Discrepancies in Subjective Sleep Quality Between Home and Hospital Settings: Insights of Hypnotic Agents Use with...

Background/Objectives: Polysomnography (PSG) is the gold standard for diagnosing sleep-disordered breathing (SDB). However, in a hospital testing setting, it may produce the first-night effect, viz., prolonged sleep latency, lower sleep efficiency, and uncertain apnea-hypopnea index (AHI). Here, we aim to determine the influences of hypnotic agents and gender. Methods: In this retrospective study, we reviewed the post-PSG questionnaires and electronic medical records of patients aged ≥20 years receiving overnight PSG for the diagnosis of SDB at Taichung Veterans General Hospital in a period between April 2024 and March 2025. Results: We studied a total of 1053 patients, aged 47.0 ± 14.7 years old. Compared to sleeping at home, 42.2% of patients reported worse perceived sleep quality (PSQ) with hypnotic agents, and 53.0%, without, before PSG testing in the hospital. For those without taking hypnotic agents, men had an odds ratio (OR) of 1.570 (95% CI: 1.127-2.189) for worsening PSQ compared to women (p = 0.008). Also, per increasing 1 Epworth Sleepiness Scale (ESS) score, the risk of worsening PSQ was reduced by OR of 0.963 (95% CI: 0.933-0.994) (p = 0.021). Once male patients had ESS < 10, as many as 57.3% of them reported the worse PSQ. Conclusions: Our study suggests a potentially more patient-centric approach to diagnosing sleep-disordered breathing. In some male patients with ESS scores < 10, short-acting hypnotics might be considered during in-lab PSG to improve subjective comfort, thereby potentially enhancing study reliability. Meanwhile, home sleep apnea testing can serve as a practical initial tool for selected patients-offering convenience, mitigating the first-night effect, and potentially reducing long wait times. However, its use in individuals with comorbid insomnia requires careful clinical judgment to avoid false-negative results, often making in-lab assessment the preferred option in such cases.