grado con el análisis automático respecto al análisis manual, el análisis automático fue sensible (0,94), pero poco específico (0,51). El valor predictivo positivo fue también bajo (0,46), y en cambio, el valor predictivo negativo fue alto (0,95). La sensibilidad para diagnosticar AOS fue moderada (0,78) y con una especificidad muy baja (0,46). El valor predictivo positivo fue alto (0,98), y en cambio, el valor predictivo negativo muy bajo (0,49). La sensibilidad para diagnosticar AOS leve fue muy baja (0,31) con una especificidad de 0,82, que aunque más alta, tampoco fue adecuada (0,82). El valor predictivo positivo también fue muy bajo (0,55) y el valor predictivo negativo, fue en cambio alto (0,86). La sensibilidad para diagnosticar AOS moderado fue muy baja (0,29), con una especificidad de 0,88. El valor predictivo positivofue muy bajo (0,36, y en cambio el valor predictivo negativo fue más alto (0,84). La sensibilidad para diagnosticar AOS grave, es muy baja (0,29) con una especificidad de 0,89. El valor predictivo positivo fue muy bajo (0,37) y el valor predictivo negativo fue, en cambio más alto (0,84). Y por último, la sensibilidad para diagnosticar AOS muy grave fue muy baja (0,39) con una especificidad de 0,99, mientras que el valor predictivo positivo fue muy alto (0,97) y el valor predictivo negativo fue también alto, aunque en menor medida (0,87). Conclusiones: Comparado el análisis de las PR automático con el análisis manual, el análisis automático no tiene validez en el diagnóstico de AOS, sólo posee capacidad diagnóstia en el caso de no existir AOS o en el caso de AOS muy grave, pero no en diagnósticos de AOS intermedios. El análisis automático de las PR no es recomendable en el diagnóstico de certeza de la AOS. Sólo se recomienda como método de cribado para posteriormente demostrar el diagnóstico con un análisis poligráfico con el método manual realizado por personal sanitario experto en sueño."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Evaluación de la precisión diagnóstica del análisis automático de la poligrafía frente al análisis manual en la apnea obstructiva del sueño"]}]}],"canonical_facts":{"dc:contributor":["García Pichel, José Manuel (Universidad de La Rioja)","Ruiz Martínez, Carlos (Universidad de La Rioja)"],"dc:creator":["Roncero Lázaro, Alejandra"],"dc:date":["2024"],"dc:description":["Introduction: Obstructive sleep apnea (OSA) is a chronic pathology that affects more than 20% of the adult population. It is one of the main sleep disorders with great clinical, economic and social repercussions. To evaluate the impact and severity of OSA, the number of apneas and hypopneas per hour (AHI) were counted. To define that a person has OSA, they must have an AHI ≥15/h, predominantly obstructive, in a sleep study, or the presence of an AHI ≥5/h accompanied by symptoms. The diagnosis of certainty or exclusion of OSA, as well as the severity, is established with a sleep study. Polysomnography (PSG) continues to be the reference standard for the diagnosis of OSA, it covers the recording of cardiorespiratory and neurophysiological variables, which allows the analysis of the time and structure of sleep, the presence of different respiratory episodes and their repercussions. Respiratory polygraphy (RP) includes the recording of a flow sensor, respiratory effort, oxygen saturation, heart rate and also position but not EEG. There are several studies that have explored the diagnostic agreement of PR versus PSG, being a validated, useful and necessary test for the diagnosis of OSA in different clinical situations. Being more economical and accessible. When we talk about the diagnosis of OSA, it refers to establishing whether or not there is, the severity and the therapeutic decision that will greatly affect the quality of life, prognosis and day-to-day life of the patient, since it is a chronic disease. It must be taken into account that the majority of studies are carried out in a field specialized in dream interpretation, so caution must be taken when interpreting results in another field. PR equipment incorporates increasingly better developed software that allows automatic analysis of records, but the technology and algorithms used vary depending on the device, and until now the AASM continues to recommend manual analysis based on the evidence that exists today. Several studies have analyzed the agreement between automatic and manual analysis of PR recording or between automatic analysis of PR and PSG. It seems that this agreement is reached above all at higher AHIs, above 25-30, which may limit its use in clinical practice. The PR studies previously carried out were not standardized, they were applied to a non-OSA population and using different softwares. Therefore, it is important to develop a study with a large number of patients to achieve statistical significance and strong conclusions that would support