Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
J Clin Sleep Med. 2021 Sep 1;17(9):1751-1758. doi: 10.5664/jcsm.9300.
Night-to-night variability of obstructive sleep apnea severity is considerable and may depend on the diagnostic modality used. We investigated the night-to-night variability using peripheral arterial tonometry (PAT).
Home sleep apnea testing was performed in 51 patients during 3 consecutive nights using PAT. Patients referred to our sleep clinic were screened and prospectively recruited for this study. All recordings were automatically and manually scored according to the PAT scoring guidelines.
No systematic differences in PAT-derived apnea-hypopnea index (pAHI) were found between the nights. The night-to-night variability was comparable between manually and automatically scored data. pAHI varied in 35% of patients more than 10 events/h between the nights. The obstructive sleep apnea severity of 24% of patients was misclassified when using 1 night compared to the average of all nights. On average, pAHI varied by 57% from night to night. The variability of pAHI could partially be explained by the variability of time spent in the supine position with more time supine leading to a higher pAHI. On measuring a subsequent night, 12-14% of patients spontaneously fulfilled the commonly accepted criteria for treatment success without any intervention.
With repeated recordings of PAT, we found no first night effect. However, there is considerable night-to-night variability similar to values found for polysomnography, which can partially be explained by the variability of time spent in the supine position. Obstructive sleep apnea severity was frequently misclassified due to the night-to-night variability. Our findings make a strong case for multiple testing in the diagnostic work-up of obstructive sleep apnea patients.
Tschopp S, Wimmer W, Caversaccio M, Borner U, Tschopp K. Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry: a case for multiple night testing. . 2021;17(9):1751-1758.
阻塞性睡眠呼吸暂停严重程度的夜间变异性相当大，可能取决于所使用的诊断方式。我们使用外周动脉张力测定（PAT）来研究夜间变异性。
51 例患者连续 3 个晚上在家中进行睡眠呼吸暂停测试，使用 PAT。我们的睡眠诊所对这些患者进行了筛查，并前瞻性地招募他们进行这项研究。所有记录均根据 PAT 评分指南进行自动和手动评分。
在这 3 个晚上之间，PAT 衍生的呼吸暂停低通气指数（pAHI）没有系统差异。手动和自动评分数据的夜间变异性相当。在 35%的患者中，pAHI 在这 3 个晚上之间的差异超过 10 次/小时。与使用所有夜晚的平均值相比，24%的患者的阻塞性睡眠呼吸暂停严重程度被错误分类。平均而言，pAHI 每晚变化 57%。pAHI 的变异性部分可以通过仰卧时间的变异性来解释，仰卧时间越多，pAHI 越高。在测量随后的一个晚上时，12-14%的患者在没有任何干预的情况下自发地达到了普遍接受的治疗成功标准。
通过反复记录 PAT，我们没有发现第一晚效应。然而，存在相当大的夜间变异性，与多导睡眠图的数值相似，这部分可以通过仰卧时间的变异性来解释。由于夜间变异性，阻塞性睡眠呼吸暂停的严重程度经常被错误分类。我们的研究结果强烈支持在阻塞性睡眠呼吸暂停患者的诊断中进行多次测试。
