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Sleep apnoea is a common condition that is unrecognised and is thought to affect millions of people globally. Multiple breathing pauses can occur during sleep when the upper airway can become obstructed intermittently, which can cause then cause if untreated a range of health issues. Screening for and diagnosing sleep apnea accurately is important to enable clinicians to prescribe effective treatment. Polysomnography is usually an in-lab sleep study and is considered the gold standard diagnostic test for Sleep apnoea. However, recent research is shining a light on the evidence to support multi-night home sleep studies as a valuable tool in accurate diagnostic pathway 1,2,3,4.
In this article, we look at why conducting multi-night home sleep studies is necessary for the accurate screening and diagnosis of this condition.
1. Usual Sleep Environment
Home based multi-night home sleep studies allow individuals to be tested in their usual sleep environment where conditions are more natural, and individuals are more likely to sleep as they would normally in their own bed 5,6. In contrast, a lab-based sleep study might not capture the person's usual sleep pattern as accurately. By conducting multiple night home studies, night to night variability in sleep can be captured more accurately, allowing a more accurate picture of the patient's sleep apnea severity.
2. Increased Data Collection
Sleep Apnoea is categorised as Mild, Moderate and Severe depending on how many breathing pauses are seen on a home sleep test 1,2. For example, some individuals may experience more significant disruptions on certain nights and multi-night home sleep studies captures a larger dataset which increases the likelihood of obtaining a more accurate picture to assist in the clinician in the diagnostic and treatment decision process.
3. The so called First-Night Effect
The "first-night effect" is a known phenomenon where the person undergoing a sleep study experiences a poorer quality of sleep during a sleep lab study due to unfamiliar environment, personnel and equipment 6. This may result inaccurate results, especially for those with milder sleep apnea. Multi-night home studies mitigate for this issue, as patients can sleep in their own beds, making it more likely to record representative data from various nights.
4. Cost-Effectiveness
Traditional in-lab sleep studies are more costly due to the need for specialised facilities, trained personnel, and overnight stays. Also, there are long waiting times for in lab studies and conducting multi night home sleep tests are more cost effective and more accessible to a wider range of people requiring a home sleep test 6.
5. Convenience and Compliance
Having a home sleep study is convenient for the majority of patients where they don't have to travel to a sleep center for an in-lab test, and this means less disruption to their working day or daily routine. This increased convenience often leads to better patient compliance, as individuals are more likely to complete multiple nights of testing with the added benefit of more reliable data collection, leading to more accurate diagnosis.
In the sleep medicine field, there is growing evidence that a shift towards multi-night home sleep studies is a necessary requirement in accurately detecting sleep apnea. Multi night home studies that are conducted in a realistic sleep environment, can facilitate more data collection, mitigate for the first-night effect, are cost-effective, and can support patient compliance. All of these factors contribute to a more accurate diagnosis and ultimately better outcomes for individuals suffering from sleep apnea. Multi- night sleep testing may become a more widely available home sleep study option in the near future with the emergence of new technologies that use AI and machine learning technology that is already available.
References:
1. Simonds AK. How Many More Nights? Diagnosing and Classifying Obstructive Sleep Apnea Using Multinight Home Studies. Am J Respir Crit Care Med. 2022 Mar 1;205(5):491-492. doi: 10.1164/rccm.202112-2677ED. PMID: 34929101; PMCID: PMC8906487.
2. Lechat B, Naik G, Reynolds A, Aishah A, Scott H, Loffler KA, Vakulin A, Escourrou P, McEvoy RD, Adams RJ, Catcheside PG, Eckert DJ. Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea. Am J Respir Crit Care Med. 2022 Mar 1;205(5):563-569. doi: 10.1164/rccm.202107-1761OC. PMID: 34904935; PMCID: PMC8906484.
3. Walter J, Lee JY, Blake S, Kalluri L, Cziraky M, Stanek E, Miller J, Harty BJ, Yu L, Park J, Zhang M, Coughlin S, Serao A, Lee J, Buban A, Bae M, Edel C, Toloui O, Rangel SM, Power T, Xu S. A new wearable diagnostic home sleep testing platform: comparison with available systems and benefits of multinight assessments. J Clin Sleep Med. 2023 May 1;19(5):865-872. doi: 10.5664/jcsm.10432. PMID: 36692166; PMCID: PMC10152349.
4. Chouraki A, Tournant J, Arnal P, Pépin JL, Bailly S. Objective multi-night sleep monitoring at home: variability of sleep parameters between nights and implications for the reliability of sleep assessment in clinical trials. Sleep. 2023 May 10;46(5):zsac319. doi: 10.1093/sleep/zsac319. PMID: 36583300.
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