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



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


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).


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.

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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.

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Correspondence to Seok Hyun Cho.

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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).

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