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CC BY-NC-ND 4.0 · Sleep Sci 2018; 11(01): 28-33
DOI: 10.5935/1984-0063.20180007
ORIGINAL ARTICLE

Reproducibility and predictors of the apnea hypopnea index across multiple nights

Authors

  • Hisham Alshaer

    1   Sleep Research Laboratory and Home & Community Team, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.

  • Clodagh Ryan

    2   Department of Medicine, University of Toronto and Sleep Research Laboratory of the Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.

  • Geoff R Fernie

    3   Department of Surgery, University of Toronto, and Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.

  • T. Douglas Bradley

    4   Sleep Research Laboratories of the Toronto Rehabilitation Institute and Toronto General Hospital, University Health Network, Toronto, ON, Canada. Centre for Sleep Medicine and Circadian Biology of the University of Toronto, Toronto, ON, Canada.
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Background: Attended polysomnography (PSG) is the standard diagnostic test for sleep apnea (SA). However, due to internight variability in SA, a single night PSG may not accurately reflect the true severity of SA. Although internight variability is a well-known phenomenon, its root causes have not been fully elucidated. The objective of this study was to determine factors associated with internight variability in the apnea-hypopnea index (AHI) and its magnitude in the home environment.

Methods: Each participant had a full overnight PSG simultaneous with a validated portable sleep apnea monitoring device (BresoDx®) followed by two overnight home tests using the portable monitor only. Patients were stratified into those with variable AHI and consistent AHI (AHI difference ≥10 or <10 between any 2 nights, respectively). Demographics, sleepiness, sleep test variable, and supine-predominant SA (supine-SA) were examined for any association with variable AHI.

Results: Forty patients completed the protocol. The correlation between PSG and simultaneous BresoDx derived AHIs was 93.4%. Inter-class correlation between the three nights’ AHIs was 89.2%. Over two-thirds (67.5%) of patients had consistent AHIs across the three nights while 32.5% had variable AHI. AHI variability was significantly associated with supine-SA (p=0.0014) and correlated with first night’s AHI (r=0.664,p<0.001). None of the other variable, including BMI, sleepiness, gender, or test duration were associated with internight variability.

Conclusion: Although portable monitoring was highly reproducible over three nights in the majority of participants, one third had a variable AHI. Supine-SA and high AHI on the first night were predictors of high internight variability.

