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Is Polysomnography Always Best?

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A new study from researchers in Australia suggests that, contrary to current medical practice, a sleep lab may not always be the best way to accurately diagnose obstructive sleep apnea (OSA).

The scientists from Flinders University studied the sleep test results of over 62,000 adults.  For the study, adults used a non-invasive sleep home sleep monitoring device. Many of the adults had also had a traditional sleep study.

The scientists found that, even in patients with OSA, the disease is remarkably variable from night to night.  Single-night sleep studies missed 20-50% of patients who had OSA.  Meanwhile, with each additional night of monitoring up to 14 nights, the accuracy of diagnosis increased. After 14 nights there was no benefit to additional sleep monitoring. 

Why is this finding important?

Because so many underlying conditions can impact the severity of OSA, a single night sleep study just can’t give physicians the entire story. For instance, a patient who has allergies may not have the same symptoms night after night, or the humidity in the room may vary and affect the ease of breathing. Patients don't sleep in exactly the same position every night either.  Something as simple as the positioning of pillows and blankets could make a difference on whether they qualify for a clinical OSA diagnosis.

This is a huge problem since OSA can have lifelong health impacts.  If we wait to diagnose and treat until the patient has severe OSA every time they drift off, we're letting them accumulate years of irreversible damage to their brains, hearts, lungs, immune systems, and endocrine systems.  The earlier a patient gets treatment, the longer and healthier their lives will be.

What can I, as a clinician, do with this information?

  1. If you haven’t already been trained to identify and treat OSA, get trained.
  2. If a patient has been negative in the past but their symptoms have continued to progress, have them screened again.
  3. If a patient has all the symptoms of OSA but ‘failed’ the sleep test, push for a retest, either with a different lab or with a different method.
  4. Find professionals who understand why OSA and Upper Airway Resistance Syndrome (UARS) are so deadly and work with them to get your patients help.

Our patients are counting on us to ensure that they get accurate diagnoses so that they can improve their health. If sleep labs may be failing to diagnose 1/5-1/2 of our patients with OSA, we need to be advocates so that our patients can get care.