Resources for Medical Professionals

Discover tools, reports and data to help answer your questions about sleep testing and SleepMed products.


Order a Home Sleep Study

SleepMed provides home sleep diagnostics directly to patients through a mail-to-patient process to support physicians who are not currently providing such diagnostics.

To order a home sleep study for your patient, please complete and fax the Home Sleep Study Order Form

  1.   Step 1: Complete and fax the Home Sleep Study Order Form 
  2.   Step 2: SleepMed will verify benefits coverage and contact the patient to schedule delivery of the home sleep test device.
  3.   Step 3: Patient receives the device and completes a 1-2 night home sleep study. SleepMed will contact the patient on the night of the study to provide education on use.
  4.   Step 4: Patient returns the device via prepaid / preaddressed mailer.
  5.   Step 5: SleepMed will perform a technical edit of the raw study data and have a professional interpretation completed by a boarded sleep physician, then fax the final study report to you for review.

About ARES™

ARES™ measures:

  • Blood oxygen saturation (reflectance pulse oximetry)
  • Pulse rate (reflectance pulse oximetry)
  • Airflow (nasal cannula connected to a pressure transducer)
  • Snoring intensity and pattern (calibrated acoustic microphone)
  • Head movement and head position (multi- axis accelerometers)
  • Respiratory effort (optional; piezocrystal belt)
  • Behaviorally-estimated sleep (movement, airflow, snoring)
  • Behavioral arousals (pulse rate increase, movement increase, breakthrough snoring)
  • EEG/EOG/EMG (NREM vs. REM; FP1 and FP2)
  • AHI = Average number of apneas and hypopneas (4%) per hour of valid recording time
  • RDI = Average number of apneas, hypopneas(4%), and hypopneas that terminate in an behavioral arousal w/ >1% desaturation per hour of valid recording time
  • a An ARES can be equipped with an optional piezo crystal belt upon request for an additional cost. This modification will not influence sleep/wake detection, but will eliminate NREM/REM detection
  • Valid recording time refers to the length of the sleep period [time in bed] minus wake after sleep onset and periods of poor signal integrity

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ARES™ Validation Studies and Reports

Numerous studies have evaluated the accuracy of the ARES™, both under controlled laboratory settings and unattended environments. 

Overall, the system has demonstrated very strong concordance with simultaneously-collected PSG (intraclass correlation coefficient .93-.96) as well as good sensitivity (.84-.97) and specificity (85.6-1.0) for the detection of OSA and a very low failure rate (<2%) (Westbrook et al., 2005; To et al., 2009; Ayappa et al., 2008). Further, the system has been studied on a variety of populations, including Latinos (Redline et al., 2014), Asians (To et al., 2009), and pregnant females (Sharkey et al., 2014). Validation of the sleep/wake algorithm, which is based on behavioral measures (actigraphy, flow pattern, and snoring) and the NREM/REM discrimination algorithm have been peer-reviewed in abstract form (Popovic et al., 2008a; Popovic et al., 2008b). 

The system is designed to be used in conjunction with the validated SleepMed ARES OSA screening questionnaire (link to: SleepMed ARES Questionnaire v3 (2).docx which aids in the determination of testing appropriateness. The screener has demonstrated strong sensitivity (.94) and reasonable specificity (.79) in identifying those at risk for OSA (AHI>5 events per hour; 4%) (Levondowski et al., 2007). The system is completely portal-based, which allows for seamless data management, including quality review by a registered sleep technologist to evaluate data adequacy prior to test interpretation.  

New Research Using the ARES™ Device 

  1.  Redline S, Sotres-Alvarez D, Loredo J, Hall M, Patel S, Ramos A, et al… (2014). Sleep-disordered breathing in hispanic/latino individuals of diverse backgrounds: the hispanic community health study/study of latinos. American Journal of Respiratory and Critical Care Medicine, 189 (3), 335–344. 

