Characterization of Respiratory Events in Obstructive Sleep Apnea Using Suprasternal Pressure Monitoring

In obstructive sleep apnea (OSA) esophageal pressure (Pes) is the gold standard for measurement of respiratory effort, and respiratory inductance plethysmography (RIP) is considered an accepted measurement technique. However, the use of RIP could lead to limited accuracy in certain cases and therefore suprasternal pressure (SSP) monitoring might improve the reliability of OSA diagnosis. We aimed to use SSP for the visual characterization of respiratory events in adults and compared results to those obtained by RIP from polysomnography (PSG).

In patients with OSA, a 1-night SSP recording using the PneaVoX sensor (Cidelec, Sainte-Gemmes-sur-Loire, France) was done. In parallel, PSG was performed according to American Academy of Sleep Medicine criteria. A subgroup of patients agreed to have Pes measurement in addition. Characterizations of apneas as obstructive, central, and mixed as well as hypopneas as central and obstructive were done by visual evaluation of SSP, RIP, and Pes in random order by two independent scores (S1 and S2). The sensitivity and specificity of characterization by SSP compared to RIP and to Pes were calculated.

Synchronous recordings of SSP and PSG were analyzed from n = 34 patients with OSA (AHI 34.1 ± 24.2 events/h); 9 of them had synchronized Pes monitoring as well. Interscorer agreement for apnea characterization as obstructive, central, and mixed based on SSP, RIP, and Pes were found, with R² values from 0.91-0.99. The sensitivity of SSP in apnea characterization with reference to RIP (S1/S2) was 91.5%/92.3% for obstructive, 82.7%/76.2% for central, and 87.4%/79.9% for mixed. The sensitivity of SSP in apnea characterization with reference to Pes was (S1/S2) 93.1%/92.1% for obstructive, 80.8%/81.6% for central, and 91.7%/90.8% for mixed. Hypopnea was only classified for the nine patients with Pes.

This study demonstrated a good agreement in the detection of respiratory effort with the SSP signal using the PneaVoX sensor compared to the RIP belts signals as well as to the Pes signal. These findings were consistently found by two independent scorers. In summary, results suggest that SSP is a reliable signal for the classification of respiratory events and could be used as an additional tool for OSA characterization in clinical practice.