CHEST Guidelines-It’s-Time-for-Multiple-Sleep-Night-Testing- (1)

It’s-Time-for-Multiple-Sleep-Night-Testing- (1)

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The article, authored by Maurice Roeder, MD, and Malcolm Kohler, MD, discusses the importance of multiple night sleep studies in diagnosing obstructive sleep apnea (OSA) due to the considerable night-to-night variability in respiratory events. Current guidelines typically recommend a single night of polysomnography or home sleep apnea testing (HSAT), but this may lead to misdiagnosis, as evidenced by a study by Punjabi et al. This study involved 10,340 patients undergoing three consecutive nights of HSAT, revealing high variability in the Apnea-Hypopnea Index (AHI) with nearly a third potentially misdiagnosed when relying on just one night.<br /><br />The research indicates that the variability of respiratory events can be even higher when testing is conducted in sleep laboratories due to the "first night effect," which can alter sleep architecture. Although multiple night testing could improve diagnostic accuracy, it raises issues such as higher healthcare costs and patient discomfort. The American Academy of Sleep Medicine acknowledges night-to-night variability but still recommends single-night testing for uncomplicated cases.<br /><br />Critical questions remain about the number of nights needed for accurate diagnosis and how to handle conflicting results across multiple tests. Some researchers suggest using the worst night to classify OSA, though this could overestimate the disease burden. Cost-effectiveness and the technical feasibility of multinight testing are also important considerations, given the high prevalence of sleep-disordered breathing.<br /><br />The article advocates for more research to determine the optimal number of sleep study nights and the potential role of new technologies, like telemedicine, in facilitating cost-effective, accurate diagnosis. Ultimately, the authors call for a reconsideration of current diagnostic practices in light of the demonstrated variability in respiratory event rates.

Keywords

obstructive sleep apnea

multiple night sleep studies

respiratory event variability

polysomnography

home sleep apnea testing

Apnea-Hypopnea Index

diagnostic accuracy

first night effect

American Academy of Sleep Medicine

telemedicine