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Updated: Nov 15, 2025

Multi-Modal Home Sleep Monitoring in Older Adults
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A protocol for mitigating safety events in a sleep laboratory.

Margaret Blattner1, Kelley Dunham2, Robert Thomas3

  • 1Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|March 4, 2021
PubMed
Summary

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Adverse events during polysomnography (sleep studies) are increasing due to more medically complex patients. Standardized protocols and technician training are crucial for managing these safety events effectively.

Area of Science:

  • Sleep Medicine
  • Patient Safety
  • Medical Diagnostics

Background:

  • Polysomnography (PSG) is a common outpatient procedure with historically low adverse event rates.
  • The rise of home sleep apnea testing (HSAT) has shifted patient populations towards in-laboratory PSG, potentially increasing medical complexity and risk.
  • Existing protocols may not adequately address the safety needs of this evolving patient demographic.

Purpose of the Study:

  • To assess the incidence and characteristics of adverse events during in-laboratory polysomnography.
  • To evaluate the effectiveness of a newly implemented referral triage and technician training protocol for managing safety events.
  • To advocate for standardized safety protocols in sleep laboratories.

Main Methods:

  • A retrospective analysis of safety events from January 2016 to January 2020 in sleep laboratories affiliated with Beth Israel Deaconess Medical Center.
Keywords:
adverse eventspolysomnographysleep laboratory

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  • Development and implementation of a patient referral triage protocol and a formalized sleep technician training program for medical incidents.
  • Documentation and analysis of patient demographics, referral characteristics, event details, and outcomes.

    • Main Results:

    • Sixty-five safety events occurred over the study period, representing a rate of 1:147 PSG studies.
    • The most frequent events included chest pain (31%), shortness of breath (20%), and vital sign abnormalities (18%).
    • Patients experiencing events were often female (49%), median age 57, with a high prevalence of comorbidities (92%, median 3).
    • The formalized response protocol reduced the median time from incident identification to response activation to 3 minutes.

    Conclusions:

    • The incidence of in-laboratory polysomnography safety events may be underestimated due to increasing patient medical complexity.
    • Formalized response protocols and comprehensive sleep technician training are essential for managing safety events in medically complex populations undergoing PSG.
    • Standardized safety measures are needed to ensure patient well-being during in-laboratory sleep studies.