Peripheral arterial tonometry versus polysomnography in suspected obstructive sleep apnoea

Area of Science:

• Sleep Medicine
• Cardiovascular Health
• Diagnostic Accuracy

Background:

• Polysomnography (PSG) is the gold standard for diagnosing obstructive sleep apnoea (OSA).
• Home sleep apnoea testing using peripheral arterial tonometry (PAT) is a recommended alternative for patients at increased risk for OSA.
• Investigating the concordance between PAT and PSG is crucial for understanding diagnostic accuracy and patient outcomes.

Purpose of the Study:

• To assess the concordance between PAT and PSG in diagnosing OSA.
• To identify predictors of discordant OSA diagnoses between PAT and PSG.
• To evaluate the three-year cardiovascular risk in patients with discordant OSA diagnoses compared to matched concordant patients.

Main Methods:

• A retrospective monocentric cohort study included 940 patients with a PAT Apnoea-Hypopnoea Index (AHI) ≥ 5/h and subsequent in-hospital PSG within three months.
• Patients were classified as discordant (PAT AHI ≥ 5/h, PSG AHI < 5/h) or concordant (PAT AHI ≥ 5/h, PSG AHI ≥ 5/h).
• Major adverse cardiovascular events (MACE) were analyzed over 3.1 years in discordant patients and matched concordant patients.

Main Results:

• Overall agreement in OSA diagnosis between PAT and PSG was 80% (55% mild, 86% moderate/severe OSA).
• Discordant diagnoses were associated with female sex, younger age, and lower BMI, but not comorbidities.
• No significant difference in MACE was observed between discordant (n=155) and matched concordant (n=274) patients.

Conclusions:

• PAT demonstrates good concordance with PSG for OSA diagnosis, particularly for moderate and severe OSA.
• Age, sex, and BMI are significant predictors of discordant OSA diagnoses between PAT and PSG.
• The risk of major adverse cardiovascular events is similar regardless of whether OSA is diagnosed by PAT or PSG.