Download PDF
CC BY-NC-ND 4.0 · Sleep Sci 2023; 16(03): e310-e316
DOI: 10.1055/s-0043-1772809
Original Article

Nocturnal Polysomnography without Technical Supervision in the Diagnosis of Respiratory Sleep Disorders, Diagnostic Performance of Home and Sleep Laboratory Studies

María Florencia Angellotti
1   Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
,
Sofía Grandval
2   Instituto Argentino de Investigación Neurológica, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
,
Ileana Palma 
1   Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
,
Vanina Giovini
1   Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
,
Verónica Jaritos
1   Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
,
Gastón Diaz-Lapasini
1   Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
,
Denise Carnevale
1   Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
,
Juan Facundo Nogueira
1   Hospital de Clínicas, Universidad de Buenos Aires, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
2   Instituto Argentino de Investigación Neurológica, Sleep Laboratory, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Unattended Polysomnography (type 2 PSG) is a procedure for the diagnosis of sleep-disordered breathing (SDB). Published evidence on its performance and efficacy is limited. Available studies reveal a high rate of lost records that could limit its application.

Objective To assess the efficacy of type 2 PSG and the rate of studies that must be repeated due to critical loss of signals.

Methods prospective, descriptive study. Adult patients with suspected SDB were included. Unattended PSG was performed using portable equipment. 75 patients were connected at home and another 75 in the laboratory, without subsequent monitoring. Records were evaluated to determine the percentage of the night with adequate quality for each of the signals, considered as an evaluable signal for = 70% of the total recording time (TRT). The need to repeat the studies was also estimated. Results: 150 patients were recruited; 44% women; age 57.3 ± 15.4 years; BMI 29.4 ± 6.5. EEG and EOG signals were adequate in 149 records. Flow signal by pressure cannula was adequate in 146 and by thermistor in 67.8%. In only one study the signal of both effort bands were inadequate. Oximetry was lost in 4 cases. Ten tracings (6%) met the criteria for repetition; 8 hospital and 2 home.

Conclusions Acceptable records were obtained in most unattended PSG studies, both at home and in the sleep laboratory. The rate of repetition of studies due to loss of signal was 6%, with failure in SaO2 or in flow signals being the main cause of the indication.

Keywords

sleep apnea - obstructive - polysomnography - monitoring - ambulatory - home care services - hospital based


Publication History

Received: 27 July 2022

Accepted: 13 December 2022

Article published online:
11 September 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/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Grupo Español de Sueño (GES). Consenso Nacional sobre el síndrome de apneas-hiponeas del sueño. Arch Bronconeumol 2005; 41 (Suppl. 04) 12-29
    Google Scholar
  • 2 Kapur VK, Auckley DH, Chowdhuri S. et al. Clinical practice guideline for diagnostic testing for adults with obstructive sleep apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13 (03) 479-504
    CrossrefPubMedGoogle Scholar
  • 3 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) 1230-1235
    CrossrefPubMedGoogle Scholar
  • 4 Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men. Am J Respir Crit Care Med 2004; 169 (02) 168-173
    CrossrefPubMedGoogle Scholar
  • 5 Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med 2010; 11 (05) 441-446
    CrossrefPubMedGoogle Scholar
  • 6 Heinzer R, Vat S, Marques-Vidal P. et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015; 3 (04) 310-318
    CrossrefPubMedGoogle Scholar
  • 7 Portier F, Portmann A, Czernichow P. et al. Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome. Am J Respir Crit Care Med 2000; 162 (3 Pt 1): 814-818
    CrossrefPubMedGoogle Scholar
  • 8 Bruyneel M, Ninane V. Unattended home-based polysomnography for sleep disordered breathing: current concepts and perspectives. Sleep Med Rev 2014; 18 (04) 341-347
    CrossrefPubMedGoogle Scholar
  • 9 Mykytyn IJ, Sajkov D, Neill AM, McEvoy RD. Portable computerized polysomnography in attended and unattended settings. Chest 1999; 115 (01) 114-122
    CrossrefPubMedGoogle Scholar
  • 10 Kapur VK, Rapoport DM, Sanders MH. et al. Rates of sensor loss in unattended home polysomnography: the influence of age, gender, obesity, and sleep-disordered breathing. Sleep 2000; 23 (05) 682-688
    PubMedGoogle Scholar
  • 11 Bruyneel M, Sanida C, Art G. et al. Sleep efficiency during sleep studies: results of a prospective study comparing home-based and in-hospital polysomnography. J Sleep Res 2011; 20 (1 Pt 2): 201-206
    CrossrefPubMedGoogle Scholar
  • 12 Nogueira JF, Borsini E, Cambursando H. et al. Guías prácticas de diagnóstico y tratamiento del síndrome de apneas e hiponeas obstructivas del sueño: actualización 2019. RAMR 2019; 1: 59-90
    Google Scholar
  • 13 Nilius G, Domanski U, Schroeder M. et al. A randomized controlled trial to validate the Alice PDX ambulatory device. Nat Sci Sleep 2017; 9: 171-180
    CrossrefPubMedGoogle Scholar
  • 14 Collop NA, Tracy SL, Kapur V. et al. Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med 2011; 7 (05) 531-548
    CrossrefPubMedGoogle Scholar
  • 15 Berry R, Brooks R, Gamaldo C. et al. The AASM manual for the scoring of sleep and associated events. Version 2.2. American Academy of Sleep Medicine; 2015
    Google Scholar
  • 16 Di Rienzo JA. et al. InfoStat versión 2018. Grupo InfoStat, FCA, Universidad Nacional de Córdoba, Argentina: www.infostat.com.ar
    Google Scholar
  • 17 Iber C, Redline S, Kaplan Gilpin AM. et al. Polysomnography performed in the unattended home versus the attended laboratory setting–Sleep Heart Health Study methodology. Sleep 2004; 27 (03) 536-540
    CrossrefPubMedGoogle Scholar
  • 18 Campbell AJ, Neill AM. Home set-up polysomnography in the assessment of suspected obstructive sleep apnea. J Sleep Res 2011; 20 (1 Pt 2): 207-213
    CrossrefPubMedGoogle Scholar
  • 19 Bruyneel M, Libert W, Ameye L, Ninane V. Comparison between home and hospital set-up for unattended home-based polysomnography: a prospective randomized study. Sleep Med 2015; 16 (11) 1434-1438
    CrossrefPubMedGoogle Scholar
  • 20 Fry JM, DiPhillipo MA, Curran K, Goldberg R, Baran AS. Full polysomnography in the home. Sleep 1998; 21 (06) 635-642
    CrossrefPubMedGoogle Scholar