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Obstructive Sleep Apnea & Home Testing

Am J Med; ePub 2016 Mar 8; Aurora, Putcha, et al

Publish date:: March 22, 2016

Home sleep testing reliably identified obstructive sleep apnea in a study of 191 community-based adults, over half (56.5%) of whom had obstructive sleep apnea. The study sought to assess if obstructive sleep apnea can be diagnosed with home sleep testing in a non-referred sample without involvement of a sleep medicine specialist. Researchers found:

• Without involvement of a sleep medicine specialist, obstructive sleep apnea was not identified in only 5.8% of the study sample.

• 32 participants (16.8%) were misclassified in analyses comparing the categorical assessment of disease severity with and without a sleep medicine specialist.

• Agreement in disease severity with and without a sleep medicine specialist was not influenced by the pretest probability or daytime sleep tendency.

Citation: Aurora RN, Putcha N, Swartz R, Punjabi NM. Agreement between results of home sleep testing for obstructive sleep apnea with and without a sleep specialist. [Published online ahead of print March 8, 2016]. Am J Med. doi:http://dx.doi.org/10.1016/j.amjmed.2016.02.015.

Commentary: Obstructive sleep apnea (OSA) is defined by daytime sleepiness, snoring and apnea, along with at least 5 obstructive respiratory events per hour of sleep, or >15 apneic events per hour in the absence of symptoms. High-risk patients include individuals who are obese, have CHF, atrial fibrillation, resistant hypertension, type 2 diabetes, stroke, nocturnal dysrhythmias, or pulmonary hypertension. Physical features that increase the probability of OSA include BMI >30 and neck circumference >17 inches in men and 16 inches in women. Guidelines from the American Academy of Sleep Medicine suggest that portable home monitors underestimate the severity of hypopneic events compared to a full evaluation with polysomnography.¹ The results of this study support that conclusion. Home monitoring seems to be a reasonable option in patients with a low pre-test probability of OSA, and full polysomnography would be preferable in those with a high likelihood of OSA. —Neil Skolnik, MD

1. Epstein LJ , et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263- 276.

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