False negative home sleep apnea testing - an important concept to prevent misdiagnosis in patients with underlying sleep apnea

Abstract

Obstructive Sleep Apnea (OSA) syndrome is characterized by repetitive reduction or cessation of airflow due to partial or complete obstruction of the airway leading to hypoxemia, arousals from sleep and fragmented sleep. It affects 5% of adult men and 2% of women in western countries and is associated with comorbidities such as cardiovascular and cerebrovascular diseases and several neurobehavioral morbidities. The current gold standard for a definitive diagnosis of OSA is an overnight Polysomnography (PSG). The overnight polysomnogram performed in a sleep center will give the comprehensive report of that includes the number of apneas, hypopneas and respiratory effort related arousals (RERAs). The total number of apneas and hypopneas per hour of sleep is called Apnea Hypopnea Index (AHI) while the total number of apneas, hypopneas and RERAs per hour of sleep is called 'Respiratory Disturbance Index' -RDI. Sleep Apnea is diagnosed if the RDI is 5 or more per hour of sleep. Home Sleep Apnea Testing (HSAT) has become an important tool in identifying high risk population. As the name suggests, the study is done while the patients sleep in their homes. One of the limitations of the study is the lack of Electroencephalographic (EEG) data. This prevents the inclusion of RERAs in the diagnosis of Sleep Apnea. The results of this preliminary analysis serves as the foundation to elucidate whether subtle changes in breathing patterns recorded during a sleep study are reflected in changes in cortical activity.