Validation of a polyvinylidene fluoride impedance sensor for respiratory event classification during polysomnography.

STUDY OBJECTIVES The AASM has recommended specific sensors in measuring apnea and hypopnea based on published reliability and validity data. As new technology emerges, these guidelines will need revision. Polyvinylidene fluoride (PVDF) measures impedance and can be incorporated into a belt to approximate airflow and respiratory effort. We compared respiratory event detection using PVDF impedance belts (PVDFb), respiratory inductance plethysmography (RIP), and nasal-oral pneumotachography (PNT). METHODS First, in a clinical setting, 50 subjects (median AHI 26) undergoing polysomnography were fitted with PVDFb and standard sensors. Studies were scored in 4 independent passes using 4 respiratory montages (M); M1: nasal pressure transduction (NPT), thermistry, and RIP; M2: NPT, thermistry, and PVDFb; M3: thermistry and PVDFb; M4: PVDFb alone. Each experimental montage (M2-M4) was compared to the reference standard (M1) for total apneas and hypopneas. In a second experimental study, respiratory event detection was compared across a series of breathing trials for PVDFb, RIP, and PNT in normal subjects. Agreement was evaluated with intraclass correlation coefficient (ICC), κ statistics, and Bland-Altman plots. RESULTS ICCs comparing event numbers by M1 to M 2, 3, and 4 were: 0.99, 0.93, and 0.91, respectively. Almost identical numbers of events were identified for M 1 and M2 (177.5 ± 122.7 vs 177.6 ± 123.2). Event subtypes also were comparable. PVDFb was less sensitive than PNT but no different than RIP in detecting decreased breathing amplitude. CONCLUSIONS PVDFb was comparable to standard RIP in determining respiratory events during polysomnography and in detecting decreased breathing amplitude, suggesting that PVDFb can be used as an alternative to RIP for apnea/hypopnea evaluation.

[1]  P. Escourrou,et al.  Accuracy of respiratory inductive plethysmography during wakefulness and sleep in patients with obstructive sleep apnea. , 1992, Chest.

[2]  C. Guilleminault,et al.  EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. , 1992, Sleep.

[3]  V. Hoffstein,et al.  Comparison of direct and indirect measurements of respiratory airflow: implications for hypopneas. , 1997, Sleep.

[4]  K. Iwasa,et al.  Temperature changes associated with nerve excitation: detection by using polyvinylidene fluoride film. , 1981, Biochemical and biophysical research communications.

[5]  C. Guilleminault,et al.  Obstructive sleep apnea syndrome, sleepiness, and quality of life. , 2004, Chest.

[6]  C W Whitney,et al.  Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. , 2001, American journal of respiratory and critical care medicine.

[7]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[8]  D. Navajas,et al.  Accuracy of thermistors and thermocouples as flow-measuring devices for detecting hypopnoeas. , 1998, The European respiratory journal.

[9]  M. Stokes,et al.  Relationship between inspiratory mouth pressure and respiratory muscle activity in normal subjects. , 1992, Respiratory medicine.

[10]  David Gozal,et al.  The scoring of respiratory events in sleep: reliability and validity. , 2007, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[11]  E. Fukada History and recent progress in piezoelectric polymers , 2000, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[12]  Bonnie K. Lind,et al.  Methods for obtaining and analyzing unattended polysomnography data for a multicenter study. Sleep Heart Health Research Group. , 1998, Sleep.

[13]  B. Caffo,et al.  Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study , 2009, PLoS medicine.

[14]  T. Young,et al.  Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. , 2008, Sleep.

[15]  W. J. Tompkins,et al.  Comparison of impedance and inductance ventilation sensors on adults during breathing, motion, and simulated airway obstruction , 1997, IEEE Transactions on Biomedical Engineering.

[16]  S. Karr,et al.  Transducer system for the noninvasive recording of arterial pressure contours , 2006, Annals of Biomedical Engineering.

[17]  W. Flemons,et al.  Validation of nasal pressure for the identification of apneas/hypopneas during sleep. , 2002, American journal of respiratory and critical care medicine.

[18]  R. Chervin,et al.  Effects of esophageal pressure monitoring on sleep architecture. , 1997, American journal of respiratory and critical care medicine.

[19]  L. Lorenz,et al.  Ueber die Fortpflanzung der Electricität , 2022 .

[20]  J. Mead,et al.  IMPROVED TECHNIQUE FOR ESTIMATING PLEURAL PRESSURE FROM ESOPHAGEAL BALLOONS. , 1964, Journal of applied physiology.

[21]  N J Douglas,et al.  Assessment of thoracoabdominal bands to detect respiratory effort-related arousal , 2003, European Respiratory Journal.

[22]  K. Bloch,et al.  Accuracy of nasal cannula pressure recordings for assessment of ventilation during sleep. , 2001, American journal of respiratory and critical care medicine.