Chest
Clinical InvestigationsOne Negative Polysomnogram Does Not Exclude Obstructive Sleep Apnea
Section snippets
Patients
All patients were examined in the Rhode Island Hospital Sleep Disorders Center for suspected OSA between 1989 and 1991. Baseline blood pressure, height, and weight were obtained on the initial clinical evaluation prior to the first sleep study. Based on clinical criteria defined by Crocker et al8 patients were believed to have significant risk for OSA if they fulfilled one or more of the following: (1) a history of witnessed apneas, (2) the presence of hypertension, and (3) an increased BMI.
RESULTS
As shown in Figure 1, 6 of the 11 patients in this study (group A) had a positive second night study with a mean AHI of 19.8 ± 4.7 (mean ± SEM) compared with a first night AHI of 3.1 ± 1.0 (p<0.05). The remaining five patients (group B) had a negative second night study with no significant increase in AHI between the first and second nights (1.1 ± 0.6 and 2.4 ± 0.7, respectively). The first and second night apnea indices (AI) for group A were 1.4 ± 0.9 and 5.5 ± 2.3 (p = 0.21), respectively,
DISCUSSION
The results of this study clearly demonstrate that a single negative sleep study is insufficient to exclude OSA in patients with one or more clinical markers for the disease. It is not clearly apparent, however, why one group of patients developed a positive second night study, and the other group did not. The two groups of patients in this study were similar with respect to age, risk factor pattern, and test interval. There were also no significant differences in sleep architecture within each
CONCLUSION
Overnight polysomnography is the diagnostic gold standard for OSA. However, it is known that night-to-night variability in apneas exists in patients with documented OSA, raising the possibility of missing the diagnosis of this serious disease. Our prospective study shows that a significant number of patients with OSA can be missed with one study alone. These patients all presented with significant predictive clinical risk factors for OSA. Reasons for a negative first study are not readily
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Cited by (132)
Night-to-night variability in respiratory sleep parameters to diagnose obstructive sleep apnea in children: A systematic review and meta-analysis
2022, International Journal of Pediatric OtorhinolaryngologyThe Accuracy of Repeated Sleep Studies in OSA: A Longitudinal Observational Study With 14 Nights of Oxygen Saturation Monitoring
2021, ChestCitation Excerpt :Our current data confirmed these findings in a cohort of CPAP-naïve patients with suspected OSA, showing a change in OSA severity in 76% of patients over 14 nights using the highest ODI3%. The intraindividual variability of our cohort measured by CV was similarly high (32%) and comparable with the results reported by Stöberl et al.3 Only few data are available in literature that address the change in accuracy in relationship to different numbers of sleep studies in the diagnostic workup of OSA.4,12,25 These studies are limited by their small patient numbers, lack of a priori power calculations, and poor comparability because of different study designs.
Night-to-night variability of the obstructive sleep apnoea-hypopnoea syndrome
2016, Revue des Maladies Respiratoires
Manuscript received April 24; revision accepted July 30