One Negative Polysomnogram Does Not Exclude Obstructive Sleep Apnea

Meyer, Thomas J.; Eveloff, Scott E.; Kline, Lewis R.; Millman, Richard P.

doi:10.1378/chest.103.3.756

Cited by 138 publications

(85 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Secondly, there may be a temporal variability in the intensity of SDB when sleep studies are performed on different nights. In OSA, differences between two polysomnographies carried out within a short time interval are small, although there are some discrepancies in mild cases [27]. In stable congestive heart failure changes of intensity of SDB along the time have not been assessed, although it may be assumed that they may be of a greater magnitude than in OSA since the haemodynamic, symptomatic, and therapeutic profile of congestive heart failure is not static.…”

Section: Discussionmentioning

confidence: 99%

Home respiratory polygraphy for diagnosis of sleep-disordered breathing in heart failure

Quintana‐Gallego

Villa-Gil²,

Carmona-Bernal³

et al. 2004

European Respiratory Journal

View full text Add to dashboard Cite

The present study assessed the usefulness of home cardiorespiratory polygraphy as an alternative to overnight polysomnography for the diagnosis of sleepdisordered breathing in heart failure.A total of 75 patients with chronic stable heart failure due to systolic dysfunction (left ventricular ejection fraction f45%) underwent polysomnography at the Virgen del Rocio Hospital and cardiorespiratory polygraphy at home. The two studies were performed in random order and within 30 days. The accuracy of polygraphical findings was determined by sensitivity and specificity obtained by area under the receiver operating characteristics (ROC) curves for apnoea-hypopnoea index (AHI) thresholds of o5, o10 and o15 in the polysomnography.The area under the ROC curve for AHI o5, o10 and o15 was 0.896, 0.907 and 0.862, respectively. The diagnostic accuracy of polygraphy compared with polysomnography ranged 78.6-84%, with sensitivities of 68.4-82.5%, and specificities of 88.6-97.8% for the different AHI thresholds. Altogether, 29 patients had an AHI o10 (central pattern 24, obstructive pattern 5). Sensitivity and specificity of home polygraphy for identifying the sleep-disordered breathing pattern was 100%.These data show that home cardiorespiratory polygraphy has a high sensitivity and specificity for the diagnosis of sleep-disordered breathing associated with heart failure.

show abstract

Section: Discussionmentioning

confidence: 99%

Home respiratory polygraphy for diagnosis of sleep-disordered breathing in heart failure

Quintana‐Gallego

Villa-Gil²,

Carmona-Bernal³

et al. 2004

European Respiratory Journal

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…To avoid false-negative results of polysomnography due to a "first night effect", all patients were studied for two consecutive nights. Patients with an oAHI of Š10 during the second polysomnographic recording were considered positive for obstructive sleep apnoea [21,22].…”

Section: Diagnosis Of Sleep Apnoeamentioning

confidence: 99%

Obstructive sleep apnoea and diabetes mellitus: the role of cardiovascular autonomic neuropathy

Ficker¹,

Dertinger²,

Siegfried³

et al. 1998

Eur Respir J

121

View full text Add to dashboard Cite

Knowledge of conditions associated with an increased prevalence of obstructive sleep apnoea (OSA) may help to identify patients with OSA and might give some insight into the pathogenesis of OSA and its sequelae. A number of earlier, smaller studies hinted at an association between diabetic cardiovascular autonomic neuropathy (AN) and OSA. The present study was, therefore, conducted with the aim of establishing the prevalence of OSA in diabetics with AN and of determining whether OSA is more prevalent in diabetics with AN, than in those without.We studied two groups of diabetic patients: 23 with and 25 without AN. All patients were evaluated for possible OSA (apnoea/hypopnoea index Š10) using initial ambulatory screening followed by polysomnography.Six patients with AN (26%) were found to have OSA, but none of the patients without AN met the diagnostic criteria (p<0.01). When the patients with OSA were compared to those without, no differences were found in terms of age, sex, body mass index or diabetes type or duration.In conclusion, about one in four diabetic patients with autonomic neuropathy suffers from OSA. Thus, obstructive sleep apnoea is more prevalent in diabetic patients with autonomic neuropathy, than in those without.

show abstract

One Negative Polysomnogram Does Not Exclude Obstructive Sleep Apnea

Cited by 138 publications

References 13 publications

Home respiratory polygraphy for diagnosis of sleep-disordered breathing in heart failure

Home respiratory polygraphy for diagnosis of sleep-disordered breathing in heart failure

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

Obstructive sleep apnoea and diabetes mellitus: the role of cardiovascular autonomic neuropathy

Contact Info

Product

Resources

About