Supine Position - Sleep Apnea Syndromes - Sleep Monitoring


Publication History

Received: 19 October 2017

Accepted: 22 January 2018

Article published online:
13 October 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230-5. PMID: 8464434 DOI: http://dx.doi.org/10.1056/NEJM199304293281704
  • 2 Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14. PMID: 23589584 DOI: http://dx.doi.org/10.1093/aje/kws342
  • 3 Ward KL, Hillman DR, James A, Bremner AP, Simpson L, Cooper MN, et al. Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea. J Clin Sleep Med. 2013;9(10):1013-21. DOI: http://dx.doi.org/10.5664/jcsm.3072
  • 4 Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep. 1997;20(8):608-13. DOI: http://dx.doi.org/10.1093/sleep/20.8.608
  • 5 Bradley TD, Floras JS. Sleep apnea and heart failure: Part I: obstructive sleep apnea. Circulation. 2003;107(12):1671-8. PMID: 12668504 DOI: http://dx.doi.org/10.1161/01.CIR.0000061757.12581.15
  • 6 Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172(11):1447-51. PMID: 16141444 DOI: http://dx.doi.org/10.1164/rccm.200505-702OC
  • 7 Bliwise DL, Benkert RE, Ingham RH. Factors associated with nightly variability in sleep-disordered breathing in the elderly. Chest. 1991;100(4):973-6. DOI: http://dx.doi.org/10.1378/chest.100.4.973
  • 8 Chediak AD, Acevedo-Crespo JC, Seiden DJ, Kim HH, Kiel MH. Nightly variability in the indices of sleep-disordered breathing in men being evaluated for impotence with consecutive night polysomnograms. Sleep. 1996;19(7):589-92. DOI: http://dx.doi.org/10.1093/sleep/19.7.589
  • 9 Cartwright RD. Effect of sleep position on sleep apnea severity. Sleep. 1984;7(2):110-4. DOI: http://dx.doi.org/10.1093/sleep/7.2.110
  • 10 Kavey NB, Blitzer A, Gidro-Frank S, Korstanje K. Sleeping position and sleep apnea syndrome. Am J Otolaryngol. 1985;6(5):373-7. DOI: http://dx.doi.org/10.1016/S0196-0709(85)80015-6
  • 11 Berry R, Brooks R, Gamaldo C, Harding S, Lloyd R, Marcus C, et al. Respiratory Rules for Adults. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.2. Darien: American Academy of Sleep Medicine; 2015. p. 50-6. DOI: http://dx.doi.org/10.5664/jcsm.4618
  • 12 White LH, Lyons OD, Yadollahi A, Ryan CM, Bradley TD. Effect of below-the-knee compression stockings on severity of obstructive sleep apnea. Sleep Med. 2015;16(2):258-64. DOI: http://dx.doi.org/10.1016/j.sleep.2014.12.005
  • 13 Alshaer H, Levchenko A, Bradley TD, Pong S, Tseng WH, Fernie GR. A system for portable sleep apnea diagnosis using an embedded data capturing module. J Clin Monit Comput. 2013;27(3):303-11. DOI: http://dx.doi.org/10.1007/s10877-013-9435-8
  • 14 Alshaer H, Fernie GR, Maki E, Bradley TD. Validation of an automated algorithm for detecting apneas and hypopneas by acoustic analysis of breath sounds. Sleep Med. 2013;14(6):562-71. DOI: http://dx.doi.org/10.1016/j.sleep.2012.12.015
  • 15 Alshaer H, Fernie GR, Tseng WH, Bradley TD. Comparison of in-laboratory and home diagnosis of sleep apnea using a cordless portable acoustic device. Sleep Med. 2016;22:91-6. DOI: http://dx.doi.org/10.1016/j.sleep.2015.11.003
  • 16 Bittencourt LR, Suchecki D, Tufik S, Peres C, Togeiro SM, Bagnato MC, et al. The variability of the apnoea-hypopnoea index. J Sleep Res. 2001;10(3):245-51. DOI: http://dx.doi.org/10.1046/j.1365-2869.2001.00255.x
  • 17 Levendowski DJ, Zack N, Rao S, Wong K, Gendreau M, Kranzler J, et al. Assessment of the test-retest reliability of laboratory polysomnography. Sleep Breath. 2009;13(2):163-7. DOI: http://dx.doi.org/10.1007/s11325-008-0214-6
  • 18 Aber WR, Block AJ, Hellard DW, Webb WB. Consistency of respiratory measurements from night to night during the sleep of elderly men. Chest. 1989;96(4):747-51. DOI: http://dx.doi.org/10.1378/chest.96.4.747
  • 19 Quan SF, Griswold ME, Iber C, Nieto FJ, Rapoport DM, Redline S, et al.; Sleep Heart Health Study (SHHS) Research Group. Short-term variability of respiration and sleep during unattended nonlaboratory polysomnography--the Sleep Heart Health Study. [corrected]. Sleep. 2002;25(8):843-9.
  • 20 Le Bon O, Hoffmann G, Tecco J, Staner L, Noseda A, Pelc I, et al. Mild to moderate sleep respiratory events: one negative night may not be enough. Chest. 2000;118(2):353-9. DOI: http://dx.doi.org/10.1378/chest.118.2.353
  • 21 Prasad B, Usmani S, Steffen AD, Van Dongen HP, Pack FM, Strakovsky I, et al. Short-Term Variability in Apnea-Hypopnea Index during Extended Home Portable Monitoring. J Clin Sleep Med. 2016;12(6):855-63. DOI: http://dx.doi.org/10.5664/jcsm.5886