Short-Term Variability in Apnea-Hypopnea Index during Extended Home Portable Monitoring.

STUDY OBJECTIVES Apnea-hypopnea index (AHI) is the primary measure used to confirm a diagnosis of obstructive sleep apnea (OSA). However, there may be significant night-to-night variability (NNV) in AHI, limiting the value of AHI in clinical decision-making related to OSA management. We examined short-term NNV in AHI and its predictors during home portable monitoring (PM). METHODS Single center prospective observational study of patients (n = 84) with newly diagnosed OSA by polysomnography (PSG) AHI ≥ 5/h. All participants underwent 2 to 8 consecutive nights of PM. RESULTS Participants (n = 84) were middle-aged (47 ± 8.3 y, mean ± standard deviation; SD), including 28 women, with mean AHI on baseline PSG (AHIPSG) of 30.1 ± 31.8. Mean AHI on PM (AHIPM) was 27.4 ± 23.7. Intraclass correlation coefficient (ICC) for AHIPM in the entire sample was 0.73 (95% CI 0.66-0.8), indicating that 27% of the variability in AHIPM was due to intra-individual factors. Mild severity of OSA, defined by AHIPSG 5-15/h, was associated with higher NNV (likelihood ratio, -0.4 ± 0.14; p = 0.006) and absence of comorbidity showed a trend towards higher NNV (-0.54 ± 0.27, p = 0.05) on AHIPM. CONCLUSIONS The intraindividual short-term NNV in AHIPM is higher in mild versus moderately severe OSA, even in the home setting, where first-night effect is not expected. Larger studies of NNV focused on patients with mild OSA are needed to identify characteristics that predict need and timing for repeated diagnostic testing and treatment. COMMENTARY A commentary on this article appears in this issue on page 787.

[1]  J. Gangwisch,et al.  A review of evidence for the link between sleep duration and hypertension. , 2014, American journal of hypertension.

[2]  J. Molnar,et al.  The Role of Severity of Obstructive Sleep Apnea Measured by Apnea–Hypopnea Index in Predicting Compliance With Pressure Therapy, a Meta-analysis , 2014, American journal of therapeutics.

[3]  Ronald R Grunstein,et al.  Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. , 2014, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[4]  M. Montagnana,et al.  Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis. , 2014, Chest.

[5]  V. Polotsky,et al.  Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. , 2013, Journal of the American College of Cardiology.

[6]  W. Shen,et al.  Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. , 2013, Journal of the American College of Cardiology.

[7]  Thomas Penzel,et al.  Agreement in the scoring of respiratory events and sleep among international sleep centers. , 2013, Sleep.

[8]  Naresh M Punjabi,et al.  Home sleep testing for obstructive sleep apnea: one night is enough! , 2013, Chest.

[9]  C. Guilleminault,et al.  The impact of sleep duration in obstructive sleep apnea patients , 2013, Sleep and Breathing.

[10]  Greg Maislin,et al.  Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. , 2012, American journal of respiratory and critical care medicine.

[11]  Donald Hedeker,et al.  Modeling between‐subject and within‐subject variances in ecological momentary assessment data using mixed‐effects location scale models , 2012, Statistics in medicine.

[12]  A. Pack,et al.  Reliability of a single objective measure in assessing sleepiness. , 2012, Sleep.

[13]  Kannan Ramar,et al.  Updates on definition, consequences, and management of obstructive sleep apnea. , 2011, Mayo Clinic proceedings.

[14]  K. To,et al.  Validation of Embletta portable diagnostic system for identifying patients with suspected obstructive sleep apnoea syndrome (OSAS) , 2010, Respirology.

[15]  D. Normolle,et al.  Reliability and reproducibility of clinic and home blood pressure measurements in hypertensive women according to age and ethnicity , 2009, Blood pressure monitoring.

[16]  Djordje Popovic,et al.  International Archives of Medicine the Impact of Obstructive Sleep Apnea Variability Measured In-lab versus In-home on Sample Size Calculations , 2022 .

[17]  Negar Ahmadi,et al.  Clinical diagnosis of sleep apnea based on single night of polysomnography vs. two nights of polysomnography , 2009, Sleep and Breathing.

[18]  Daniel J. Levendowski,et al.  Assessment of the test–retest reliability of laboratory polysomnography , 2009, Sleep and Breathing.

[19]  D. Gozal,et al.  Daytime sleepiness and polysomnography in obstructive sleep apnea patients. , 2008, Sleep medicine.

[20]  David Cunnington,et al.  Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function. , 2008, European heart journal.

[21]  T. Young,et al.  Sleep-disordered breathing and psychomotor vigilance in a community-based sample. , 2007, Sleep.

[22]  M. Littner,et al.  Mild obstructive sleep apnea syndrome should not be treated. Con. , 2007, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[23]  Medical Advisory Secretariat.  Polysomnography in patients with obstructive sleep apnea: an evidence-based analysis. , 2006, Ontario health technology assessment series.

[24]  Carl J Stepnowsky,et al.  Nightly Variability of Sleep-Disordered Breathing Measured over 3 Nights , 2004, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[25]  Giuseppe Curcio,et al.  Paradoxes of the first-night effect: a quantitative analysis of antero-posterior EEG topography , 2004, Clinical Neurophysiology.

[26]  A. Pack,et al.  Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. , 2003, Sleep.

[27]  N J Douglas,et al.  The effect of in-laboratory polysomnography on sleep and objective daytime sleepiness. , 2000, Sleep.

[28]  A Noseda,et al.  Mild to moderate sleep respiratory events: one negative night may not be enough. , 2000, Chest.

[29]  T. Rice,et al.  Reproducibility of resting blood pressure and heart rate measurements. The HERITAGE Family Study. , 2000, Annals of epidemiology.

[30]  Erry,et al.  Prospective study of the association between sleep-disordered breathing and hypertension. , 2000, The New England journal of medicine.

[31]  A. Smiley,et al.  Sleep apnea & automobile crashes. , 1999, Sleep.

[32]  Daniel J Buysse,et al.  Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. , 1999, Sleep.

[33]  H. Davis,et al.  Hour-to-hour variability of oxygen saturation in sleep apnea. , 1998, Chest.

[34]  A. Chediak,et al.  Nightly variability in the indices of sleep-disordered breathing in men being evaluated for impotence with consecutive night polysomnograms. , 1996, Sleep.

[35]  M. Johns,et al.  Sleepiness in different situations measured by the Epworth Sleepiness Scale. , 1994, Sleep.

[36]  S. Redline,et al.  Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device. , 1991, Chest.

[37]  D. Bliwise,et al.  Factors associated with nightly variability in sleep-disordered breathing in the elderly. , 1991, Chest.

[38]  N. Saunders,et al.  Night-to-night variability of disturbed breathing during sleep in an elderly community sample. , 1991, Sleep.

[39]  P. Cowen,et al.  Evaluation of first night effect using ambulatory monitoring and automatic sleep stage analysis. , 1988, Sleep.

[40]  T. Roth,et al.  Night-to-night consistency of apneas during sleep. , 1984, The American review of respiratory disease.