Clinical diagnosis of sleep apnea based on single night of polysomnography vs. two nights of polysomnography
Abstract
Purpose The purpose of this study was to investigate apnea-hypopnea index (AHI) across two polysomnographies (PSGs) to examine AHI variability and impact on clinical diagnosis. Materials and methods Two-night PSGs of 193 sleep clinic patients were reviewed, and the AHI variability was analyzed. Anonymized records from five patients with significant night-to-night AHI variability were used in this study: the two-night PSGs from two patients were represented as four individual PSGs; the two-night PSG for two others were represented as being obtained from two different sleep clinics; the last patient's PSG was shown as a two-night study. Twenty-two sleep experts attending the Associated Professional Sleep Societies meeting were recruited to make diagnoses based on the PSGs. They were told that the PSGs were from seven patients: four with single-night PSG; two with two PSGs, each one from a different clinic; and one patient with a two-night PSG. Results Twenty-one percent of the 193 sleep clinic patients had a nightly PSG AHI variability of greater than 5. Forty-eight percent of all patients had a significantly higher AHI on the first night, and 41% had a significantly higher AHI on the second night. Using an AHI > 15 diagnostic criteria, sleep apnea would have been undetected in 20% (n = 39) of patients due to low AHI on one night. Furthermore, 13% of all patients had a more severe sleep apnea classification based on the second night of PSG. For the seven cases, 27-36% of sleep…
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OSA severity was also noted to vary in a subset of subjects with 26% to 35% changing the severity classification of their OSA (in either direction) on the 2 nights, though the majority were a shift of a single category (e.g., mild to moderate).
“OSA severity was also noted to vary in a subset of subjects with 26% to 35% changing the severity classification of their OSA (in either direction) on the 2 nights, though the majority were a shift of a single category (e.g., mild to moderate).34,130”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [34]
Using an AHI cutoff of ≥ 5 to diagnose OSA, three of the studies identified that 9.9% to 25% of subjects had an AHI < 5 on the first PSG but an AHI ≥ 5 only on the second PSG.
“Using an AHI cutoff of ≥ 5 to diagnose OSA, three of the studies34,130,131 identified that 9.9% to 25% of subjects had an AHI < 5 on the first PSG but an AHI ≥ 5 only on the second PSG.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [34]
Our literature search identified four observational studies that compared AHI scores between two consecutive nights of PSG.
“Our literature search identified four observational studies that compared AHI scores between two consecutive nights of PSG.34,129–131”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [34]
A meta-analysis of four studies compared AHI data between 2 consecutive nights of PSG and found the mean difference in the AHI between the 2 nights was 0.14 (95% CI: −1.86 to 2.15), which was not statistically or clinically significant.
“A meta-analysis of four studies compared AHI data between 2 consecutive nights of PSG34,129–131 (see supplemental material, Figure S28 and Table S66) and found the mean difference in the AHI between the 2 nights was 0.14 (95% CI: −1.86 to 2.15), which was not statistically or clinically significant.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [34]
The overall quality of evidence for comparing night-to-night AHI variability was originally considered high, due to precise and consistent data across studies.
“The overall quality of evidence for comparing night-to-night AHI variability was originally considered high, due to precise and consistent data across studies.34,129–131”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [34]
Using an AHI cutoff of ≥ 15 or 20 as a potential treatment threshold, 2 of the studies observed that 7.6% and 25% of subjects crossed this threshold only on the second study.
“Likewise, using an AHI cutoff of ≥ 15 or 20 as a potential treatment threshold, 2 of the studies34,130 observed that 7.6% and 25% of subjects crossed this threshold only on the second study.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [34]
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- Authors
- Ahmadi, N., Shapiro, G. K., Chung, S. A., & Shapiro, C. M.
- Affiliations
- University Health Network (CA)
- Corresponding author
- Ahmadi, Negar
- Venue
- Sleep and Breathing
- Published
- 2008-12-09
- Volume
- 13
- Issue
- 3
- Pages
- 221-226
- ISSN
- 1520-9512 (ISSN-L)
- 1522-1709
- OpenAlex
- W2032190775
- Cited by
- 134
- References
- 1
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 6 · 2023: 15 · 2022: 5 · 2021: 13 · 2020: 12 · 2019: 7 · 2018: 10 · 2017: 8 · 2016: 11 · 2015: 8 · 2014: 6 · 2013: 3 · 2012: 6
- FWCI
- 2.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Sleep And Breathing (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- sleep apnea, apnea-hypopnea index, night-to-night variability, missed diagnosis, sleep apnea severity classification, sleep clinic patients, diagnostic accuracy
- MeSH terms
- Adult, Aged, Female, Humans, Male, Middle Aged, Severity of Illness Index, Time Factors, Incidence, Polysomnography, Sleep Apnea, Obstructive
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