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      Potential Underestimation of Sleep Apnea Severity by At-Home Kits: Rescoring In-Laboratory Polysomnography Without Sleep Staging

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          Abstract

          Study Objectives:

          Home sleep apnea testing (HSAT) is increasingly available for diagnosing obstructive sleep apnea (OSA). One key limitation of most HSAT involves the lack of sleep staging, such that the respiratory event index is calculated using the total recording time (TRT) rather than total sleep time (TST).

          Methods:

          We performed a retrospective analysis of n = 838 diagnostic polysomnography (PSG) nights from our center; n = 444 with OSA (4% rule, apneahypopnea index (AHI) ≥ 5), and n = 394 with AHI < 5. We recalculated the AHI using time in bed (TIB) instead of TST, to assess the predicted underestimation risk of OSA severity.

          Results:

          Of all the patients with OSA, 26.4% would be reclassified as having less severe or no OSA after recalculating the AHI using TIB rather than TST. Of the n = 275 with mild OSA, 18.5% would be reclassified as not having OSA. The risk of underestimation was higher in those with moderate or severe OSA.

          Of the n = 119 moderate OSA cases, 40.3% would be reclassified as mild, and of the n = 50 severe OSA cases, 36.0% would be reclassified as moderate. Age strongly correlated with the degree of underestimation of the AHI, because age was significantly correlated with time awake during PSG.

          Conclusions:

          The risk of sleep apnea underestimation is predicted to be substantial in a tertiary sleep center population. Phenotyping errors included risk of falsely negative results (from mild to normal), as well as category errors: moderate or severe moving to mild or moderate severity, respectively. Clinicians should recognize this underestimation limitation, which directly affects diagnostic phenotyping and thus therapeutic decisions.

          Commentary:

          A commentary on this article appears in this issue on page 531.

          Citation:

          Bianchi MT, Goparaju B. Potential underestimation of sleep apnea severity by at-home kits: rescoring in-laboratory polysomnography without sleep staging. J Clin Sleep Med. 2017;13(4):551–555.

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          Author and article information

          Journal
          J Clin Sleep Med
          J Clin Sleep Med
          JCSM
          Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
          American Academy of Sleep Medicine
          1550-9389
          1550-9397
          15 April 2017
          : 13
          : 4
          : 551-555
          Affiliations
          [1 ]Neurology Department, Massachusetts General Hospital, Boston, MA
          [2 ]Division of Sleep Medicine, Harvard Medical School, Boston, MA
          Author notes
          Address correspondence to: Matt T. Bianchi, MD, PhD, Wang 7 Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 (617) 724-7426 (617) 724-6513 mtbianchi@ 123456partners.org
          Article
          PMC5359331 PMC5359331 5359331 jc-00248-16
          10.5664/jcsm.6540
          5359331
          28095966
          © 2017 American Academy of Sleep Medicine
          Categories
          Scientific Investigations

          diagnosis, underestimation, prediction

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