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 shortterm 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 (AHI PSG ) of 30.1 ± 31.8. Mean AHI on PM (AHI PM ) was 27.4 ± 23.7. Intraclass correlation coefficient (ICC) for AHI PM in the entire sample was 0.73 (95% CI 0.66-0.8), indicating that 27% of the variability in AHI PM was due to intra-individual factors. Mild severity of OSA, defined by AHI PSG 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 AHI PM . Conclusions:The intraindividual short-term NNV in AHI PM 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.

Purpose: To determine whether acute kidney injury (AKI) is identified within the US Food and Drug Administration's Adverse Events and Reporting System (FDA AERS) as an adverse event resulting from bisphosphonate (BP) use in cancer therapy. Methods:A search of the FDA AERS records from January 1998 through June 2009 was performed; search terms were "renal problems" and all drug names for BPs. The search resulted in 2,091 reports. We analyzed for signals of disproportional association by calculating the proportional reporting ratio for zoledronic acid (ZOL) and pamidronate. Literature review of BP-associated renal injury within the cancer setting was conducted.Results: Four hundred eighty cases of BP-associated acute kidney injury (AKI) were identified in patients with cancer. Two hundred ninety-eight patients (56%) were female; mean age was 66 Ϯ 10 years. Multiple myeloma (n ϭ 220, 46%), breast cancer (n ϭ 98, 20%), and prostate cancer (n ϭ 24, 5%) were identified. Agents included ZOL (n ϭ 411, 87.5%), pamidronate (n ϭ 8, 17%), and alendronate (n ϭ 36, 2%). Outcomes included hospitalization (n ϭ 304, 63.3%) and death (n ϭ 68, 14%). The proportional reporting ratio for ZOL was 1.22 (95% CI, 1.13 to 1.32) and for pamidronate was 1.55 (95% CI, 1.25 to 1.65), reflecting a nonsignificant safety signal for both drugs.

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