normal clinical practice, and to disable a study that does not meet the scientific requirements when it comes to interpretation and reading. Objetives: - Establish the diagnostic performance of AHI measured by automatic analysis with respect to manual analysis in polygraphy and depending on the severity of OSA. - Assess the degree of agreement between the automatic analysis with respect to the manual analysis in the calculation of the AHI, average SatO2 and CT90%. - Descriptive analysis of the demographic variables of patients who undergo polygraphy. Methodology: Descriptive, observational and retrospective study in which polygraphs performed at HUSP during the years 2014 to March 2020 are recruited with the sample size is 3144 subjects First, an automatic analysis of the polygraphy was performed to obtain the variables: AHI, supine AHI, non-supine AHI, average SatO2 and Ct90 and subsequently, according to usual clinical practice, the manual analysis was performed. Polygraphy analyzes are performed with the emletta MPR 3 model. Results: The polygraphies performed progressively increased during the study period: 169 in 2014, 695 in 2015, 502 in 2016, 417 in 2017, 530 in 2018, 723 in 2019 and 114 in 2020 (until March). The most prevalent type of patient who attended the consultation and underwent the test was male (67.6%) and with an average age of 56.63+/-14.6 years. However, according to sex, with similar ages in both groups, it is slightly higher in the group of women. This age difference was statistically significant. From the automatic analysis of the PR, a mean AHI of 17.7 +/- 14.6 (moderate OSA) was obtained, while in the manual analysis the mean AHI was 31.6 +/-36.24 (severe OSA). . When the degree of OSA was analyzed with the automatic analysis, OSA was ruled out in 29.2% of the subjects, 29.4% were diagnosed with mild OSA, 20.1% moderate, 13.5% severe, and 7.8% very serious. With manual analysis the results were different. OSA was ruled out in 13.9% of subjects, and mild OSA was diagnosed in 22.7%, moderate in 22.5%, severe in 18.1%, and very severe in 19.2%. Therefore, although the automatic analysis ruled out false positives, it undervalued and consequently undertreated patients with OSA. 86.1% of the polygraphs performed by manual analysis were diagnosed with OSA, so only 1 in 8 of the polygraphs performed was not diagnostic of OSA, of which 40.0% were serious or very serious. The diagnostic frequency of OSA analyzed by sex was 87.8% in men (42.4% severe or very severe). On the other hand, it was 81.8% in women (28.4% is serious or very serious). Therefore, in women the severity of OSA was less than in men and more frequent of a moderate nature. The linear correlation coefficient between both types of analysis was high (p<0.001) when studying the AHI (supine and non-supine). The highest correlation was obtained with SatO2 (0.969) and to a lesser extent with CT90 (0.77). The agreement in the severity of OSA between both PR evaluations was 44.52% and the kappa index was 0.3068, indicating low/moderate agreement. When the ability to rule out or not rule out OSA and to diagnose its degree was analyzed with the automatic analysis compared to the manual analysis, the automatic analysis was sensitive (0.94), but not very specific (0.51). The positive predictive value was also low (0.46), and on the other hand, the negative predictive value was high (0.95). The sensitivity to diagnose OSA was moderate (0.78) and with very low specificity (0.46). The positive predictive value was high (0.98), and on the other hand, the negative predictive value was very low (0.49). The sensitivity to diagnose mild OSA was very low (0.31) with a specificity of 0.82, which although higher, was not adequate (0.82) either. The positive predictive value was also very low (0.55) and the negative predictive value is high (0.86). The sensitivity for diagnosing moderate OSA was very low (0.29), with a specificity of 0.88. The positive predictive value was very low (0.36, and on the other hand the negative predictive value was higher (0.84). The sensitivity to diagnose severe OSA is very low (0.29) with a specificity of 0.89. The positive predictive value was very low (0.37) and the negative predictive value was, on the other hand, higher (0.84).And finally, the sensitivity to diagnose very severe OSA was very low (0.39) with a specificity of 0.99, while the positive predictive value was very high (0.97) and the negative predictive value was also high, although to a lesser extent (0.87). Conclusions: Compared the automatic PR analysis with the manual analysis, the automatic analysis is not valid in the diagnosis of OSA, it only has diagnostic capacity in the case of no OSA or in the case of very severe OSA, but not in intermediates OSA diagnoses. Automatic analysis of PR is not recommended in the definitive diagnosis of OSA. It is only recommended as a screening