ABSTRACT
Introduction: The need for having in-home sleep testing has grown due to the COVID-19 pandemic. While Type 3 Home Sleep Apnea Tests (HSAT) are frequently used, their accuracy remains questionable. This study aimed to compare respiratory events and diagnosis of obstructive sleep apnea between Type 2 and Type 3 studies. Methods: 550 participants completed overnight Type 2 sleep studies using the Cerebra Sleep System. Files were autoscored as a type 2 acquisition and were manually edited by a RPSGT. On a second auto-score, mapped file channels were reduced to nasal cannula, chest belt, SpO2, position, heart rate, and audio channels to simulate a Type 3 study. The respiratory disturbance index (RDI) in the Type 2 tests was compared to the apnea-hypopnea index (AHI) in the simulated Type 3 files using a 4% desaturation threshold. Diagnosis of severity of OSA was classified based on indices of <5 as “None”, 5-14.99 as “Mild”, 15-29.99 as “Moderate”, and above 30 as “Severe”. Results: 5 records were removed for having a TST <4 hours. Type 2 sleep tests detected significantly more respiratory events (21.0±21.2/hr.) compared to Type 3 tests (13.4 ±17.2;t(549) = 26.8, p<.0001). The use of the Type 2 RDI resulted in 104 patients (18.9% of patients;39.4% of treatable patients) with moderate OSA falling into the mild category under the Type 3 AHI. The number of treatable patients was thus 71% higher with a Type 2 study. Overall, the diagnoses of Type 2 RDI and Type 3 AHI were only in agreement for 263 out of the 550 records, or 47.8% of the time. Conclusion: The use of a Type 2 study detected more respiratory events than the Type 3 device. Consequentially, 104 patients received a higher severity of obstructive sleep apnea when the EEG information was included. Our results provide support for the use of Type 2 devices for in-home detection of obstructive sleep apnea to provide more accurate diagnostic detection than the more frequently used Type 3 home sleep apnea tests.
ABSTRACT
Myxomas are very rare intracardiac benign tumors. They can arise in any of the cardiac chambers, although 75% occur in the left atrium. Atrial myxomas (AMs) show a female predominance with a sex ratio of 3:1. There is a diversity in the clinical presentation;it may resemble many cardiovascular or systemic diseases. Furthermore, it is possible to present as an acute upper or lower limb ischemia or organ infarction due to systemic emboli. Hereby, we report a previously healthy 38-year-old male, who presented to the emergency department with acute pain of both lower limbs, unilateral upper limb, and acute abdomen. A bedside transthoracic echocardiogram was done which showed a mass that was confirmed to be an AM. The patient underwent surgical embolectomy and tumor resection. As this tumor is rare, the duration between the onset of symptoms to finally reaching the correct diagnosis is usually prolonged, and meanwhile, the patient can experience irreversible neurological damage or even death. Hence, we would like to highlight the role of echocardiogram in detecting AMs. In addition, excluding the primary cause of the thrombi, the patient's ischemic pain has a spectrum of differential diagnosis ranging from peripheral vascular disease to COVID-19. We would also like to emphasize the importance of a high index of suspicion by emergency physicians when such cases present.