Comparison of Direct and Indirect Measurements of Respiratory Airflow: Implications for Hypopneas

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Abstract
The purpose of this study was to compare indirect methods for measuring respiratory airflow, such as temperature difference between inspired and expired air, thoracoabdominal movements, and nasal respiratory-airflow pressures—with a more direct measurement of minute ventilation using a head-out body plethysmograph. Measurements were obtained in healthy, awake, seated subjects during sequences of different levels of voluntary hypoventilations at 20 breaths/minute and analyzed to determine how well different methods could identify hypopneas (defined as reduction in minute ventilation by 50% or more). The results varied widely between different methods. Sensitivities ranged from 0 to 1, specificity ranged from 0.33 to 1, positive predictive values (PPV) ranged from 0 to 0.73, negative predictive values (NPV) ranged from 0.68 to 0.93. Cohen's κ varied between 0 and 0.65 The poorest agreement was for the thermistor method, and the best agreement was obtained when a combination of thoraco-abdominal movements and nasal respiratory-airflow pressure was employed (sensitivity = 0.86, specificity = 0.83, PPV = 0.71, NPV = 0.92, Cohen's κ = 0.65). We conclude that none of the indirect methods investigated, individually or in combination, proved adequate for identification of voluntary hypopneas in awake individuals.

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