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

It’s-Time-for-Multiple-Sleep-Night-Testing-

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The editorial discusses the current diagnostic practices for Obstructive Sleep Apnea (OSA), emphasizing the need for multiple night testing due to high intraindividual variability in respiratory events. Despite recommendations for a single polysomnography or home sleep apnea testing (HSAT) by current guidelines, a study by Punjabi et al. with 10,340 patients showed significant night-to-night variability. Nearly one-third of mild-to-moderate OSA cases might be misdiagnosed if based on a single night of monitoring.<br /><br />The study noted that using the posterior mean of three consecutive nights as a reference still resulted in 23% misclassification after one night of testing. Additional studies, such as Stöberl et al. which analyzed 14 nights of pulse oximetry, further underline this variability, with only 22% of patients maintaining the same OSA severity across multiple nights.<br /><br />The "first night effect" in sleep labs can also contribute to variability, due to patients adapting to the unfamiliar sleep environment, yielding different respiratory event rates than home-based measurements. Although the American Academy of Sleep Medicine still recommends single-night studies, concerns regarding multinight testing, such as potential false positives, higher costs, and discomfort, persist.<br /><br />No definitive guidance exists on how many nights are needed or how to handle conflicting results from multiple nights. A "treat the worst" approach, using the most severe night's data, is debatable without clear evidence of solitary nights causing prolonged pathophysiological changes.<br /><br />The editorial concludes that while single-night studies may underrepresent the full scope of OSA, multinight ambulatory testing using HSAT could provide a cost-effective, accurate diagnostic tool, particularly with advancements in telemedicine facilitating these processes. Further research and cost-effectiveness studies are needed to shape future guidelines and address the concerns associated with multinight testing.

Keywords

Obstructive Sleep Apnea

diagnostic practices

intraindividual variability

polysomnography

home sleep apnea testing

night-to-night variability

first night effect

multinight testing

telemedicine

cost-effectiveness