Accuracy Analysis of Embletta X100 for the Diagnosis of Obstructive Sleep Apnea and the Assessment of Sleep Structure

Hyun Jun Kim; Jae Hoon Cho; So Young Kang; Byoung-Joo Choi

doi:10.18787/jr.2018.25.1.32

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Kim, Cho, Kang, and Choi: Accuracy Analysis of Embletta X100 for the Diagnosis of Obstructive Sleep Apnea and the Assessment of Sleep Structure

ORIGINAL ARTICLE

J Rhinol 2018;25(1):32-37.

Published online: 19 January 2018

DOI: https://doi.org/10.18787/jr.2018.25.1.32

Accuracy Analysis of Embletta X100 for the Diagnosis of Obstructive Sleep Apnea and the Assessment of Sleep Structure

Hyun Jun Kim, MD, PhD^1,^∗, Jae Hoon Cho, MD, PhD^2,^∗, So Young Kang³, Byoung-Joo Choi, MD, PhD^4,

¹Departments of Otorhinolaryngology, Seoul, Korea

²Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konkuk University, Seoul, Korea

³Office of Biostatistics, Institute of Medical Sciences, Seoul, Korea

⁴Departments of Cardiology, Ajou University School of Medicine, Suwon, Korea

Address for correspondence: Byoung-Joo Choi, MD, PhD, Department of Cardiology, Ajou University, School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5265, Fax: +82-31-2195264, E-mail: bjchoi@ajou.ac.kr

^∗ Hyun Jun Kim and Jae Hoon Cho were equally contributed to this work.

Received 27 January 2018 Revised 25 April 2018 Accepted 21 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives:

To measure the accuracy of Embletta X100, a level 2 portable sleep monitoring device, for diagnosis of obstructive sleep apnea and assessment of sleep structure.

Materials and Method:

We enrolled 200 consecutive patients who had been referred due to habitual snoring or witnessed apnea during sleep and had undergone standard polysomnography (PSG). We created a simulated situation similar to that of the Embletta X100 using only data from PSG and scored the sleep stage and the apnea-hypopnea index (AHI). Thereafter, the results of PSG and simulated Embletta X100 were compared.

Results:

Sensitivity, specificity, and positive and negative predictive values of simulated Embletta X100 based on PSG were nearly 100% at three different cutoff values of AHI (5, 15, and 30). Intraclass correlation (ICC) of simulated Embletta X100 based on PSG was also excellent (≥0.9) for most of the sleep-related parameters and respiratory index. However, ICC of sleep stage percent was variable according to sleep stage (>0.9 for N1 and N2, 0.664 for N3, and 0.864 for R).

Conclusion:

Although sleep staging is not very precise, Embletta X100 matches well with PSG overall.

Keywords: Obstructive sleep apnea, Portable sleep monitoring, Embletta X100.

REFERENCES

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Fig. 1

Bland-Altman agreement plot for various parameters measured by standard polysomnography and simulated Embletta X100.

Table 1.

Demographics of patients

	Total (n=200)	Men (n=156)	Women (n=44)
Age (year)	39.6±14.4	39.2±13.9	40.9±16.0
BMI (kg/m²)	25.7±3.8	25.7±3.5	25.7±4.9
Sleep efficiency (%)	83.5±11.5	83.8±11.7	82.4±11.1
Mean O₂ saturation (%)	95.5±2.0	95.4±2.1	96.0±1.5
Mean AHI	21.6±21.8	23.1±22.5	16.3±18.3
Distribution based on AHI severity
AHI <5 (n)	50	34	16
5 ≤ AHI <15 (n)	50	38	12
15 ≤ AHI <30 (n)	50	43	7
30 ≤ AHI (n)	50	41	9

BMI: body mass index, AHI: apnea-hypopnea index, n: number

Table 2.

Sensitivities, specificities, positive predictive values, and negative predictive values of simulated Embletta X100 according to different AHI cutoff values

Cutoff value	Embletta X100
Cutoff value	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
AHI=5	100.0	98.0	99.3	100.0
AHI=15	99.0	99.0	99.0	99.0
AHI=30	100.0	99.3	98.0	100.0

AHI: apnea-hypopnea index, PPV: positive predictive value, NPV: negative predictive value

Table 3.

Intraclass correlation between polysomnography and simulated Embletta X100

Variable index	ICC	95% confidence interval	p-value
Total sleep time	0.904	0.875-0.927	<0.001
Sleep efficiency	0.927	0.905-0.944	<0.001
Wake time after sleep onset	0.926	0.949-0.943	<0.001
Apnea-hypopnea index	0.972	0.964-0.979	<0.001
Apnea index	0.955	0.941-0.966	<0.001
Hypopnea index	0.978	0.971-0.984	<0.001
Respiratory disturbance index	0.914	0.888-0.934	<0.001
Central apnea index	0.948	0.932-0.961	<0.001
Mixed apnea index	0.972	0.963-0.979	<0.001
Respiratory arousal index	0.979	0.972-0.984	<0.001
Stage N1	0.933	0.912-0.949	<0.001
Stage N2	0.907	0.879-0.929	<0.001
Stage N3	0.664	0.579-0.735	<0.001
Stage R	0.864	0.824-0.895	<0.001

ICC: intraclass correlation coefficient

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