Pilot Validation of Watch-PAT—Homebased Sleep Study Against in Sleep Laboratory Polysomnography in Amyotrophic Lateral Sclerosis (ALS) Subjects
Urvi Desai1
1Neurology, Wake Forest University Atrium Health
Objective:

 Assessment of sleep disordered breathing in ALS by Watch PAT would correlate with key variables from PSG.   

Background:
Most frequent terminal event in ALS (Amyotrophic Lateral Sclerosis) is respiratory insufficiency which occurs earlier during sleep. ALS patients have difficulty tolerating multichannel overnight PSG (polysomnography) because of weakness, reduced mobility, secretions and dysarthria. Watch PAT (Peripheral arterial tonometry) based HST (Homebased Sleep Study) advantages include remote testing, simplicity of equipment, reduced cost and inbuilt actigraphy. 
Design/Methods:

14 adults with non-bulbar ALS underwent a standard laboratory-based PSG (polysomnography) while simultaneously wearing the Watch-PAT device. Both compared and analyzed variables such as sleep-wake detection, sleep staging, AHI (apnea hypopnea index), REM (Rapid Eye Movement) AHI, O2 desaturation minimum and Heart rate. PSGs were interpreted by a blinded AASM (American Academy of Sleep Medicine) certified physician and Watch-PAT data was analyzed by an automatic algorithm with conformation by another blinded ABPN Sleep Medicine board certified physician. The results from the PSG and Watch-PAT were entered into the RedCap database for further analysis.  

 

 

Results:

14 ALS patients were studied. Age range was 58.6±10.05 years, BMI range was 27.41±5.75, Mean Epworth Sleepiness Scale 5.4±31, suggesting no significant hypersomnia. Key variables generated by PSG and Watch-PAT correlated well for respiratory indices, including the apnea-hypopnea index (AHI, r=0.98, p<0.01); respiratory disturbance index (RDI, r=0.78, p=0.02), mean oxygen saturation (r=0.93, p<0.01), and minimum oxygen saturation (r=0.95, p<0.01). Association between sleep stages and sleep efficiency was not statistically significant. 

Conclusions:

In ALS patients, Watch-PAT based home sleep study testing could provide an alternative to laboratory based overnight PSG. Respiratory insufficiency during sleep substantially adds to the disease burden in ALS and early deployment of ventilatory support is crucial for prolonging survival. This study will help validate Watch-PAT home-based testing to PSG as a clinically meaningful yet cost effective and convenient alternative for ALS patients.  

 

10.1212/WNL.0000000000206660