Home Testing for OSA: Cardiorespiratory Polygraphy vs Peripheral Arterial Tonometry

Home testing of patients with obstructive sleep apnea (OSA) via peripheral arterial tonometry (PAT) leads to less time in supine sleeping position and is associated with less technical failures and is less patient discomfort than cardiorespiratory polygraphy (RP). These were among the findings of a study recently published in Sleep and Breathing.

This prospective study included 56 patients from an outpatient university sleep clinic who were suspected to have sleep-disordered breathing, based on patient self-reports via interviews and questionnaires. During the study, these self-reports were confirmed by loud/irregular snoring, witnessed apneas, and daytime sleepiness. Patients in the test cohort were 68% male and ranged from 19 to 76 years of age (mean age: 44 ± 12 years and median age: 44 years) with a BMI ranging from 19.2 to 41.4 kg/m² (median BMI 27.3 kg/m², mean value 28.1 kg/m²).

Researchers compared the 56 cohort patients in terms of sleep position, patients’ comfort, and technical failure rates of PAT and RP receiving 2 nights of HST with either PAT or RP. After instruction, patients self-administered each test in assigned random order on consecutive nights. Afterwards, they completed a questionnaire to assess testing discomfort and device performance.

OSA was diagnosed with PAT and/or RP in 51 cases. Time in supine position with PAT was significantly lower (173.7 ± 88 minutes; median: 167 minutes) compared with the time in supine position with RP (181.7 ± 103.7 minutes; median: 189 minutes; P <.001), although the absolute mean difference was not clinically significant. Notably, the supine position is vulnerable for apnea events.

In other results: 74% of patients reported sleeping well during the PAT night vs 39% sleeping well during the RP night; 12% reported that the PAT was disturbing when they went to sleep vs 60% who reported the RP was disturbing when they went to sleep; 6% of patients lost sensors during the night with PAT vs 20% who reported lost sensors with RP; 30% reported waking up during PAT testing vs 50% of RP users who reported wakening. With respect to patient-reported awakenings, researchers noted that this perceived number is subjective.  Investigators also reported that 80% of participants rated PAT as being the superior sleep test and that 88% indicated that they would prefer PAT for further investigations” (P <.001).

Researchers wrote, “patients slept better during the night, felt less disturbed when falling asleep, suffered less sensor loss during the night and reported less nightly awakening with the PAT testing. In contrast, more patients experienced pain (13% at the side of the finger probe) during the night with PAT.” They added that home sleep testing with the PAT system might lead to less time in supine position, which is a vulnerable position for sleep apnea events. However, the investigators also acknowledged that their research was limited by its small sample size, as well as the subjectivity of patient’s reports of perceived awakenings and other limitations.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Mueller CE, Li H, Begasse SM, et al. Sleep position, patient comfort, and technical performance with two established procedures for home sleep testing. Sleep and Breath, Published online December 31, 2021. doi.10.1007/s11325-021-02530-w