Michelle R Zeidler1,2, Vicente Santiago3, Joseph M Dzierzewski2,4, Michael N Mitchell4, Silverio Santiago1, Jennifer L Martin2,4. 1. VA Greater Los Angeles Healthcare System, Pulmonary/Critical Care and Sleep Medicine. 2. David Geffen School of Medicine at the University of California, Los Angeles. 3. VA Central California Healthcare System and University of California, San Francisco Fresno Medical Education Program. 4. VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center.
Abstract
STUDY OBJECTIVES: Home sleep testing (HST) is an accepted alternative to polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA) in high-risk populations. Clinical guidelines recommend PSG in cases where the HST is technically inadequate (TI) or fails to establish the diagnosis of OSA in patients with high pretest probability. This retrospective study evaluated predictors of OSA on PSG within patients who had a TI or normal HST. METHODS: Electronic medical records were reviewed on 1,157 patients referred for HST at our sleep center. Two hundred thirty-eight patients had a TI or normal HST with subsequent PSG. Age, BMI, Epworth score, HST result, and PSG-based apnea-hypopnea index (AHI) were abstracted. RESULTS: Two hundred thirty-eight consecutive patients with either a normal HST (n = 127) or TI HST (n = 111) underwent subsequent PSG. Of 127 who had a normal HST, 76% had a normal PSG and 24% had OSA (23 mild, 6 moderate, 1 severe). Of 111 who had a TI HST, 29% had a normal PSG and 71% had OSA (43 mild, 19 moderate, 17 severe). Individuals younger than 50 years old with a normal HST were more likely to have a normal PSG. Older age predicted diagnosis of OSA on PSG among individuals with a TI HST. CONCLUSION: In this retrospective analysis of a clinical sample, when the HST is interpreted as normal in a younger patient population, the subsequent PSG is likewise normal in majority of the patients, although significant OSA is sometimes discovered. When a HST is read as TI, the majority of patients have OSA.
STUDY OBJECTIVES: Home sleep testing (HST) is an accepted alternative to polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA) in high-risk populations. Clinical guidelines recommend PSG in cases where the HST is technically inadequate (TI) or fails to establish the diagnosis of OSA in patients with high pretest probability. This retrospective study evaluated predictors of OSA on PSG within patients who had a TI or normal HST. METHODS: Electronic medical records were reviewed on 1,157 patients referred for HST at our sleep center. Two hundred thirty-eight patients had a TI or normal HST with subsequent PSG. Age, BMI, Epworth score, HST result, and PSG-based apnea-hypopnea index (AHI) were abstracted. RESULTS: Two hundred thirty-eight consecutive patients with either a normal HST (n = 127) or TI HST (n = 111) underwent subsequent PSG. Of 127 who had a normal HST, 76% had a normal PSG and 24% had OSA (23 mild, 6 moderate, 1 severe). Of 111 who had a TI HST, 29% had a normal PSG and 71% had OSA (43 mild, 19 moderate, 17 severe). Individuals younger than 50 years old with a normal HST were more likely to have a normal PSG. Older age predicted diagnosis of OSA on PSG among individuals with a TI HST. CONCLUSION: In this retrospective analysis of a clinical sample, when the HST is interpreted as normal in a younger patient population, the subsequent PSG is likewise normal in majority of the patients, although significant OSA is sometimes discovered. When a HST is read as TI, the majority of patients have OSA.
Authors: W Ward Flemons; Michael R Littner; James A Rowley; Peter Gay; W McDowell Anderson; David W Hudgel; R Douglas McEvoy; Daniel I Loube Journal: Chest Date: 2003-10 Impact factor: 9.410
Authors: Indira Gurubhagavatula; Greg Maislin; Jonathan E Nkwuo; Allan I Pack Journal: Am J Respir Crit Care Med Date: 2004-05-13 Impact factor: 21.405
Authors: Samuel T Kuna; Indira Gurubhagavatula; Greg Maislin; Sakhena Hin; Kathryn C Hartwig; Sue McCloskey; Robert Hachadoorian; Sharon Hurley; Rajesh Gupta; Bethany Staley; Charles W Atwood Journal: Am J Respir Crit Care Med Date: 2011-01-21 Impact factor: 21.405
Authors: Nancy A Collop; W McDowell Anderson; Brian Boehlecke; David Claman; Rochelle Goldberg; Daniel J Gottlieb; David Hudgel; Michael Sateia; Richard Schwab Journal: J Clin Sleep Med Date: 2007-12-15 Impact factor: 4.062
Authors: Matthew P Light; Thalia N Casimire; Catherine Chua; Viachaslau Koushyk; Omar E Burschtin; Indu Ayappa; David M Rapoport Journal: Sleep Breath Date: 2018-10-11 Impact factor: 2.816
Authors: Robert Stretch; Armand Ryden; Constance H Fung; Joanne Martires; Stephen Liu; Vidhya Balasubramanian; Babak Saedi; Dennis Hwang; Jennifer L Martin; Nicolás Della Penna; Michelle R Zeidler Journal: J Clin Sleep Med Date: 2019-11-15 Impact factor: 4.062
Authors: Marcello Di Pumpo; Mario Cesare Nurchis; Antonio Moffa; Lucrezia Giorgi; Lorenzo Sabatino; Peter Baptista; Lorenzo Sommella; Manuele Casale; Gianfranco Damiani Journal: Sleep Breath Date: 2021-11-26 Impact factor: 2.655
Authors: Jeremy R Tietjens; David Claman; Eric J Kezirian; Teresa De Marco; Armen Mirzayan; Bijan Sadroonri; Andrew N Goldberg; Carlin Long; Edward P Gerstenfeld; Yerem Yeghiazarians Journal: J Am Heart Assoc Date: 2019-01-08 Impact factor: 5.501