Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry: a case for multiple night...

Area of Science:

• Sleep Medicine
• Respiratory Physiology

Background:

• Obstructive sleep apnea (OSA) diagnosis relies on sleep studies.
• Night-to-night variability in OSA severity can impact diagnostic accuracy.
• Peripheral arterial tonometry (PAT) is a home sleep apnea testing modality.

Purpose of the Study:

• To investigate the night-to-night variability of OSA severity using PAT.
• To assess the impact of this variability on OSA classification.
• To determine if multiple nights of PAT testing are necessary.

Main Methods:

• 51 patients underwent 3 consecutive nights of home sleep apnea testing using PAT.
• Recordings were scored manually and automatically.
• Apnea-hypopnea index (AHI) was calculated for each night.

Main Results:

• No systematic differences in PAT-derived AHI (pAHI) were observed between nights.
• 35% of patients showed a pAHI variability >10 events/h.
• 24% of patients were misclassified based on a single night's data.
• Average pAHI varied by 57% night-to-night.
• Supine sleeping time partially explained pAHI variability.
• 12-14% met treatment criteria spontaneously on a subsequent night.

Conclusions:

• Considerable night-to-night variability in OSA severity exists with PAT, similar to polysomnography.
• This variability can lead to frequent misclassification of OSA severity.
• Multiple night testing with PAT is strongly recommended for accurate OSA diagnosis.