Clinical diagnosis of sleep apnea based on single night of polysomnography vs. two nights of polysomnography (original) (raw)
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Kathmandu University Medical Journal, 2021
Background Obstructive sleep apnea is a highly prevalent yet largely under-diagnosed disease that poses a significant burden on the healthcare system. Objective To determine the role of predictors for Obstructive sleep apnea syndrome and its severity in Nepalese population. Method Prospective and analytical study conducted in the Department of Otorhinolaryngology and Head and Neck surgery at Kathmandu University Hospital between March 2018 and June 2020. A total of 85 adult patients with Obstructive sleep apnea with an Epworth sleepiness score greater than 10 were included. Overnight polysomnography was done and scoring of sleep associated events were done according to the American Academy of Sleep Medicine criteria. Participants were classified as simple snoring and mild, moderate or severe Obstructive sleep apnea syndrome groups depending on the Apnea Hypopnea Index values. Relationship of Apnea hypopnea index was analyzed with age, neck circumference, body mass index and Epworth Sleepiness score. Result Simple snoring was seen in 18(21.17%) patients, 14(16.47%) had mild Obstructive sleep apnea, 13(15.29%) had moderate Obstructive sleep apnea, whereas the severe group consisted of 40(47.05%) patients. The minimum Epworth Sleepiness Score was 10 and the maximum was 25. The Apnea hypopnea index correlated positively with Body mass index (p=.010) and Epworth sleepiness score (p<.001). However, Apnea hypopnea index had no association with age (p=.437) and neck circumference (p=.118). Conclusion Health professionals need to be extremely vigilant while examining patients presenting with Obstructive Sleep Apnea. Polysomnography is the investigation of choice in the early identification of this treatable disease.
Discrepancy in Polysomnography Scoring for a Patient with Obstructive Sleep Apnea Hypopnea Syndrome
The Tohoku Journal of Experimental Medicine, 2005
Overnight polysomnography (PSG) is indispensable for diagnosis of obstructive sleep apnea hypopnea syndrome. However, studies on interscorer agreement on PSG scoring between laboratories are few. The purpose of this study was to examine the reliability of interscorer agreement on PSG scoring among 16 sleep laboratories in Japan. We found a relatively moderate interscorer reliability of the index of oxygen desaturation and arousal during sleep, but a relatively low reliability of the index of transient reduction in and complete cessation of breathing (apnea hypopnea index). The median rate of interscorer coincidence of sleep staging was the lowest for slow wave (deep) sleep (23.5%), followed by those for Stage 1 (59.8%), Wake (73.2%) and Stage 2 (74.2%) in this order, and rapid eye movement was the most reliably identified stage (91.3%). The median rate of interscorer coincidence for all stages was 71.8%. The present study demonstrates that scorers tend to analyze PSG data according to a relatively empirical decision as opposed to a rule-dependent decision. Further detailed scoring manuals are required to decrease the interscorer discrepancy in PSG scoring. obstructive sleep apnea hypopnea syndrome; polysomnography; sleep stages; arousals; apnea hypopnea index
Reproducibility and predictors of the apnea hypopnea index across multiple nights
Sleep science (Sao Paulo, Brazil)
Attended polysomnography (PSG) is the standard diagnostic test for sleep apnea (SA). However, due to internight variability in SA, a single night PSG may not accurately reflect the true severity of SA. Although internight variability is a well-known phenomenon, its root causes have not been fully elucidated. The objective of this study was to determine factors associated with internight variability in the apnea-hypopnea index (AHI) and its magnitude in the home environment. Each participant had a full overnight PSG simultaneous with a validated portable sleep apnea monitoring device (BresoDx) followed by two overnight home tests using the portable monitor only. Patients were stratified into those with variable AHI and consistent AHI (AHI difference ≥10 or <10 between any 2 nights, respectively). Demographics, sleepiness, sleep test variable, and supine-predominant SA (supine-SA) were examined for any association with variable AHI. Forty patients completed the protocol. The correl...
