Quantifying the magnitude of pharyngeal obstruction during sleep using airflow shape

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorMANN, Dwayne L.
dc.contributor.authorTERRILL, Philip I.
dc.contributor.authorAZARBARZIN, Ali
dc.contributor.authorMARIANI, Sara
dc.contributor.authorFRANCIOSINI, Angelo
dc.contributor.authorCAMASSA, Alessandra
dc.contributor.authorGEORGESON, Thomas
dc.contributor.authorMARQUES, Melania
dc.contributor.authorTARANTO-MONTEMURRO, Luigi
dc.contributor.authorMESSINEO, Ludovico
dc.contributor.authorREDLINE, Susan
dc.contributor.authorWELLMAN, Andrew
dc.contributor.authorSANDS, Scott A.
dc.date.accessioned2019-11-06T18:52:25Z
dc.date.available2019-11-06T18:52:25Z
dc.date.issued2019
dc.description.abstractRationale and objectives: Non-invasive quantification of the severity of pharyngeal airflow obstruction would enable recognition of obstructive versus central manifestation of sleep apnoea, and identification of symptomatic individuals with severe airflow obstruction despite a low apnoea-hypopnoea index (AHI). Here we provide a novel method that uses simple airflow-versus-time (""shape"") features from individual breaths on an overnight sleep study to automatically and non-invasively quantify the severity of airflow obstruction without oesophageal catheterisation. Methods: 41 individuals with suspected/diagnosed obstructive sleep apnoea (AHI range 0-91 events.h(-1)) underwent overnight polysomnography with gold-standard measures of airflow (oronasal pneumotach: ""flow"") and ventilatory drive (calibrated intraoesophageal diaphragm electromyogram: ""drive""). Obstruction severity was defined as a continuous variable (flow: drive ratio). Multivariable regression used airflow shape features (inspiratory/expiratory timing, flatness, scooping, fluttering) to estimate flow: drive ratio in 136264 breaths (performance based on leave-one-patient-out cross-validation). Analysis was repeated using simultaneous nasal pressure recordings in a subset (n=17). Results: Gold-standard obstruction severity (flow: drive ratio) varied widely across individuals independently of AHI. A multivariable model (25 features) estimated obstruction severity breath-by-breath (R-2=0.58 versus gold-standard, p<0.00001; mean absolute error 22%) and the median obstruction severity across individual patients (R-2=0.69, p<0.00001; error 10%). Similar performance was achieved using nasal pressure. Conclusions: The severity of pharyngeal obstruction can be quantified non-invasively using readily available airflow shape information. Our work overcomes a major hurdle necessary for the recognition and phenotyping of patients with obstructive sleep disordered breathing.eng
dc.description.indexMEDLINEeng
dc.description.sponsorshipNational Health and Medical Research Council of Australia (NHMRC)National Health and Medical Research Council of Australia [1064163]
dc.description.sponsorshipNational Institutes of Health (NIH)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R01HL128658]
dc.description.sponsorshipUniversity of Queensland Research ScholarshipUniversity of Queensland
dc.description.sponsorshipGraduate School International Travel Award
dc.description.sponsorshipAmerican Heart AssociationAmerican Heart Association [15SDG25890059]
dc.description.sponsorshipNHMRC Early Career FellowshipNational Health and Medical Research Council of Australia
dc.description.sponsorshipR.G. Menzies award [1053201]
dc.description.sponsorshipAmerican Thoracic Society foundation
dc.description.sponsorshipNIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R24HL114473, U01HL119991, R35HL135818]
dc.identifier.citationEUROPEAN RESPIRATORY JOURNAL, v.54, n.1, article ID 1802262, 12p, 2019
dc.identifier.doi10.1183/13993003.02262-2018
dc.identifier.eissn1399-3003
dc.identifier.issn0903-1936
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/34187
dc.language.isoeng
dc.publisherEUROPEAN RESPIRATORY SOC JOURNALS LTDeng
dc.relation.ispartofEuropean Respiratory Journal
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright EUROPEAN RESPIRATORY SOC JOURNALS LTDeng
dc.subject.otherresistance syndromeeng
dc.subject.otherblood-pressureeng
dc.subject.othernrem sleepeng
dc.subject.otherlimitationeng
dc.subject.otherapneaeng
dc.subject.wosRespiratory Systemeng
dc.titleQuantifying the magnitude of pharyngeal obstruction during sleep using airflow shapeeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryFrança
hcfmusp.affiliation.countryAustrália
hcfmusp.affiliation.countryEspanha
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryisous
hcfmusp.affiliation.countryisofr
hcfmusp.affiliation.countryisoes
hcfmusp.affiliation.countryisoau
hcfmusp.author.externalMANN, Dwayne L.:Univ Queensland, Sch Informat Technol & Elect Engn, GP South, Brisbane, Qld 4072, Australia; Brigham & Womens Hosp, Dept Med, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA; Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA
hcfmusp.author.externalTERRILL, Philip I.:Univ Queensland, Sch Informat Technol & Elect Engn, GP South, Brisbane, Qld 4072, Australia; Brigham & Womens Hosp, Dept Med, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA; Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA
hcfmusp.author.externalAZARBARZIN, Ali:Brigham & Womens Hosp, Dept Med, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA; Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA
hcfmusp.author.externalMARIANI, Sara:Brigham & Womens Hosp, Dept Med, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA; Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA
hcfmusp.author.externalFRANCIOSINI, Angelo:Aix Marseille Univ, Inst Neur Timone, Marseille, France
hcfmusp.author.externalCAMASSA, Alessandra:IDIBAPS, Barcelona, Spain
hcfmusp.author.externalGEORGESON, Thomas:Univ Queensland, Sch Informat Technol & Elect Engn, GP South, Brisbane, Qld 4072, Australia
hcfmusp.author.externalTARANTO-MONTEMURRO, Luigi:Brigham & Womens Hosp, Dept Med, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA; Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA
hcfmusp.author.externalMESSINEO, Ludovico:Brigham & Womens Hosp, Dept Med, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA; Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA
hcfmusp.author.externalREDLINE, Susan:Brigham & Womens Hosp, Dept Med, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA; Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA
hcfmusp.author.externalWELLMAN, Andrew:Brigham & Womens Hosp, Dept Med, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA; Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA
hcfmusp.author.externalSANDS, Scott A.:Brigham & Womens Hosp, Dept Med, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA; Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA
hcfmusp.citation.scopus32
hcfmusp.contributor.author-fmusphcMELANIA DIRCE OLIVEIRA MARQUES
hcfmusp.description.articlenumber1802262
hcfmusp.description.issue1
hcfmusp.description.volume54
hcfmusp.origemWOS
hcfmusp.origem.pubmed31000679
hcfmusp.origem.scopus2-s2.0-85068761472
hcfmusp.origem.wosWOS:000486537500032
hcfmusp.publisher.citySHEFFIELDeng
hcfmusp.publisher.countryENGLANDeng
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