Rethinking AASM guideline for split-night polysomnography in Asian patients with obstructive sleep apnea.

Abstract

Split-night polysomnography (SN-PSG) provides both a diagnosis and titration of continuous positive airway pressure over a single night in patients with suspected obstructive sleep apnea (OSA). However, in Asian patients, the diagnostic validity of American Academy of Sleep Medicine (AASM) guidelines for SN-PSG remains uncertain. Therefore, we examined whether the current criteria for SN-PSG are pertinent for Asian patients. We investigated 134 consecutive patients who were diagnosed with OSA (apnea-hypopnea index (AHI) ≥ 5). We divided the raw data (full-night study) into two parts and compared the first 2h of sleep with the full night of sleep to evaluate the diagnostic precision and accuracy of the first 2h of sleep. No difference in AHI was observed between the first 2h and the full night of sleep. A significant correlation of AHI was observed between the first 2h and the full night of sleep for severe OSA patients (AHI ≥ 30). A correlation coefficient of AHI was higher by the criterion of AHI ≥ 30 than by the criterion of AHI ≥ 40 (r = 0.831 and r = 0.778, respectively), which is the current AASM criterion for SN-PSG. Moreover, the criterion AHI ≥ 30 showed better diagnostic accuracy than the criterion AHI ≥ 40 (89.3 and 88.7%, respectively). This study found possible evidence supporting different diagnostic criteria for SN-PSG in Asian population. We suggest further studies in other Asian populations to confirm these findings.