Sleep efficiency during sleep studies: results of a prospective study comparing home-based and in-hospital polysomnography

Abstract

, the clinical use of unattended home-based polysomnography (PSG) is not recommended. To assess whether sleep efficiency is better at home, we have performed a prospective, crossover, single-blind study comparing unattended home-versus attended in-hospital PSG in a population referred for high clinical suspicion of obstructive sleep apnoea syndrome (OSA). Within 2 weeks, all the patients underwent both PSG performed by the same sleep technician, which were analysed by another blinded technician. Payments for each procedure were also calculated. Sixty-six patients (mean age: 49 ± 13 years; mean body mass index: 30 ± 7; mean Epworth Sleepiness Scale: 10 ± 5) were included. The quality of recordings was poor in 1.5% of the attended PSG versus 4.7% for unattended PSG (P = 0.36). Sleep efficiency at home was better (82% versus 75%, P < 0.001), and sleep duration longer (412 min versus 365 min, P < 0.001). Sleep latency was also shorter at home (28 min versus 45 min, P = 0.004), and patients spent more time in rapid eye movement sleep (19% versus 16%, P = 0.006). Apnoea-hypopnoea index (23 versus 26, P = 0.08) was similar at home and in the sleep lab. Sixty-seven per cent of patients preferred home-based PSG. PSG payment was also lower at home (268 Euros versus 1057 Euros). We conclude that home-based PSG is associated with a better sleep efficiency. It also appears as feasible and reliable in patients with high preclinical suspicion for OSA. It is also more comfortable for the patients whose sleep efficiency is better and allows cost saving related to the absence of hospitalization. k e y w o r d s cost, diagnosis, obstructive sleep apnoea, polysomnography, sleepdisordered breathing

Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis

“…The unattended level 1 studies had similar rates of technical failures, despite using full polysomnography equipment, suggesting the failures were because a sleep technician was not in attendance. 106 Despite the heterogeneity we saw at some apnea-hypopnea index cut-offs in our metaanalysis, the pooled estimates of diagnostic accuracy parameters appear reliable. We used a model that accounts for this heterogeneity [107][108][109][110] despite the use of different level 3 devices, which each measured the same core parameters.…”

Impact of Intelligent Volume-Assured Pressure Support on Sleep Quality in Stable Hypercapnic Chronic Obstructive Pulmonary Disease Patients: A Randomized, Crossover Study

“…Furthermore, Jaye et al [18 ]reported no difference between iVAPS and pressure support ventilation in restrictive patients. However, all of these studies focused only on sleep quality measured in hospital via PSG [7,8,18], and it is widely accepted that sleep quality at home is different from that in hospital [22]. Data about how NPPV using target volumes influences sleep quality at home and whether there might be an improvement in sleep quality over time are lacking; we assessed these in this study.…”

Monitoring Noninvasive Ventilation in Patients with Obesity Hypoventilation Syndrome: Comparison between Ventilator Built-in Software and Respiratory Polygraphy

“…Moreover, better patient acceptability and preference for home monitoring have been reported [25] . Portier et al [26] reported longer sleep duration at home than in the laboratory and Bruyneel et al [23] found better sleep efficiency at home.…”

“…Certain authors have suggested that this can be achieved with clinical assessment, measurement of arterial blood gas and nocturnal SpO 2 under NIV [21] , although others recommend using PG or PSG as the gold standard [22,23] . Some home ventilators include built-in monitoring systems allowing the clinician to assess various PG parameters.…”