    Summary [from authors]: SDB is prevalent in U.S. Latinos but rarely associated with a clinical diagnosis. Associations with diabetes and hypertension suggest a large burden of disease may be attributed to untreated SDB, supporting the development and evaluation of culturally relevant detection and treatment approaches.
  2.  Sharkey K, Waters K, Millman R, Moore R, Martin S, & Bourjeily G. (2014). Validation of the apnea risk evaluation system (ARES) device against laboratory polysomnography in pregnant women at risk for obstructive sleep apnea syndrome. Journal of Clinical Sleep Medicine, 10(5):497-502. 

    Summary [from authors]:When compared with PSG diagnosis of OSA, the ARES 3% algorithm provided the best balance between sensitivity (1.0 for PSG AHI, 0.91 for PSG RDI) and specificity (0.5 for PSG AHI, 0.8 for PSG RDI) for detecting sleep disordered breathing in our sample. 
  3.  Cairns, A, Westbrook, P, Poulos, G, & Bogan, R. (2014). Risk Factors for OSA Based on Results from 200,421 Patients Undergoing Portable Recording:  Gender Differences and Implications for Screening. [Abstract]. Sleep, 289, A104. (link to pdf)

    Summary [from authors]: Risk factors for OSA based on home PR data are similar to those based on laboratory PSG. The finding that anthropomorphic indices were more robust predictors of OSA in males may be related to differences in fat distribution (i.e. central vs. peripheral). Further analyses will explore how age relates to OSA risk in females. Future studies should investigate gender-appropriate OSA screening measures.
  4.  Cairns, A, Westbrook, P, Poulos, G, & Bogan, R. (2014). Evaluation of Pre-Test Risk and Test Outcomes using a Portable Recording System. [Abstract]. Sleep, 391, A138. (link to pdf) 

    Summary [from authors]: Clinical evaluation and follow-up by providers appropriately-trained in sleep medicine is paramount since screening indices for pre-test risk are not always predictive of outcome or severity. Additional analyses of pre-test risk factors are needed to enhance predictive accuracy of current/future screening measures for OSA.
  5.  Bogan, R, Cairns, A, Poulos, G, & Westbrook, P. (2014). Who is Getting Portable Recording for OSA? Test Results on 200,421 Patients. [Abstract]. Sleep, 386, A136. (link to pdf) 

    Summary [from authors]: These data are the first of its kind to describe basic demographic and diagnostic test outcomes in a large sample of patients being tested with a PR . These findings confirm that the majority of individuals being home tested for OSA are obese, sleepy, males with a moderate degree of OSA based on PR and a high likelihood of hypertension. 

Seminal Validation Data 

Manuscripts

  1.  Ayappa I, Norman R, Seelall V, Rapoport D.2008. Validation of a self-applied unattended monitor for sleep disordered breathing. J Clin Sleep Med, 4(1), 26-37. 

    Summary: The correlations between the ARES and PSG for simultaneously acquired recordings was 0.96 using an apnea/hypopnea index with a 4% desaturation (AHI-4%), and 0.93 using a respiratory disturbance index based on Chicago criteria (RDI). The diagnostic sensitivity of in-lab ARES RDI was 0.95 and the specificity was 0.94; comparable measures to PSG for the in-home ARES RDI values were 0.85 and 0.91.
  2.  To Kw, Chan WC, Chan To et al. 2009. Validation study of a portable monitoring device for identifying OSA in a symptomatic patient population. Respirology, 14(2): 270-275. 

    Summary: There were 141 patients who wore the ARES while undergoing a PSG study. Results of AHI from the ARES study were presented in the order of different scoring criteria--4% oxygen desaturation alone, obstructive events with 1% desaturation plus surrogate arousal criteria. The sensitivity was 0.84 (95% confidence interval (CI): 0.77-0.90) and 0.97 (95% CI: 0.94-0.99), respectively. The specificity was 1, and 0.63 (95% CI: 0.55-0.71), respectively. The receiver operating curve had an area of 0.96 and 0.98, respectively. The ARES device has reasonable sensitivity and specificity for diagnosing severe OSAS in symptomatic Chinese patients 
  3.  Westbrook PR, Levendowski DJ, Cvetinovic M, et al. 2005. Description and validation of the apnea risk evaluation system: a novel method to diagnose sleep apnea-hypopnea in the home. Chest, 128, 2166-2175. 

