A full-night PSG (P Series Sleep System; Compumedics; Melbourne, Australia) monitoring recorded parameters as follows: electroencephalogram, oculogram, chin and bilateral anterior tibials electromyogram, electrocardiogram, nasal airflow, chest and abdominal movement, pulse oxygen saturation, snoring, and body position. All tracings were scored manually according to the guideline of the American Academy of Sleep Medicine (AASM) in 2007 [19 (link)]. Apnea was defined as a complete cessation (≥90 %) from baseline in airflow of ≥10s and hypopnea as a drop (≥30 %) in airflow of ≥10s accompanied by oxygen desaturation ≥4 %. Apnea-hypopnea index (AHI) was expressed as a total number of episodes of obstructive apneas plus hypopneas per hour during sleep. Oxygen desaturation index (ODI) was attained from the frequency of desaturations of ≥4 % per hour. The percentage of sleep duration with SpO2 < 90 % (TS90 %), and lowest O2 saturation (LaSO2), mean oxygen saturation (mean SpO2) were also recorded. Subjects were classified into four groups according to AHI. OSA was defined as absent, mild, moderate and severe when AHI was < 5/h, 5–14.9/h, 15–29.9/h, and > 30/h, respectively.
P series sleep system
Manufactured by Compumedics
Sourced in Australia
The P Series Sleep System is a comprehensive sleep assessment solution developed by Compumedics. It provides advanced diagnostic capabilities for the evaluation of sleep disorders, including polysomnography and other sleep studies. The system offers reliable and accurate data collection to support healthcare professionals in diagnosing and managing sleep-related conditions.
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5 protocols using p series sleep system
1
Comprehensive Polysomnographic Assessment of OSA
2
Polysomnography for OSAHS Diagnosis
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Overnight polysomnography (P Series Sleep System, Compumedics, Melbourne, Australia) was conducted to diagnose OSAHS. Electroencephalography, electrooculography, electromyography, and electrocardiography were performed during polysomnography, and the variables assessed being as follows: oronasal airflow, thoracic and abdominal respiratory efforts, and pulse oxygen saturation. AHI was defined as the number of episodes of apnea and hypopnea per hour of sleep. ODI was defined as number of episodes of oxyhemoglobin desaturation ≥ 3% from the immediate baseline per hour of total sleep time. Other variables, including LaSO2, MaSO2, and TS90%, were also assessed. All PSG studies were scored according to the criteria of the American Academy of Sleep Medicine published in 2012 [24 (link)]. The severity of OSAHS was classified based on AHI status as follows: no OSAHS, < 5 events/h; mild OSAHS, 5 to < 15 events/h; moderate OSAHS, 15 to < 30 events/h; and severe OSAHS, ≥ 30 events/h.
3
Polysomnographic Diagnosis of Obstructive Sleep Apnea
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The diagnosis of OSA was established by full-night polysomnography (P-Series Sleep System, Compumedics, Victoria, Australia) including the following parameters: electrooculography, electroencephalography, electromyography, electrocardiography, snoring, oronasal airflow, thoracic and abdominal respiratory efforts, pulse oxygen saturation, and body position. The main independent variables were AHI, defined as the number of episodes of apnea and hypopnea per hour of sleep, and three different indices of nocturnal hypoxemia: the defined mean arterial oxyhemoglobin saturation during sleep as measured by blood analysis (SaO2), the 3% oxygen desaturation index (ODI), and the percent of sleep time with SaO2 < 90%. The following commonly used cut-offs for AHI were used to assess the severity of OSA: <5 events/h (no OSA), 5–15 events/h (mild OSA), >15–30 events/h (moderate OSA), and >30 events/h (severe OSA).
4
Polysomnography Assessment of Sleep Apnea
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All individuals underwent a full night (22:00 to 06:00) polysomnography testing (P Series Sleep System, Compumedics, Melbourne, Australia) to assess the following parameters: electroencephalogram, electrooculogram, submental and anterior tibialis electromyogram, electrocardiogram, arterial oxyhemoglobin saturation with pulse oximetry, nasal airflow, thoracoabdominal movement, snoring, and body position. We used the American Academy of Sleep Medicine (AASM) manual to score sleep and associated events,10 (link) including the following indices: apnea-hypopnea index (AHI; representing the number of episodes of apnea and hypopnea per hour of sleep); oxygen desaturation index (ODI; 3% oxygen desaturation index per hour of sleep); LaSO2 (lowest arterial oxyhemoglobin saturation during sleep); mean SpO2 (mean arterial oxyhemoglobin saturation during sleep); and TS90% (% sleep time in which SpO2 < 90%). Apnea was defined as decrements in airflow ≥ 90% from baseline for ≥ 10s, measured using an oronasal thermal sensor. Hypopnea was defined as a ≥ 30% decrease in flow lasting ≥ 10s associated with ≥ 4% oxyhemoglobin desaturation, or as a ≥ 50% decrease in flow lasting ≥ 10s associated with ≥ 3% oxygen desaturation. Participants were classified according to their AHI levels as non-OSA (AHI < 5/h), mild-moderate OSA (AHI from 5–30/h), or severe OSA (AHI > 30/h).
5
Baseline Evaluation and Polysomnography for OSA
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A detailed baseline evaluation including age, smoking habits, alcohol consumption, snoring, witnessed apneas, other medical history, and medication use were performed. Excessive daytime sleepiness was evaluated by the Epworth Sleepiness Scale. Body weight and height were measured in bare feet and light clothing in the morning by the same person using the same equipment. Body mass index (BMI) was calculated by dividing body weight by height squared (kg/m 2 ). Waist circumference (WC) was measured at the level midway between the lower costal margin and the iliac crest. Neck circumference (NC) was measured at the level of the laryngeal prominence. A full-night polysomnography (P Series Sleep System, Compumedics, Melbourne, Australia) was performed for every participant at the sleep center. All of the PSG data were visually scored by trained technicians according to standardized criteria [14] .Details have been described in our previous study [15] . The existing literature shows that there is a signi cant dose-response effect between AHI and the risk of cancer death, therefore patients with an apnea-hypopnea index (AHI) higher than or equal to 15 were categorized as having clinically signi cant OSA. Patients with an AHI less than 15 were categorized into control group [16, 17] .
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