Hospital-Based Polysomnography May Overestimate Obstructive Sleep Apnoea Severity: Comparison of Hospital-Based and Home-Based Measurements with a Single-Lead Electrocardiogram Patch

Abstract

Purpose: Obstructive sleep apnoea (OSA) is a global health concern, and polysomnography (PSG) is the gold standard for assessing OSA severity. However, the sleep parameters of home-based and in-laboratory PSG vary because of environmental factors, and the magnitude of these discrepancies remains unclear.Methods: We enrolled 125 Taiwanese patients who underwent PSG while wearing a single-lead electrocardiogram patch (RootiRx). After the PSG, all participants were instructed to continue wearing the RootiRx over the 3 subsequent nights. Scores on OSA indexes, namely the apnoea–hypopnea index, chest effort index (CEI), cyclic variation of heart rate index (CVHRI), and combined CVHRI and CEI (Rx index), were determined. The patients were divided into 3 groups based on PSG-determined OSA severity. The variables (various severity groups and environmental measurements) were subjected to mean comparisons and their correlations were examined by Pearson’s correlation coefficient. Results: The hospital-based CVHRI, CEI, and Rx index differed significantly among the severity groups. All 3 groups exhibited a significantly lower percentage of supine sleep time in the home-based assessment relative to in the hospital-based assessment. Significant positive correlations were noted between the variations in the supine percentage (∆Supine%) and the OSA indexes. For the patients with high sleep efficiency (≥ 80%), significant correlations were observed between the ∆Supine% and ∆Rx index.Conclusion: The high supine percentage of sleep may cause OSA indexes’ overestimation in hospital-based PSG. Sleep recording at home with patch-type wearable devices may aid accurate OSA diagnosis.