Case report: multiple negative polysomnograms in patients with obstructive sleep apnea.

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Neurology

Background:

• Obstructive sleep apnea (OSA) diagnosis commonly relies on a single overnight polysomnogram (PSG).
• PSG is the gold standard for identifying sleep-disordered breathing events.
• Excluding OSA is crucial for managing associated cardiovascular and neurological risks.

Observation:

• This report details three cases where patients received an OSA diagnosis after multiple initially negative polysomnograms.
• These false-negative results highlight potential limitations of standard diagnostic protocols.
• Factors contributing to false negatives included reduced sleep time, lateral sleeping posture, predominant hypopneas, and recent therapeutic interventions.

Findings:

• Multiple negative polysomnograms can occur in patients with obstructive sleep apnea.
• Reduced total sleep time, REM sleep, lateral sleeping position, hypopnea-dominant events, and recent treatments can lead to false-negative PSG results.
• A strong clinical suspicion of sleep apnea warrants careful reevaluation of sleep and clinical parameters, potentially including repeat polysomnography.

Implications:

• Clinicians should consider repeat polysomnography in cases of high clinical suspicion despite initial negative results.
• Understanding factors causing false-negative PSGs can improve diagnostic accuracy for obstructive sleep apnea.
• This underscores the importance of integrating clinical judgment with polysomnogram findings for accurate OSA diagnosis.