    Summary: ARES had a 0.96 correlation with PSG when recorded concurrently and 0.88 for in-home ARES vs. PSG. ARES demonstrated a sensitivity of 97.4 and a specificity of 85.6 in 284 subjects with data acquired concurrently with PSG, and a sensitivity of 91.5 and a specificity of 85.7 in 187 subjects when comparing in-home recordings to PSG. 32 of 35 of the in-home misclassifications were attributed to differences in the percent time supine. Twenty-percent of the subjects included in this study were healthy controls. The failure rate for the in-home comparisons was only 2%.
  4.  Levondowski D, Olmstead R, Popovic D et al. 2007. Assessment of obstructive sleep apnea risk and severity in truck drivers:  validation of a screening questionnaire.  Sleep Diagnosis and Therapy, 2(2): 20-26. 

    Summary: The sensitivity and specificity of the ARES Screener in predicting who will have an AHI > 5 was 0.94 and 0.79 in 850 subjects.  77% of the transportation workers predicted by ARES Questionnaire to have severe OSA had an AHI > 20.
  5.  Westbrook PR, Dickel MJ, Nicholson D, Levendowski D, Zavora T, Simenovic V, Dalati R. 2007. Comparison of two limited-channel systems for the diagnosis of sleep apnea/hypopnea in the homeSleep Diagnosis and Therapy, 2(1): 33-37.  

    Summary: The Kappa coefficients between the ARES vs. PSG were 0.88 for the ARES, and 0.69 and 0.66 for the NovaSom 4% and 2% respectively.  The ARES provided greater sensitivity than the NovaSom 4% or 2% (100% vs. 78.6% and 85.7%, respectively). The NovaSom 4% provided better specificity than the ARES or NovaSom 2% (100% vs. 83.3% and 83.3% respectively).  The positive predictive values of the ARES and NovaSom 4% and 2% were essentially equivalent (93.3%, 100% and 93.3%, respectively) while the ARES provided substantially better negative predictive values (100% vs. 66.7% and 71.4%, respectively).
  6.  Enciso R & Clark G. 2010. Comparing the Berlin and the ARES questionnaire to identify patients with obstructive sleep apnea in a dental setting. Sleep and Breathing, 15(1): 83–89. 

    Summary: The ARES questionnaire had a sensitivity of 90.6%, specificity of 43.2%, a positive and negative predictive value of 73.8% and 73.7%, respectively. This is in comparison to the Berlin at 67.9%, 54.8%, 72%, and 50%, respectively [RDI≥15]. In this specific patient group, not uncommon to the regular dental private practice, the ARES questionnaire performed better than the Berlin questionnaire with higher sensitivity, similar PPV, higher NPV, but lower specificity.

Abstracts

  1.  Popovic D, Velimirovic V, Ayappa I, et al. Sleep/wake classification using head actigraphy, snoring and airflow signals [Abstract]. Sleep 2008a; 32:379. 

    Summary: One-hundred and nine subjects wore the ARES UnicorderTM concurrent during laboratory polysomnography. The PSG records were staged for sleep according to the AASM criteria. Behavioral sleep/wake was derived using an algorithm that combined changes in actigraphy, snoring and airflow. On average there was an 85% agreement between the EEG and behavioral sleep/wake with mean Kappa scores of 0.52. The sensitivity and specificity of sleep/wake was consistent across RDI severities; the concordance between total sleep time and sleep efficiency improved when short/split-night PSG studies were excluded from analysis.
  2.  Popovic D, Ayappa I, Hauri P, Levendowski D, Velimirovic V, Burschtin O, Rapoport D, Westbrook P. Accuracy of automated sleep staging using signals from a single forehead site [Abstract]. Sleep 2008b; 31:33. 

    Summary: Using actigraphy acquired from the forehead to detect sleep/wake provided an overall agreement of 91% with a sensitivity of detecting wave of 0.76.  There was good agreement in estimating sleep latency, total sleep time and sleep efficiency and within clinically acceptable ranges.

 

More Sleep Resources

Here are some helpful resources that will help you with your journey to a more restful sleep.

SLEEP EDUCATION WEBSITE

A.W.A.K.E. CPAP SUPPORT GROUP

CPAP LIFE ON FACEBOOK

Do you have questions?

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