First-night-effect on polysomnographic respiratory sleep parameters in patients with sleep-disordered breathing and upper airway pathology

Abstract

The objective of this study is to test whether there is a difference between the polysomnographic (PSG) values of Apnea-hypopnea index (AHI), minimal oxygen saturation (SpO(2)), oxygen desaturation index (ODI) and arousal index recorded on two consecutive nights (so-called "first night effect") in patients with sleep-disordered breathing (SDB) and concomitant upper airway pathology. Retrospective case-control study of polysomnographical recordings of 130 patients (112 males, 18 females, age range 23-80 years) with SDB and upper airway pathology who were tested on two consecutive nights in a hospital sleep laboratory was conducted. Only patients with upper airway pathology without other medical conditions causing SDB were included. AHI, minimal SpO(2), ODI and arousal index values of the first night were compared to those of the second night using Wilcoxon's test. There were no significant statistical differences between AHI, SpO(2), ODI and arousal index values (P = 0.130, P = 0.640, P = 0.052, and P = 0.692, respectively) between the two nights. However, 15% of the patients showed significant variability in the AHI between the two recordings and in 6% of the patients, a diagnosis of severe OSA (AHI > 10/h) would have been missed if only one night of sleep study had been performed. In general, one night of sleep study is sufficient to lead to a clear diagnosis of severe OSA in patients with sleep-disordered breathing and upper airway pathology but may still not diagnose 6% of the patients with severe OSA. Additionally, 15% of the patients showed a significant variability in the AHI between the two nights.

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

“…34,[129][130][131] There was a wide range of OSA severity within the populations included in the four studies (AHI range: 7-34). None of the studies included data on body position during the 2 nights of PSG.…”

“…131 Only one of the studies indicated that PSG scorers were blinded to the other PSG result. ahi (niGht-to-niGht variaBility): A meta-analysis of four studies compared AHI data between 2 consecutive nights of PSG 34,[129][130][131] (see supplemental material, Figure S28 and Table S66) and found the mean difference in the AHI between the 2 nights was 0.14 (95% CI: −1.86 to 2.15), which was not statistically or clinically significant. Nonetheless, a subset of individuals had considerable night-to-night variability in their AHIs, which could have potential clinical implications if the AHI crosses a treatment threshold only during the second PSG.…”

“…34,[129][130][131] However, the available literature did not address other clinically meaningful outcomes (e.g., impact on costs, QOL, comorbidities and long-term outcomes) resulting from undergoing a second night of PSG testing. As such, the TF downgraded the overall quality of evidence supporting this recommendation to very low, to reflect the likelihood that future research could result in different estimates of effect for the outcomes of interest, many of which were not available in the current literature.…”

Pilot Study of Oral Negative Pressure Therapy for Obstructive Sleep Apnea-Hypopnea Syndrome

“…In consequence, concern about a potential "first-night effect" might be raised regarding the effectiveness for apnea severity. Based on the fact that several studies have uniformly reported no firstnight effect on respiratory parameters [14][15][16], it has been considered that the improvement of apnea severity with the iNAP ® device is not likely to be due to the first-night effect. However, the amelioration of WASO with the iNAP ® device might be due to the first-night effect.…”

Oral pressure therapy for treatment of obstructive sleep apnea: clinical feasibility

“…With chronic therapy, improvements in these measures and further improvements in stage-shifts and awakenings and in daytime symptoms such as excessive daytime sleepiness can be anticipated but should be confirmed directly by future studies. In each subject, the sequence of PSG studies was not randomized and the baseline study was completed before the PSG with OPT; however, order of PSG evaluation is unlikely to have any significant effect on respiratory parameters 13. Moving beyond this feasibility study, in future studies, a randomized sequence of treatment conditions on PSG nights may be employed.…”