0491 Is a Single Night Sleep Study Sufficient for the Accurate Diagnosis of Sleep Apnea? An Exploration of Multi-Night Sleep Studies. (27th April 2018)

• Record Type: Journal Article
• Authors: Dzierzewski, J M; Dautovich, N D; Rybarczyk, B; Alattar, M; Taylor, S A
• Is Part Of: Sleep. Volume 41(2018)Supplement 1
• Page Start: A185
• Page End: A185
• Publication Date: 2018-04-27
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsy061.490
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Sleep apnea is underdiagnosed in part due to inconveniences associated with laboratory testing and concerns about false negatives. AASM guidelines recommend a second sleep study when negative findings result from an initial sleep study and clinical suspicion for sleep apnea remains. It is unclear whether the severity level of sleep apnea varies significantly night-to-night, or if an individual may display symptoms of sleep apnea one night and not another. This study addressed these questions and examined potential clinical predictors of sleep apnea variation. Methods: Analyses of clinical data obtained from a large medical device and service company specializing in home sleep testing for sleep-related breathing disorders. A total of 47, 422 individuals (mean age=52.22 years, 54% male) completed 2–3 nights of home sleep apnea testing (HSAT) of ≥ four hours. Each HSAT was conducted with a Type III device, measuring nasal and oral airflow, respiratory effort, snoring sounds, oxygen saturation, and pulse rate, resulting in a total apnea-hypopnea index (AHI). Individuals provided limited demographic and clinical information, including the Epworth Sleepiness Scale and STOP-Bang. Results: In total, 38.8% of the sample displayed different levels of sleep apnea severity (i.e., none, mild, moderate, severe) across multiple HSATs. When using classification of severity AHI≥15, 8, 979 patients (18.9% of the total sample) had at least one night that fell above and one night that fell below a common PAP treatment cutoff. On average, individuals' AHI fluctuated 5.79 points night-to-night. Regression analysis found that patients with higher STOPBang ( β =.15, p< .001) and Epworth scores ( β =.02, p <.001) fluctuate more in AHI from night-to-night. Conclusion: A large nationally representative sample undergoing HSAT for suspected sleep apnea showed clinically meaningful fluctuation in apnea severity across multiple nights. Nearly 20% of patients could be misdiagnosed/mistreated if only a single night of HSAT were used instead of 2(+) nights of HSAT. Consequently, a second night of sleep testing should be considered for the accurate diagnosis and optimal treatment of sleep apnea. Support (If Any): K23AG049955, PI: Dzierzewski.