Use of chest wall electromyography to detect respiratory effort during polysomnography

Abstract

Study Objectives: To evaluate the ability of chest wall EMG (CW-EMG) using surface electrodes to classify apneas as obstructive, mixed, or central compared to classification using dual channel uncalibrated respiratory inductance plethysmography (RIP). Methods: CW-EMG was recorded from electrodes in the eighth intercostal space at the right mid-axillary line. Consecutive adult clinical sleep studies were retrospectively reviewed, and the first 60 studies with at least 10 obstructive and 10 mixed or central apneas and technically adequate tracings were selected. Four obstructive and six central or mixed apneas (as classified by previous clinical scoring) were randomly selected. A blinded experienced scorer classified the apneas on the basis of tracings showing either RIP channels or the CW-EMG channel. The agreement using the two classification methods was determined by kappa analysis and intraclass correlation. Results: The percentage agreement was 89.5%, the kappa statistic was 0.83 (95% confidence interval 0.79 to 0.87), and the intraclass correlation was 0.83, showing good agreement. Of the 249 apneas classified as central by RIP, 26 were classified as obstructive (10.4%) and 7 as mixed (2.8%) by CW-EMG. Of the 229 events classified as central by CW-EMG, 7 (3.1%) were classified as obstructive and 6 (2.6%) as mixed by RIP. Conclusions: Monitoring CW-EMG may provide a clinically useful method of detection of respiratory effort when used with RIP and can prevent false classification of apneas as central. RIP can rarely detect respiratory effort not easily discernible by CW-EMG and the combination of the two methods is more likely to avoid apnea misclassification.