Comparison between home and hospital set-up for unattended home-based polysomnography: a prospective randomized study

Unattended home-based polysomnography (H-PSG) is a reliable tool for the diagnosis of obstructive sleep apnoea (OSA). The quality of the recording can be influenced by several factors including the set-up location - at home versus in the sleep laboratory. Previous studies have suggested that the failure rate is higher when H-PSG is fitted in hospital. The aim of this study was to determine the influence of hook-up location on H-PSG recording quality. Feasibility and repeatability of H-PSG were also assessed.

Consecutive patients suspected of OSA were selected. Each patient underwent two H-PSGs within two weeks, one fitted at home and one fitted in the sleep laboratory. The order of H-PSG was randomly assigned.

Among the 102 included patients, 95 completed the study. Ninety-three per cent of the 190 H-PSGs were satisfactory. The failure rate of H-PSG was similar for both the home set-up and the sleep laboratory set-up (p = 0.33). Seventy-nine per cent of patients opted to be fitted at home. OSA was diagnosed in 59%. The apnoea-hypopnoea index was similar for home and sleep laboratory set-up, resulting in a very good reproducibility (intraclass correlation coefficient of 0.85). No differences in total sleep time and sleep architecture were observed in both set-up protocols. Except for sleep duration, which was longer in the first H-PSG test, we did not observe any first-night effect during the first H-PSG.

The present study demonstrates that hospital hook-up is as effective as home hook-up for home-unattended polysomnography, and that feasibility and repeatability of H-PSG are very good.