The role of novel clinical digital tools in the screening or diagnosis of Obstructive Sleep Apnea - A systematic review

Abstract

Background: Clinical digital tools are an up-and-coming new technology that can be used in the screening or diagnosis of obstructive sleep apnea (OSA) patients, notwithstanding the crucial role of polysomnography (PSG) - the gold standard. Objective: The aim of our study was to identify, gather, and analyze existing digital tools and smartphone-based health platforms that are being used for this disease's screening or diagnosis in the adult population. Methods: We performed a comprehensive literature search in MEDLINE, Scopus, and ISI databases for studies evaluating the validity of digital tools in OSA screening or diagnosis until November 2022. The risk of bias was assessed using JBI Critical Appraisal Tool for Diagnostic Test Accuracy Studies. Sensitivity, specificity, and area under the receiver-operating curve (AUC) were used as discrimination measures. This systematic review was registered in PROSPERO under reference CRD42023387748. Results: We retrieved 1714 articles, 41 of which were included. We found 7 smartphone-based tools, 10 wearables, 11 bed/mattress sensors, 5 nasal airflow devices, and 8 other sensors that did not fit the previous categories. Only 8 (20%) studies performed external validation of their developed tool. The highest measures were 99%, 96%, and 92%, respectively, for a clinical cutoff of apnea-hypopnea index (AHI) ≥ 30, and correspond to a non-contact audio recorder that records sleep sounds, which are then analyzed by a deep learning technique that automatically detects sleep apnea events, calculates the AHI, and identifies OSA. Looking at the best studies that only internally validated their models, the work that arose as the best showed AUC, sensitivity, and specificity values of 100%, 100%, and 96%, respectively, for a clinical cutoff AHI ≥ 30. It uses the Sonomat - a foam mattress that, aside from recording breath sounds, has pressure sensors that generate voltage when deformed, thus detecting respiratory movements, and using it to classify OSA events. Conclusions: These clinical tools presented promising results, showing high discrimination measures. However, there is still a need for quality studies, comparing the developed tools with the gold standard and validating them in external populations and other environments before they can be used in a clinical setting. Keywords: obstructive sleep apnea; diagnosis; digital tools; smartphone; wearables; sensor; polysomnography, systematic review