Variability and Misclassification of Sleep Apnea Severity Based on Multi-Night Testing.

Area of Science:

• Sleep Medicine
• Respiratory Physiology
• Diagnostic Accuracy

Background:

• Portable monitoring offers convenience for sleep apnea diagnosis.
• Limited data exists on the precision of single-night monitoring for sleep apnea diagnosis.

Purpose of the Study:

• To assess variability and misclassification of sleep apnea severity using multi-night portable monitoring.
• To evaluate the reliability of one-night portable monitoring against a three-night reference.

Main Methods:

• 10,340 adults referred for sleep apnea testing used a type III monitor for three consecutive nights.
• Apnea-hypopnea index (AHI) calculated nightly and as a three-night reference.
• Correlations and misclassification rates of single-night AHI versus reference AHI analyzed.

Main Results:

• Strong correlations (r=0.87-0.89) observed between nightly and reference AHI.
• Significant within-patient AHI variability and misclassification of sleep apnea severity noted with one-night monitoring.
• While severe/normal cases showed higher accuracy, ~20% of mild/moderate cases were misdiagnosed.

Conclusions:

• Single-night portable sleep apnea testing can lead to misclassification of disease severity.
• Substantial night-to-night variability in AHI challenges the accuracy of one-night diagnoses.
• Caution is advised when interpreting results from one-night portable sleep studies, particularly for mild to moderate cases.