TY - JOUR
T1 - Variability and Misclassification of Sleep Apnea Severity Based on Multi-Night Testing
AU - Punjabi, Naresh M.
AU - Patil, Susheel
AU - Crainiceanu, Ciprian
AU - Aurora, R. Nisha
N1 - Funding Information:
FUNDING/SUPPORT: This study was supported by the National Institutes of Health [grants K23-HL118414 , R01-HL117167 , and R01-HL146709 ].
Publisher Copyright:
© 2020 American College of Chest Physicians
PY - 2020/7
Y1 - 2020/7
N2 - Background: Portable monitoring is a convenient means for diagnosing sleep apnea. However, data on whether one night of monitoring is sufficiently precise for the diagnosis of sleep apnea are limited. Research Question: The current study sought to determine the variability and misclassification in disease severity over three consecutive nights in a large sample of patients referred for sleep apnea. Methods: A sample of 10,340 adults referred for sleep apnea testing was assessed. A self-applied type III monitor was used for three consecutive nights. The apnea-hypopnea index (AHI) was determined for each night, and a reference AHI was computed by using data from all 3 nights. Pairwise correlations and the proportion misclassified regarding disease severity were computed for each of the three AHI values against the reference AHI. Results: Strong correlations were observed between the AHI from each of the 3 nights (r = 0.87-0.89). However, substantial within-patient variability in the AHI and significant misclassification in sleep apnea severity were observed based on any 1 night of monitoring. Approximately 93% of the patients with a normal study on the first night and 87% of those with severe sleep apnea on the first night were correctly classified compared with the reference derived from all three nights. However, approximately 20% of the patients with mild and moderate sleep apnea on the first night were misdiagnosed either as not having sleep apnea or as having mild disease, respectively. Conclusions: In patients with mild to moderate sleep apnea, one night of portable testing can lead to misclassification of disease severity given the substantial night-to-night variability in the AHI.
AB - Background: Portable monitoring is a convenient means for diagnosing sleep apnea. However, data on whether one night of monitoring is sufficiently precise for the diagnosis of sleep apnea are limited. Research Question: The current study sought to determine the variability and misclassification in disease severity over three consecutive nights in a large sample of patients referred for sleep apnea. Methods: A sample of 10,340 adults referred for sleep apnea testing was assessed. A self-applied type III monitor was used for three consecutive nights. The apnea-hypopnea index (AHI) was determined for each night, and a reference AHI was computed by using data from all 3 nights. Pairwise correlations and the proportion misclassified regarding disease severity were computed for each of the three AHI values against the reference AHI. Results: Strong correlations were observed between the AHI from each of the 3 nights (r = 0.87-0.89). However, substantial within-patient variability in the AHI and significant misclassification in sleep apnea severity were observed based on any 1 night of monitoring. Approximately 93% of the patients with a normal study on the first night and 87% of those with severe sleep apnea on the first night were correctly classified compared with the reference derived from all three nights. However, approximately 20% of the patients with mild and moderate sleep apnea on the first night were misdiagnosed either as not having sleep apnea or as having mild disease, respectively. Conclusions: In patients with mild to moderate sleep apnea, one night of portable testing can lead to misclassification of disease severity given the substantial night-to-night variability in the AHI.
KW - home sleep apnea test
KW - portable monitoring
KW - sleep apnea
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U2 - 10.1016/j.chest.2020.01.039
DO - 10.1016/j.chest.2020.01.039
M3 - Article
C2 - 32081650
AN - SCOPUS:85085762878
VL - 158
SP - 365
EP - 373
JO - Diseases of the chest
JF - Diseases of the chest
SN - 0012-3692
IS - 1
ER -