Utility of daytime polysomnography for in-patients with suspected sleep-disordered breathing
Neurologia i neurochirurgia polska
Obstructive sleep apnoea (OSA) is a common medical problem with significant adverse consequences. Delays in diagnosing and treating OSA have increased with increasing demand for sleep services. The aim of the study was to assess the utility of daytime poly-somnography (PSG) in in-patients who were suspected during admission to have sleep disordered breathing. We compared 80 in-patients who had daytime PSG with a random sample of 180 patients who had overnight PSG. We analyzed demographic data, medical history, PSG results, and results of continuous positive airway pressure (CPAP) titration. The diagnosis of OSA was made in 70 (87.5%) daytime patients and 180 (100%) overnight patients. The daytime patients were older (53.5 +/-12.2 years vs. 46.8 +/-14 years, p < 0.001) and had a higher body mass index (BMI) than the overnight patients (43.3 +/-13.3 vs. 35 +/-8, p < 0.001). There was no significant difference between the two groups with regard to apnoea-hypopnoea index (AHI) or ...
Timing, number and complexities of sleep studies
Sleep & breathing = Schlaf & Atmung, 1997
Background: In-laboratory polysomnography for the diagnosis of obstructive sleep apnea as a standard diagnostic tool was established by consensus at an ATS conference, and the technology and methods as reviewed in the previous ATS statement are largely unchanged. Recent review by the Agency of Health Care Policy Research reaffirmed the usefulness of polysomnography in the diagnosis of patients with sleeprelated breathing disorders. One major value of in-laboratory polysomnography (simultaneous measurement of sleep cardio-respiratory variables, leg movements, and observation either directly or indirectly is that a specific diagnosis or clinical decision is made in the majority (> 60-70 %) of tests. There is a report of false negative results form one night polysomnography (Meyer et al, 1993); however, the frequency of this event is considered to be low. The predominant polysomnographic diagnosis in unselected patients is sleep-disordered breathing, varyies from 28 % to 65% of these laboratory populations, with the next major diagnosis being periodic movements during sleep or restless legs (10%). Only 3-5% of patients who present with hypersomnolence will eventually have a diagnosis of idiopathic hypersomnia, which may or may not be related to high upper airway resistance syndrome. The second major value of in-laboratory polysomnography is the discovery of a secondary diagnosis with some 30% of patients [23]. The majority of these secondary diagnoses relate to periodic limb movements or snoring. The value of these secondary diagnoses and their impact on patient outcome, however, has not been assessed. Conclusion: Full overnight polysomnography is a standard procedure for the diagnosis of obstructive sleep apnea. Its usefulness and correlation of pretest clinical suspicion with posttest outcomes, however, remains to be more fully evaluated.
Otolaryngology - Head and Neck Surgery, 2004
OBJECTIVE: To validate the role of a portable sleep monitor device (SNAP) in the diagnosis of obstructive sleep apnea syndrome (OSAS). Inter-reader variability was also assessed for both PSG and SNAP. STUDY DESIGN AND SETTING: Sixty consecutive adults referred for PSG at The University of Chicago Sleep Disorder Clinic were prospectively enrolled. RESULTS: There was no significant difference between total number of apnea and hypopnea, respiratory disturbance index (RDI), and minimum oxygen obtained by PSG and SNAP, but there was a significant difference between sleep time and mean oxygen. Pearson's correlation coefficient for RDI > 15 was 0.92. CONCLUSION: There was a significant correlation of RDIs between SNAP and PSG. SNAP has good sensitivity, specificity, positive and negative predictive values. Differences between SNAP and PSG could be attributed to inter-reader variability and not necessarily due to technical limitations of SNAP. SNAP is an excellent tool for the diagnosis of OSAS in the laboratory setting. Future studies should be performed to evaluate SNAP's accuracy in the home setting in the diagnosis of OSAS. EBM rating: B-2.
European Respiratory Journal, 1997
Recently, to reduce the costs of polysomnography, split-night studies have been introduced into routine practice: the first part of the night is used to make the diagnosis of obstructive sleep apnoea syndrome (OSAS) and the second part to achieve an appropriate level of continuous positive airway pressure. Since this split-night protocol has not yet been validated by the comparison of polysomnographic pictures obtained in the first and second parts of the night, the aim of this study was to evaluate sleep profile and respiratory disturbances in the first part (PSG1) and second (PSG2) portion of a standard full-night polysomnographic examination (PSGtot) in a group of OSAS patients.
