The effect of in-laboratory polysomnography on sleep and objective daytime sleepiness

MSLT guidelines recommend performing MSLTs following polysomnography (PSG) to document the preceding night's sleep. We tested the hypothesis that patients are objectively sleepier after in-laboratory full diagnostic PSG than after a sleep recording at home. Sixteen patients with the sleep apnea/hypopnea syndrome (SAHS; AHI 35+/-SD 28 per hour slept) were recruited into a randomized crossover study. To monitor sleep with minimal disruption at home, only sleep was recorded on 2 consecutive nights, the first for acclimatization. The laboratory limb followed standard PSG. Both study nights were followed next day by MSLT and MWT. There were no differences in MSLT (12.0 SD 5.1 home, 11.6+/-4.7 min laboratory; p=0.7), MWT (32.7+/-8.7, 31.6+/-9.3 min; p=0.6) or total sleep time (362+/-53, 343+/-51 min; p=0.15) between home and laboratory limbs. However, on the home night, fewer microarousals (31+/-14, 54+/-25/hr slept; p<0.0001) and less % wake (15+/-10, 24+/-11; p=0.006) were found. On the home study night, patients had greater % REM sleep, slow-wave sleep and sleep efficiency (all p<0.009). This study does not support the hypothesis that patients are sleepier after laboratory PSG compared to home study night. However, the improved sleep at home raises the question whether laboratory-based polysomnography is always required prior to MSLT/MWT testing or whether less obtrusive monitoring of sleep duration at home would sometimes suffice.