method to later demonstrate the diagnosis with a polygraph analysis with the manual method performed by healthcare personnel expert in sleep.","Introducción: La apnea obstructiva del sueño (AOS) es una patología crónica que afecta a más del 20% de la población adulta. Se trata de uno de los principales trastornos del sueño con gran repercusión clínica, económica y social. Para evaluar la repercusión y gravedad de la apnea obstructiva del sueño se contabiliza el número apneas e hipopneas por hora (IAH). Una persona se diagnostica de AOS cuando en un estudio de sueño presenta IAH ≥15/h, predominantemente de tipo obstructivo, o bien con IAH≥5/h acompañado de sintomatología. El diagnóstico de certeza o la exclusión de la AOS, así como la gravedad, se establecen con un estudio de sueño. La polisomnografía (PSG) sigue siendo el patrón de referencia para el diagnósticoy abarca el registro de variables cardiorrespiratorias y neurofisiológicas, lo cual permite analizar el tiempo y la estructura del sueño, la presencia de diferentes episodios respiratorios y sus repercusiones. La poligrafía respiratoria (PR), incluye el registro de un sensor de flujo, esfuerzo respiratorio, saturación de oxígeno, frecuencia cardíaca y también posición, pero no EEG. Hay varios estudios que han explorado el acuerdo diagnóstico de la PR frente a la PSG, siendo la PR una prueba validada, útil y necesaria para el diagnóstico de AOS sólo en algunas circunstancias clínicas, y también más económica y accesible. Con el diagnóstico de AOStambién se valorasu gravedad. Al tratarse de una enfermedad crónica, la decisión terapéutica va a afectar en gran medida la calidad de vida, el pronóstico y el día a día del paciente. La mayoría de estudios de AOS se desarrollan en un ámbito especializado de interpretación del sueño, por lo que hay que tener cautela en la interpretación de resultados en otro ámbito. Los equipos de PR incorporan softwares cada vez mejor desarrollados que permiten el análisis automático de los registros, pero la tecnología y algoritmos utilizados varían según el dispositivo. Sin embargo, hasta ahora y según la evidencia, la American Academy of Sleep Medicine (AASM) sigue recomendando el análisis manual de las PR. Varios estudios han analizado el acuerdo de diagnóstico de AOS entre el análisis automático y manual del registro de PR o entre el análisis automático de la PR y la PSG, aunque estos estudios se han realizado en cohortes de pacientes muy limitadas y con métodos no estandarizados. El acuerdo de diagnóstico se alcanza principalmente en los pacientes con IAH elevados, por encima de 25-30, lo cual limitaría su uso en la práctica clínica. Para alcanzar una significación estadística y conclusiones fuertes que nos avalen la práctica clínica habitual del análisis automático de la PR frente al análisis manual en el diagnóstico certero de AOS es importante desarrollar un estudio sistemático que incluya un gran número de pacientes para que cumpla los requisitos científicos a la hora de su interpretación y lectura. Objetivos: - Establecer el rendimiento diagnóstico del IAH medido mediante el análisis automático de la PR con respecto al análisis manual de la PR y en función de la gravedad de la AOS. - Valorar el grado de concordancia entre el análisis automático por PR con respecto al análisis manual por PR en el cálculo del IAH, SatO2 media y CT90%. - Análisis descriptivo de las variables demográficas de los pacientes a los que se les ha realizado una PR. Metodología: Estudio descriptivo, observacional y retrospectivo en el que se han reclutado las PR realizadas en el HUSP desde enero de 2014 a marzo del 2020 con un tamaño muestral de 3144 sujetos. En primer lugar a los sujetos se les ha realizado un análisis automático de la PR para obtener las variables: IAH, IAH en supino, IAH en no supino, SatO2 media y CT90, y posteriormente el análisis manual, según la práctica clínica habitual. Los registros de la PR se han realizado con un equipo polígrafo del modelo Embletta MPR 3. Resultados: Las poligrafías realizadas aumentaron progresivamente en el período del estudio: 169 en el año 2014, 695 en 2015, 502 en 2016, 417 en 2017, 530 en 2018, 723 en 2019 y 114 en 2020 (hasta el mes de marzo). El tipo de paciente más prevalente que asistió a la consulta y se efectuó la prueba fue del sexo masculino (67,6%) y con una edad media de 56,63+/-14,6 años. Sin embargo, según el sexo, tratándose de edades similares en ambos grupos, es ligeramente mayor en el grupo de mujeres. Dicha diferencia etaria fue estadísticamente significativa. Del análisis automático de la PR se obtuvo un IAH medio de 17,7 +/- 14,6 (AOS moderado), mientras que en el análisis manual el IAH medio fue de 31,6+/-36,24 (AOS grave). Cuando se analizó el grado de AOS con el análisis automático se descartó AOS en un 29,2% de los sujetos, el 29,4% se diagnosticó con AOS leve, el 20,1 % moderado, el 13,5% grave, y