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

Authors
  • Nakase-Richardson, Risa1
  • Schwartz, Daniel J2
  • Ketchum, Jessica M3
  • Drasher-Phillips, Leah4
  • Dahdah, Marie N5
  • Monden, Kimberley R6
  • Bell, Kathleen7
  • Hoffman, Jeanne8
  • Whyte, John9
  • Bogner, Jennifer10
  • Calero, Karel2
  • Magalang, Ulysses11
  • 1 Mental Health and Behavioral Sciences, Defense and Veterans Brain Injury Center, James A. Haley Veterans' Hospital, Morsani College of Medicine, Division of Pulmonary and Sleep Medicine, University of South Florida, Tampa, FL. Electronic address: [email protected]
  • 2 Medicine Service, James A. Haley Veterans' Hospital, Morsani College of Medicine, Division of Pulmonary and Sleep Medicine, University of South Florida, Tampa, FL.
  • 3 Research Department, Craig Hospital, and Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood, CO.
  • 4 Research and Development Service, James A. Haley Veterans' Hospital, Baylor Scott & White Institute for Rehabilitation, Dallas, TX.
  • 5 Baylor Scott & White Medical Center, Plano, TX.
  • 6 Craig Hospital, Englewood, and the Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.
  • 7 Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX.
  • 8 Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
  • 9 Moss Rehabilitation Research Institute, Albert Einstein Healthcare Network, Elkins Park, PA.
  • 10 Division of Rehabilitation Psychology, Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH.
  • 11 Division of Pulmonary, Critical Care, and Sleep Medicine and Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH.
Type
Published Article
Journal
CHEST Journal
Publisher
Elsevier
Publication Date
Oct 01, 2020
Volume
158
Issue
4
Pages
1689–1700
Identifiers
DOI: 10.1016/j.chest.2020.03.083
PMID: 32387522
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

OSA is prevalent during a time of critical neural repair after traumatic brain injury (TBI). The diagnostic utility of existing sleep studies is needed to inform clinical management during acute recovery from TBI. 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 TBI. This is a prospective clinical trial conducted at six TBI Model System study sites between May 2017 and February 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 level 3 sleep studies, with final analyses completed on 214 (median age = 42 years; ED Glasgow Coma Scale = 6; time to polysomnography [PSG] = 52 days). 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 apnea hypopnea index (AHI). Most 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 (lower confidence limits [LCL] range, 0.807-0.943), but the minimum tolerable sensitivity of 0.8 was not (LCL range, 0.665-0.764). Although the non-inferiority of level 3 portable diagnostic testing relative to level 1 was not established, strong agreement was seen across sleep apnea indexes. Most 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. Published by Elsevier Inc.

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