Identifying Predictors of True Negative Home Sleep Apnea Tests

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

Chest

Abstract

PURPOSE: Home sleep apnea testing (HSAT) has become commonplace for the diagnosis of obstructive sleep apnea, although in-lab polysomnogram (PSG) is considered gold standard for the diagnosis of sleep apnea. According to AASM guidelines when HSAT is negative and if the suspicion of sleep apnea remains positive, PSG should be done which will define original HSAT as true negative or false negative if PSG is positive. If we can identify the predictors of true negative HSAT, we can avoid PSG testing which can save the overall cost. This retrospective study aimed to determine the predictors of true negative results of HSATs. METHODS: Over a 5-year period at a single academic sleep center, 1890 patients were identified who underwent HSAT. There were 1633 positive and 257 negative HSAT results. Out of 257 negative HSAT results (defined by respiratory event index less than 5 events/h), 117 were followed by PSG. Each HSAT was conducted using the same type of FDA approved HSAT devices utilizing respiratory flow parameters. Patient demographics, HSAT and PSG data were collected through review of electronic medical record for all 117 patients identified. RESULTS: Among the 117 patients, 45 had a positive PSG while 72 had a negative PSG. During univariate regression analysis of all available variables, age, BMI, presence of HTN, STOP-BANG score, neck circumference, HSAT REI (respiratory event index), and HSAT snore index (number of snores/hour) were significant. Snore index was significantly higher in true negative HSAT (138.11 + 194.15) compared to false negative HSAT (72.99 + 131.90). During multivariate regression analysis HSAT snore index (P = 0.036) and HSAT REI (P = 0.014) remained significant. CONCLUSIONS: This retrospective study demonstrates that snore index and HSAT REI correlated with true negative result of HSAT which was expected. On the other hand, patients with a higher snore index and negative HSAT result were more likely to have negative PSG. This suggests that the snore index may be used as a surrogate for actual sleep time during HSAT. Further prospective trials are needed to confirm this result CLINICAL IMPLICATIONS: The results of this retrospective analysis suggest that clinicians may use the snore index to identify patients who do not need to undergo follow up PSG after negative HSAT. This will reduce unnecessary testing and healthcare spending.

Volume

166

Issue

4 Suppl

First Page

A6196

Comments

Chest 2024 Annual Meeting, October 6-9, 2024, Boston, MA

DOI

10.1016/j.chest.2024.06.3668

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