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. 2023 Feb 1;19(2):225-242.
doi: 10.5664/jcsm.10298.

Association of alternative polysomnographic features with patient outcomes in obstructive sleep apnea: a systematic review

Mohammadreza Hajipour  1 , Brett Baumann  2 , Ali Azarbarzin  3 , A J Hirsch Allen  2 , Yu Liu  2   4 , Sidney Fels  5 , Sebastian Goodfellow  6 , Amrit Singh  7 , Rachel Jen  2 , Najib T Ayas  2
Affiliations

Association of alternative polysomnographic features with patient outcomes in obstructive sleep apnea: a systematic review

Mohammadreza Hajipour et al. J Clin Sleep Med. .

Abstract

Study objectives: Polysomnograms (PSGs) collect a plethora of physiologic signals across the night. However, few of these PSG data are incorporated into standard reports, and hence, ultimately, under-utilized in clinical decision making. Recently, there has been substantial interest regarding novel alternative PSG metrics that may help to predict obstructive sleep apnea (OSA)-related outcomes better than standard PSG metrics such as the apnea-hypopnea index. We systematically review the recent literature for studies that examined the use of alternative PSG metrics in the context of OSA and their association with health outcomes.

Methods: We systematically searched EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews for studies published between 2000 and 2022 for those that reported alternative metrics derived from PSG in adults and related them to OSA-related outcomes.

Results: Of the 186 initial studies identified by the original search, data from 31 studies were ultimately included in the final analysis. Numerous metrics were identified that were significantly related to a broad range of outcomes. We categorized the outcomes into 2 main subgroups: (1) cardiovascular/metabolic outcomes and mortality and (2) cognitive function- and vigilance-related outcomes. Four general categories of alternative metrics were identified based on signals analyzed: autonomic/hemodynamic metrics, electroencephalographic metrics, oximetric metrics, and respiratory event-related metrics.

Conclusions: We have summarized the current landscape of literature for alternative PSG metrics relating to risk prediction in OSA. Although promising, further prospective observational studies are needed to verify findings from other cohorts, and to assess the clinical utility of these metrics.

Citation: Hajipour M, Baumann B, Azarbarzin A, et al. Association of alternative polysomnographic features with patient outcomes in obstructive sleep apnea: a systematic review. J Clin Sleep Med. 2023;19(2):225-242.

Keywords: alternative metrics; apnea-hypopnea index; outcomes; polysomnogram; sleep apnea.

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Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was performed at the University of British Columbia (UBC). Dr. Najib Ayas’s funding: Vancouver Coastal Health Research Institute Innovation funding, BC Lung Association Operating Grant, Canadian institutes of health research Operating Grant. Dr. Rachel Jen: VCHRI Investigator Grant. Dr. Azarbarzin reports grant funding from National Institute of Health, American Heart Association, American Academy of Sleep Medicine Foundation, and Somnifix. There are no other funding sources from other authors. A.A. serves as a consultant for Apnimed, Somnifix, Inspire, and Respicardia, outside the submitted work. A.A. is an author in some of the studies reported in this review. The other authors report no conflicts of interest.

Figures

Figure 1
Figure 1. PRISMA flow chart of identified studies, excluded and included.
PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses
See this image and copyright information in PMC

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