el 7,8% muy grave. Con el análisis manual los resultados fueron diferentes. Se descartó AOS en el 13,9% de los sujetos, y se diagnoticó AOS leve en el 22,7%, moderado en el 22,5%, grave en el 18,1% y muy grave en el 19,2%. Por lo tanto, aunque el análisis automático descartó falsos positivos, infravaloró y consecuentemente infratrató a los pacientes con AOS. Un 86,1% de las poligrafías realizadas por análisis manual fueron diagnósticados de AOS, por lo que sólo 1 de cada 8 de las poligrafías realizadas no fue diagnóstica de AOS, de las que un 40,0 % fuero graves o muy graves. La frecuencia diagnóstica de AOS analizada por sexo, fue del 87,8% en hombres (42,4% de carácter grave o muy grave). En cambio, fue del 81.8% en mujeres (28,4% es grave o muy grave). Por lo que en las mujeres la gravedad de la AOS fue menor que en hombres y más frecuente de carácter moderado. El coeficiente de correlación lineal entre ambos tipos de análisis fue alto (p<0.001) al estudiar el IAH (en supino y no supino). La mayor correlación se obtuvo con la SatO2 (0,969) y en menor medida con el CT90 (0,77). La concordancia en la gravedad de la AOS entre ambas evaluaciones de las PR fue de un 44,52% y el valor del índice kappa fue de 0,3068, indicando una concordancia baja/moderada. Cuando se analizó la capacidad para descartar o no descartar AOS y para diagnosticar su grado con el análisis automático respecto al análisis manual, el análisis automático fue sensible (0,94), pero poco específico (0,51). El valor predictivo positivo fue también bajo (0,46), y en cambio, el valor predictivo negativo fue alto (0,95). La sensibilidad para diagnosticar AOS fue moderada (0,78) y con una especificidad muy baja (0,46). El valor predictivo positivo fue alto (0,98), y en cambio, el valor predictivo negativo muy bajo (0,49). La sensibilidad para diagnosticar AOS leve fue muy baja (0,31) con una especificidad de 0,82, que aunque más alta, tampoco fue adecuada (0,82). El valor predictivo positivo también fue muy bajo (0,55) y el valor predictivo negativo, fue en cambio alto (0,86). La sensibilidad para diagnosticar AOS moderado fue muy baja (0,29), con una especificidad de 0,88. El valor predictivo positivofue muy bajo (0,36, y en cambio el valor predictivo negativo fue más alto (0,84). La sensibilidad para diagnosticar AOS grave, es muy baja (0,29) con una especificidad de 0,89. El valor predictivo positivo fue muy bajo (0,37) y el valor predictivo negativo fue, en cambio más alto (0,84). Y por último, la sensibilidad para diagnosticar AOS muy grave fue muy baja (0,39) con una especificidad de 0,99, mientras que el valor predictivo positivo fue muy alto (0,97) y el valor predictivo negativo fue también alto, aunque en menor medida (0,87). Conclusiones: Comparado el análisis de las PR automático con el análisis manual, el análisis automático no tiene validez en el diagnóstico de AOS, sólo posee capacidad diagnóstia en el caso de no existir AOS o en el caso de AOS muy grave, pero no en diagnósticos de AOS intermedios. El análisis automático de las PR no es recomendable en el diagnóstico de certeza de la AOS. Sólo se recomienda como método de cribado para posteriormente demostrar el diagnóstico con un análisis poligráfico con el método manual realizado por personal sanitario experto en sueño."],"dc:format":["application/pdf"],"dc:identifier":["https://dialnet.unirioja.es/servlet/oaites?codigo=342207"],"dc:language":["spa"],"dc:publisher":["Universidad de La Rioja (España)"],"dc:rights":["LICENCIA DE USO: Los documentos a texto completo incluidos en Dialnet son de acceso libre y propiedad de sus autores y/o editores. Por tanto, cualquier acto de reproducción, distribución, comunicación pública y/o transformación total o parcial requiere el consentimiento expreso y escrito de aquéllos. Cualquier enlace al texto completo de estos documentos deberá hacerse a través de la URL oficial de éstos en Dialnet. Más información: https://dialnet.unirioja.es/info/derechosOAI | INTELLECTUAL PROPERTY RIGHTS STATEMENT: Full text documents hosted by Dialnet are protected by copyright and/or related rights. This digital object is accessible without charge, but its use is subject to the licensing conditions set by its authors or editors. Unless expressly stated otherwise in the licensing conditions, you are free to linking, browsing, printing and making a copy for your own personal purposes. All other acts of reproduction and communication to the public are subject to the licensing conditions expressed by editors and authors and require consent from them. Any link to this document should be made using its official URL in Dialnet. More info: https://dialnet.unirioja.es/info/derechosOAI"],"dc:title":["Evaluación de la precisión diagnóstica del análisis automático de la poligrafía frente al análisis manual en la apnea obstructiva del sueño"],"dc:type":["text (thesis)"]},"updated_at":"2026-07-24T06:27:07Z"}