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Cited by 61Obstructive Sleep Apnea ResearchSleep and related disordersNeuroscience of respiration and sleep

Diagnostic Accuracy of Split-Night Polysomnograms

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Khawaja, Imran S., Olson, Eric J., van der Walt, Christelle, Bukartyk, Jan, Somers, Virend, Dierkhising, Ross, Morgenthaler, Timothy I.·2010·Journal of Clinical Sleep Medicine
DOI 10.5664/jcsm.27877PMC PMC2919666
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Abstract

Study objectives American Academy of Sleep Medicine (AASM) practice parameters indicate that split-night polysomnograms (SN-PSG) may be performed when the apnea hypopnea index (AHI) is > or = 20 to 40, depending on clinical factors. The aim of this study was to determine the diagnostic accuracy of SN-PSG, including at the lower range of AHIs. Methods We reviewed 114 consecutive full-night PSGs (FN-PSG) performed at our center between August 2006 and November 2008 on subjects enrolled in studies in which obstructive sleep apnea (OSA) was the sleep disorder of interest. We compared the AHI from the first 2 hours (2 hr-AHI) and 3 hours (3 hr-AHI) of sleep with the "gold standard" AHI from FN-PSG (FN-AHI), considering OSA present if FN-AHI > or = 5. Results The 2 hr-AHI and 3 hr-AHI correlated strongly with the FN-AHI (concordance correlation coefficient [CCC] = 0.93 and 0.97, respectively). After adjusting for percentage of sleep in stage REM sleep and in supine position, the correlation of 2 hr- and 3 hr-AHI with FN-AHI remained strong (0.92 and 0.96, respectively). The area under the receiver operating curves (AUC) for 2 hr-AHI and 3 hr-AHI using FN-AHI > or = 5 were 0.93 and 0.95, respectively. Conclusions The AHI derived from the first 2 or 3 hours of sleep is of sufficient diagnostic accuracy to rule-in OSA at an AHI threshold of 5 in patients suspected of having OSA. This study suggests that the current recommended threshold for split-night studies (AHI > or = 20 to 40) may be revised to a lower number, allowing for more efficient use of resources.

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  • Three studies focused on the diagnostic accuracy of the initial portion of the PSG recording, against the accuracy of using the same full-night recording, and a fourth study compared the accuracy of the diagnostic portion of a split-night study against a separate full-night study.

    “Three focused on the diagnostic accuracy of the initial portion of the PSG recording, against the accuracy of using the same full-night recording,121,122,127 and a fourth study compared the accuracy of the diagnostic portion of a split-night study against a separate full-night study.123”

    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 [121]

    Split into 2 atoms — 1 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • When comparing 3 hours of recording versus the full-night recording, excellent consistency of the AHI was observed; there was no significant difference in the AHI derived from the first 3 hours of total sleep time versus the total sleep time (concordance correlation coefficient adjusted for REM and supine sleep of 0.96 and an accuracy of 93%).

    “When comparing 3 hours of recording versus the full-night recording, excellent consistency of the AHI was observed; there was no significant difference in the AHI derived from the first 3 hours of total sleep time versus the total sleep time (concordance correlation coefficient adjusted for REM and supine sleep of 0.96 and an accuracy of 93%),121”

    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 [121]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • The available studies were methodologically limited due to use of suboptimal study designs (not RCTs), use of the initial portion of a full-night PSG recording as a surrogate for the baseline portion of a split-night study, and a lack of consistent use of standard monitoring (e.g., nasal pressure transducer).

    “The available studies were methodologically limited due to a number of issues: use of suboptimal study designs (not RCTs), use of the initial portion of a full-night PSG recording as a surrogate for the baseline portion of a split-night study,121,127 and a lack of consistent use of standard monitoring (e.g., nasal pressure transducer).121”

    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 [121]

  • That study reported a sensitivity of 0.77 (95% CI: 0.56 to 0.91) and specificity of 0.98 (95% CI: 0.92 to 1.00) using a cutoff of AHI ≥ 15.

    “This study reported a sensitivity of 0.80 (95% CI: 0.67 to 0.90) and specificity of 0.93 (95% CI: 0.83 to 0.98) using a cutoff of AHI ≥ 5, and a sensitivity of 0.77 (95% CI: 0.56 to 0.91) and specificity of 0.98 (95% CI: 0.92 to 1.00) using a cutoff of AHI ≥ 15”

    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 [121]

  • One study found that the 2-hour AHI and 3-hour AHI strongly correlated with the full-night AHI (concordance correlation coefficient = 0.93 and 0.97, respectively).

    “One study found that the 2-hour AHI and 3-hour AHI strongly correlated with the full-night AHI (concordance correlation coefficient = 0.93 and 0.97, respectively).121”

    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 [121]

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Authors
Khawaja, I. S., Olson, E. J., van der Walt, C., Bukartyk, J., Somers, V., Dierkhising, R., & Morgenthaler, T. I.
Affiliations
Mayo Clinic (US)
Corresponding author
Morgenthaler, Timothy I.
ORCID
Venue
Journal of Clinical Sleep Medicine
Publisher
Springer Science and Business Media LLC
Published
2010-08-15
Volume
6
Issue
4
Pages
357-362
ISSN
  • 1550-9389 (ISSN-L)
  • 1550-9397
DOI
10.5664/jcsm.27877
PMC
PMC2919666
OpenAlex
W41820605
Cited by
61
References
2
Citations by year
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FWCI
2.44
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Sleep Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (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
split-night polysomnography, obstructive sleep apnea, apnea-hypopnea index, diagnostic accuracy, REM sleep, supine position, sleep stage classification
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Reference Standards, Retrospective Studies, Sensitivity and Specificity, Sex Factors, Sleep, Time Factors, Comorbidity, Polysomnography, Sleep Apnea, Obstructive, Young Adult

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