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

Mohammadreza Hajipour; Brett Baumann; Ali Azarbarzin; A J Hirsch Allen; Yu Liu; Sidney Fels; Sebastian Goodfellow; Amrit Singh; Rachel Jen; Najib T Ayas

doi:10.5664/jcsm.10298

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

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

Authors

Affiliations

¹ Department of Experimental Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
² Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
³ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts.
⁴ Department of Pharmacology, Shanxi Medical University, Taiyuan, China.
⁵ Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada.
⁶ Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.

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.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adult
Humans
Oximetry
Polysomnography
Prospective Studies
Sleep Apnea, Obstructive* / diagnosis

Grants and funding

CIHR/Canada