Skip to main content

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

Sleep and Breathing volume 19, pages 1273–1277 (2015)Cite this article

Abstract

Purpose

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.

Method

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 2 h of sleep with the full night of sleep to evaluate the diagnostic precision and accuracy of the first 2 h of sleep.

Results

No difference in AHI was observed between the first 2 h and the full night of sleep. A significant correlation of AHI was observed between the first 2 h 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).

Conclusions

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5(3):263–276

    PubMed  Google Scholar 

  2. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American Academy of sleep medicine. J Clin Sleep Med 8(5):597–619

    PubMed Central  PubMed  Google Scholar 

  3. Deutsch PA, Simmons MS, Wallace JM (2006) Cost-effectiveness of split-night polysomnography and home studies in the evaluation of obstructive sleep apnea syndrome. J Clin Sleep Med 2(2):145–153

    PubMed  Google Scholar 

  4. Rodway GW, Sanders MH (2003) The efficacy of split-night sleep studies. Sleep Med Rev 7(5):391–401

    Article  PubMed  Google Scholar 

  5. Patel NP, Ahmed M, Rosen I (2007) Split-night polysomnography. Chest 132(5):1664–1671

    Article  PubMed  Google Scholar 

  6. Collen J, Holley A, Lettieri C, Shah A, Roop S (2010) The impact of split-night versus traditional sleep studies on CPAP compliance. Sleep Breath 14(2):93–99

    Article  PubMed  Google Scholar 

  7. Lim YH, Choi J, Kim KR, Shin J, Hwang KG, Ryu S, Cho SH (2014) Sex-specific characteristics of anthropometry in patients with obstructive sleep apnea: neck circumference and waist-hip ratio. Ann Otol Rhinol Laryngol 123(7):517–523

    Article  PubMed  Google Scholar 

  8. Liu Y, Lowe AA, Zeng X, Fu M, Fleetham JA (2000) Cephalometric comparisons between Chinese and Caucasian patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 117(4):479–485

    CAS  Article  PubMed  Google Scholar 

  9. Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C (2000) Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope 110(10 Pt 1):1689–1693

    CAS  Article  PubMed  Google Scholar 

  10. Lam B, Ooi CG, Peh WC, Lauder I, Tsang KW, Lam WK, Ip MS (2004) Computed tomographic evaluation of the role of craniofacial and upper airway morphology in obstructive sleep apnea in Chinese. Respir Med 98(4):301–307

    Article  PubMed  Google Scholar 

  11. Chirakalwasan N, Teerapraipruk B, Simon R, Hirunwiwatkul P, Jaimchariyatam N, Desudchit T, Charakorn N, Wanlapakorn C (2013) Comparison of polysomnographic and clinical presentations and predictors for cardiovascular-related diseases between non-obese and obese obstructive sleep apnea among Asians. J Clin Sleep Med 9(6):553–557

    PubMed Central  PubMed  Google Scholar 

  12. Chou KT, Chang YT, Chen YM, Su KC, Perng DW, Chang SC, Shiao GM (2011) The minimum period of polysomnography required to confirm a diagnosis of severe obstructive sleep apnoea. Respirology 16(7):1096–1102

    Article  PubMed  Google Scholar 

  13. Charbonneau M, Marin JM, Olha A, Kimoff RJ, Levy RD, Cosio MG (1994) Changes in obstructive sleep apnea characteristics through the night. Chest 106(6):1695–1701

    CAS  Article  PubMed  Google Scholar 

  14. Sanders MH, Black J, Costantino JP, Kern N, Studnicki K, Coates J (1991) Diagnosis of sleep-disordered breathing by half-night polysomnography. Am Rev Respir Dis 144(6):1256–1261

    CAS  Article  PubMed  Google Scholar 

  15. Scharf SM, Garshick E, Brown R, Tishler PV, Tosteson T, McCarley R (1990) Screening for subclinical sleep-disordered breathing. Sleep 13(4):344–353

    CAS  PubMed  Google Scholar 

  16. Iber C, O’Brien C, Schluter J, Davies S, Leatherman J, Mahowald M (1991) Single night studies in obstructive sleep apnea. Sleep 14(5):383–385

    CAS  PubMed  Google Scholar 

  17. Yamashiro Y, Kryger MH (1995) CPAP titration for sleep apnea using a split-night protocol. Chest 107(1):62–66

    CAS  Article  PubMed  Google Scholar 

  18. Khawaja IS, Olson EJ, van der Walt C, Bukartyk J, Somers V, Dierkhising R, Morgenthaler TI (2010) Diagnostic accuracy of split-night polysomnograms. J Clin Sleep Med 6(4):357–362

    PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to acknowledge residents from Hanyang University Hospital for their assistance as study coordinators for the patients involved in this study.

Conflict of interest

This was not an industry-supported study. No potential conflict of interests relevant to this article was reported.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital and Nano-Bio Regenerative Medical Institute, Hallym University College of Medicine, Chuncheon, Republic of Korea

    Dong-Kyu Kim

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University, Seoul, Korea

    Jihye Choi, Kyung Rae Kim & Seok Hyun Cho

  3. Dentistry, College of Medicine, Hanyang University, Seoul, Korea

    Kyung-Gyun Hwang

  4. Department of Occupational and Envrionmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

    Seungho Ryu

  5. Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222-Wangshimniro, Seongdong-gu, Seoul, 133-792, Korea

    Seok Hyun Cho

Authors
  1. Dong-Kyu Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jihye Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyung Rae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyung-Gyun Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seungho Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seok Hyun Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seok Hyun Cho.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Table S1

(DOC 43 kb)

Table S2

(DOC 43 kb)

Table S3

(DOC 43 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kim, DK., Choi, J., Kim, K.R. et al. Rethinking AASM guideline for split-night polysomnography in Asian patients with obstructive sleep apnea. Sleep Breath 19, 1273–1277 (2015). https://doi.org/10.1007/s11325-015-1158-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-015-1158-2

Keywords

  • Split-night polysomnography
  • Polysomnography
  • Obstructive sleep apnea
  • Diagnostic accuracy
  • Apnea-hypopnea index
  • Asian