Assessment of the test–retest reliability of laboratory polysomnography

Levendowski, Daniel J.; Zack, Nadene; Rao, Srinivas G.; Wong, Keith; Gendreau, Michael; Kranzler, Jay D; Zavora, Timothy; Westbrook, Philip R.

doi:10.1007/s11325-008-0214-6

Cited by 111 publications

(69 citation statements)

References 12 publications

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“…[1][2][3][4] We found that 35% of patients had a change in AHI between PSGs of greater than 10, which is comparable to the only other study assessing AHI variability over non-consecutive nights, in which 30% of patients had a change in AHI of greater than 10 between PSGs performed one month apart.…”

Section: Fluid Shift and Sleep Apnea Variabilitysupporting

confidence: 79%

“…Previous studies found a change in the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI) greater than 10 in 18% to 65% of patients undergoing polysomnograms (PSGs) on consecutive nights or one month apart. [1][2][3][4] Furthermore, in one study, 50% of patients undergoing consecutive night PSGs met criteria for OSA diagnosis (AHI ≥ 10) on one PSG but not on the other. 3 Few studies have examined the reasons for this AHI variability.…”

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confidence: 98%

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Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift

White

Lyons

Yadollahi

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: Overnight rostral fl uid shift from the legs to the neck may narrow the pharynx and contribute to obstructive sleep apnea (OSA) pathogenesis. We hypothesized that night-to-night changes in the apneahypopnea index (AHI) would be associated with changes in overnight rostral fl uid shift. Methods: Twenty-six patients with OSA (AHI ≥ 10) underwent two polysomnograms 14 days apart with measurement of neck and leg fl uid volumes (LFV), neck circumference and upper-airway cross-sectional area before and after sleep. Results: Although mean AHI did not differ between polysomnograms, 35% of patients had a difference in AHI > 10, indicating signifi cant intra-individual variability. There were direct correlations between change in non-rapid-eye movement (NREM), but not REM AHI and change in evening LFV between polysomnograms (r = 0.440, p = 0.036 and r = 0.005, p = 0.982, respectively) and between change in supine, but not non-supine AHI and change in evening LFV (r = 0.483, p = 0.020 and r = 0.269, p = 0.280, respectively). An increase in evening LFV between polysomnograms was associated with a greater overnight decrease in LFV (r = 0.560, p = 0.005) and a greater overnight increase in neck fl uid volume (r = 0.498, p = 0.016). Additionally, a greater overnight increase in neck circumference was associated with a greater overnight increase in neck fl uid volume between polysomnograms (r = 0.453, p = 0.020) and a greater overnight decrease in upperairway cross-sectional area (r = −0.587, p = 0.005). Conclusion: Intra-individual variability in OSA severity may be partly explained by day-to-day changes in evening leg fl uid volume and overnight rostral fl uid shift, which may be most important in the pathogenesis of OSA during NREM and supine sleep. S C I E N T I F I C I N V E S T I G AT I O N S BRIEF SUMMARYCurrent Knowledge/Study Rationale: Overnight rostral fl uid shift from the legs to the neck may narrow the upper airway and contribute to obstructive sleep apnea (OSA) pathogenesis. Intra-individual night-tonight variability in OSA severity may relate to night-to-night variations in overnight rostral fl uid shift. Study Impact: This study found that intra-individual variability in OSA severity may be partly explained by day-to-day changes in evening leg fl uid volume and overnight rostral fl uid shift, which may be most important in the pathogenesis of OSA during NREM and supine sleep. S everity of obstructive sleep apnea (OSA) can vary considerably from night to night, but the reasons for this are unclear. Previous studies found a change in the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI) greater than 10 in 18% to 65% of patients undergoing polysomnograms (PSGs) on consecutive nights or one month apart. [1][2][3][4] Furthermore, in one study, 50% of patients undergoing consecutive night PSGs met criteria for OSA diagnosis (AHI ≥ 10) on one PSG but not on the other. Few studies have examined the reasons for this AHI variability. While one study found increased variabi...