Journal of Medical Screening, 2013
Background Polysomnography remains the diagnostic gold standard for obstructive sleep apnea syndrome (OSAS), but it is time consuming and requires dedicated personnel and setting. It may be more useful to plan a polysomnogram based on a preliminary screening. Objective To verify whether a questionnaire of general quality of sleep, the Pittsburgh Sleep Quality Index (PSQI), could outperform a dedicated questionnaire (Epworth Sleep Scale: ESS) in targeting OSAS patients in an at risk population. Methods 254 consecutive subjects attending the outpatient clinic for respiratory diseases were clinically evaluated for sleep apnea and referred to a 12 channel night-time polysomnography. All patients were administered the ESS and the PSQI before the procedure. The correlation between the Apnoea/Hypopnoea Index (AHI) and the global score of the PSQI was calculated; Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), Diagnostic accuracy and the area u...
Apnea-hypopnea index in sleep studies and the risk of over-simplification
Sleep Science, 2018
According to recent reports, sleep disorders affect 30% of the adult population and 5-10% of children. Obstructive Sleep Apnea Hypopnea Syndrome (OSA) has a considerable epidemiological impact and demand for consultation is growing in our community. Therefore, it is necessary to know the principles of interpretation of diagnostic methods. A suspicion of OSA requires confirmation. According to the guidelines of the Argentine Association of Respiratory Medicine, polysomnography (PSG) is the gold standard for OSA diagnosis, while home sleep testing (HST) can be accepted as a comparatively effective method depending on the clinical situation of the patient. This article questions the use of AHI (apnea-hypopnea index) as the only measurement needed to diagnose OSA and assess its severity. In fact, it is surprising that, despite the large mass of data analyzed during sleep studies, current practices only focus on AHI. More than four decades have passed since OSA was first described. Our tendency to oversimplify complex conditions may prevent us from gaining a deeper and more thorough understanding of OSA. The development and validation of OSA severity scoring systems based on multiple parameters is still a pending issue.
Journal of Clinical Sleep Medicine, 2018
Study Objectives: This study has as its primary objective to evaluate the quality and effectiveness of type II ambulatory polysomnography (Amb-PSG) versus type I attended laboratory polysomnography (Lab-PSG) in diagnosing obstructive sleep apnea (OSA). Its secondary objective is to evaluate the clinical efficacy, quality of life (QoL), and treatment adherence after diagnosis. Methods: An observational study of patients with OSA (n = 225) in whom diagnosis was made via Amb-PSG (n = 114) or Lab-PSG (n = 111). Patients' clinical data were retrospectively assessed (including general demographic and clinical data, Epworth Sleepiness Scale, blood pressure, indices from polysomnography, and treatment adherence. Cross-sectional assessment (patient questionnaire) was used to evaluate clinical efficacy indicators, comorbidities, current treatment, and QoL. Results: Polysomnography indices were comparable between Amb-PSG and Lab-PSG (apnea-hypopnea index: 38.9 ± 22.5 versus 35.8 ± 23.1 events/h; P > .05), except for an elevation of total sleep time (510 ± 54.7 versus 476.3 ± 79.4 minutes; P < .01) and loss of oximetry signal (9.8% versus 0.0%; P < .05). Based on polysomnography parameters, OSA was severe in 119 patients (52.9%), moderate in 88 (39.1%), and mild in 18 (8.0%). Diagnostic effect of Amb-PSG in clinical (body mass index, blood pressure, Epworth Sleepiness Scale) and treatment follow-up (CPAP adherence and QoL) indicators was comparable to that of Lab-PSG. Conclusions: Amb-PSG showed an OSA diagnostic capacity comparable to Lab-PSG. Secondary analyses (diagnostic quality, clinical efficacy, treatment compliance, QoL) underline the value of Amb-PSG as an emerging alternative to improve accessibility to care.