Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury

Risa Nakase-Richardson; Daniel J Schwartz; Jessica M Ketchum; Leah Drasher-Phillips; Marie N Dahdah; Kimberley R Monden; Kathleen Bell; Jeanne Hoffman; John Whyte; Jennifer Bogner; Karel Calero; Ulysses Magalang

doi:10.1016/j.chest.2020.03.083

Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury

Risa Nakase-Richardson, Daniel J Schwartz, Jessica M Ketchum, Leah Drasher-Phillips, Marie N Dahdah, Kimberley R Monden, Kathleen Bell, Jeanne Hoffman, John Whyte, Jennifer Bogner, Karel Calero, Ulysses Magalang

Physical Medicine & Rehabilitation

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

BACKGROUND: Obstructive sleep apnea is prevalent during a time of critical neural repair following traumatic brain injury (TBI). The diagnostic utility of existing sleep studies is needed to inform clinical management during acute recovery from TBI.

RESEARCH QUESTION: This study aimed to evaluate the non-inferiority and diagnostic accuracy of a portable Level 3 sleep study relative to Level 1 polysomnography in hospitalized neurorehabilitation patients with traumatic brain injury.

STUDY DESIGN: and Methods: This is a prospective clinical trial conducted at six TBI Model System study sites between 05/2017 and 02/2019. Of 896 admissions, 449 were screened and eligible for the trial with 345 consented. Additional screening left 263 eligible for and completing simultaneous administration of both Level 1 and 3 sleep studies with final analyses completed on n=214 (median age=42; ED Glasgow Coma Scale=6; time to PSG=52 days).

RESULTS: Agreement was moderate to strong (weighted kappa = 0.78, 95% CI = 0.72, 0.83) with the misclassification commonly occurring with mild sleep apnea due to underestimation of AHI. A majority of those with moderate to severe sleep apnea were correctly classified (n=54/72). Non-inferiority was not demonstrated: the minimum tolerable specificity of 0.5 was achieved across all AHI cutoff scores (LCL range = 0.807-0.943) but the minimum tolerable sensitivity of 0.8 was not (LCL range = 0.665-0.764).

INTERPRETATION: While the non-inferiority of Level 3 portable diagnostic testing relative to Level 1 was not established, there was strong agreement across sleep apnea indices. A majority of those with moderate to severe sleep apnea were correctly identified; however, there was risk of misclassification with Level 3 sleep studies underestimating disease severity for those with moderate to severe AHI and disease presence for those with mild AHI during early TBI neurorehabilitation.

Original language	English (US)
Pages (from-to)	1689-1700
Number of pages	12
Journal	CHEST
Volume	158
Issue number	4
Early online date	May 6 2020
DOIs	https://doi.org/10.1016/j.chest.2020.03.083 https://doi.org/10.1016/j.chest.2020.03.083
State	Published - Oct 2020

Bibliographical note

Keywords

brain injury
rehabilitation
sleep apnea
sleep-disordered breathing

PubMed: MeSH publication types

Journal Article
Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

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Nakase-Richardson, R., Schwartz, D. J., Ketchum, J. M., Drasher-Phillips, L., Dahdah, M. N., Monden, K. R., Bell, K., Hoffman, J., Whyte, J., Bogner, J., Calero, K., & Magalang, U. (2020). Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury. CHEST, 158(4), 1689-1700. https://doi.org/10.1016/j.chest.2020.03.083, https://doi.org/10.1016/j.chest.2020.03.083

Nakase-Richardson, R, Schwartz, DJ, Ketchum, JM, Drasher-Phillips, L, Dahdah, MN, Monden, KR, Bell, K, Hoffman, J, Whyte, J, Bogner, J, Calero, K & Magalang, U 2020, 'Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury', CHEST, vol. 158, no. 4, pp. 1689-1700. https://doi.org/10.1016/j.chest.2020.03.083, https://doi.org/10.1016/j.chest.2020.03.083

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abstract = "BACKGROUND: Obstructive sleep apnea is prevalent during a time of critical neural repair following traumatic brain injury (TBI). The diagnostic utility of existing sleep studies is needed to inform clinical management during acute recovery from TBI.RESEARCH QUESTION: This study aimed to evaluate the non-inferiority and diagnostic accuracy of a portable Level 3 sleep study relative to Level 1 polysomnography in hospitalized neurorehabilitation patients with traumatic brain injury.STUDY DESIGN: and Methods: This is a prospective clinical trial conducted at six TBI Model System study sites between 05/2017 and 02/2019. Of 896 admissions, 449 were screened and eligible for the trial with 345 consented. Additional screening left 263 eligible for and completing simultaneous administration of both Level 1 and 3 sleep studies with final analyses completed on n=214 (median age=42; ED Glasgow Coma Scale=6; time to PSG=52 days).RESULTS: Agreement was moderate to strong (weighted kappa = 0.78, 95% CI = 0.72, 0.83) with the misclassification commonly occurring with mild sleep apnea due to underestimation of AHI. A majority of those with moderate to severe sleep apnea were correctly classified (n=54/72). Non-inferiority was not demonstrated: the minimum tolerable specificity of 0.5 was achieved across all AHI cutoff scores (LCL range = 0.807-0.943) but the minimum tolerable sensitivity of 0.8 was not (LCL range = 0.665-0.764).INTERPRETATION: While the non-inferiority of Level 3 portable diagnostic testing relative to Level 1 was not established, there was strong agreement across sleep apnea indices. A majority of those with moderate to severe sleep apnea were correctly identified; however, there was risk of misclassification with Level 3 sleep studies underestimating disease severity for those with moderate to severe AHI and disease presence for those with mild AHI during early TBI neurorehabilitation.",

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AU - Dahdah, Marie N

AU - Monden, Kimberley R

AU - Bell, Kathleen

AU - Hoffman, Jeanne

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Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

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