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Section: Fluid Shift and Sleep Apnea Variabilitysupporting

confidence: 79%

mentioning

confidence: 98%

Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift

White

Lyons

Yadollahi

et al. 2015

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

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“…The second night of recording often has a higher AHI and is diagnostic of OSA in 15-25% of patients who had a negative initial polysomnogram. [14][15][16][17] In our sleep laboratory, we often see patients who present with symptoms suggestive of OSA. If the first PSG, using a thermal sensor and a nasal pressure transducer to measure airflow, does not show OSA, these patients may be referred for a second night of recording with Pes.…”

Section: Brief Summarymentioning

confidence: 99%

“…When OSA is defined as an AHI greater than 5, 44% of patients were negative for OSA based on a single-night PSG and in whom OSA was diagnosed on repeat testing consistent with other findings on night-to-night variability in SDB. [14][15][16][17]21 Night-to-night variability may be especially significant on patients with overall mild OSA, when even small changes in the number of respiratory events may increase AHI above the diagnostic threshold of 5. However, our sample was not a random sample, but rather a sample of subjects whose treating provider had a high suspicion for OSA, therefore increasing the pretest probability of a positive study.…”

Section: Night-to-night Variabilitymentioning

confidence: 99%

Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea

Skiba

Goldstein

Schotland

2015

Journal of Clinical Sleep Medicine

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Study Objective: Esophageal manometry (Pes) is the gold standard to detect repetitive episodes of increased respiratory effort followed by arousal (RERAs). Because RERAs are not included in the apnea-hypopnea index (AHI), we often refer patients with symptoms of sleep disordered breathing (SDB) and AHI < 5 for a second polysomnogram (PSG) with Pes. Often, the second PSG will demonstrate AHI > 5, confi rming a diagnosis of OSA. We speculate that in most cases of suspected SDB, Pes does not add further diagnostic data and that night-to-night variability in OSA severity results in a fi rst false-negative study. Methods: We conducted a retrospective review of PSGs between 2008 and 2012 in adults with initial PSG negative for OSA followed by a second study (with or without Pes) within 6 mo. Results: Of 125 studies that met inclusion criteria, a second study was completed with Pes in 105 subjects. SDB was diagnosed in 73 subjects (68.5%) completing a second PSG with Pes: 49 (46.7%) received a diagnosis based on AHI, and 24 (22.8%) received a diagnosis based on Pes (p = 0.003). There were no statistically signifi cant differences in the mean AHI change between the two PSGs in subjects who completed the second study with or without Pes. Conclusions:In patients with symptoms of SDB and initial PSG with AHI < 5, the majority met criteria for OSA on second PSG by AHI without additional information added by Pes. Because Pes is not widely available and is somewhat invasive, a repeat study without Pes may be suffi cient to diagnose SDB. Keywords: obstructive sleep apnea, polysomnography, sleep apnea/hypopnea syndrome, sleep disordered breathing, upper airway resistance sleep apnea syndrome Citation: Skiba V, Goldstein C, Schotland H. Night-to-night variability in sleep disordered breathing and the utility of esophageal pressure monitoring in suspected obstructive sleep apnea.

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“…BMI and waist circumference provide estimates of generalised and central obesity, but do not account for fat mass. Furthermore, inherent night-to-night sleep variability can lead to fluctuations in AHI [14], and differences in physical activity level affects insulin action. Finally, cross-sectional studies do not identify cause-and-effect relationships.…”

Section: −2mentioning

confidence: 99%

Comparison of the association with sleep apnoea of obesityversusinsulin resistance

et al. 2015

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Assessment of the test–retest reliability of laboratory polysomnography

Cited by 111 publications

References 12 publications

Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift

Night-to-night Variability in Obstructive Sleep Apnea Severity: Relationship to Overnight Rostral Fluid Shift

Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea

Comparison of the association with sleep apnoea of obesityversusinsulin resistance

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