Noninvasive multi-night home monitoring signals high prevalence of obstructive sleep apnea

Noninvasive multi-night in-home monitoring of sleep and obstructive sleep apnea may support current OSA diagnosis and management practices, researchers reported in a recent study.

“Data from novel, noninvasive under-mattress sensor technology acquired across an average of at least 8 months of in-home nightly monitoring in a large, nonrandomly selected population sample from 20 countries/regions indicates a global prevalence of moderate to severe OSA of [approximately] 20%. Misdiagnosis probability based on a single night of testing, as is current standard clinical practice, was high at [approximately] 20% in the current selected population sample and increased to [approximately] 50% in people with mild to moderate OSA,” Bastien Lechat, BSc, research associate at the Adelaide Institute for Sleep Health and FHMRI Sleep Health at the College of Medicine and Public Health at Flinders University, Adelaide, Australia, and colleagues wrote in the American Journal of Respiratory and Critical Care Medicine.

Researchers evaluated 67,278 individuals aged 18 to 90 years (mean age, 47 years; 78% men; 62% from Europe) from a large, global nonrandomly selected community sample from a consumer database of novel, validated, under-mattress sleep analyzer purchases. The under-mattress sleep sensor technology (Withings Sleep Analyzer) features pneumatic and sound sensors that can detect body movement, heart rate, respiratory rate, snoring and breathing cessation episodes. All individuals underwent in-home nightly monitoring over an average of about 170 nights per individual from July 2020 to March 2021.

Outcomes included the multi-night global prevalence of OSA and likelihood of misclassification from a single-night apnea-hypopnea index (AHI) value. OSA was defined as nightly mean AHI of more than 15 events per hour.

Researchers collected more than 11.6 million nights of data; 30,051 individuals did not have OSA, 21,573 had mild OSA, 9,982 had moderate OSA and 5,672 had severe OSA.

Global prevalence of OSA was 22.6%. The likelihood of misdiagnosis ranged from 20% and 50% based on single night studies. As monitoring nights increased, misdiagnosis error rates decreased and remained stable after 14 nights of monitoring.

Misclassification of sleep apnea based on single night studies was higher among individuals with mild and/or moderate OSA. Only 54% of individuals with mild and 52% of individuals with moderate OSA were classified correctly compared with 85% of individuals without OSA and 77% of individuals with severe OSA.

“The current findings also highlight the potential utility for noninvasive multi-night assessments of sleep and OSA in the home to support current clinical diagnosis and management practices, which may provide benefits in terms of cost effectiveness and greater access to care over current routine practice. Nonetheless, our findings do not preclude the need for gold-standard polysomnography, particularly in more complex cases or in people with major or multiple comorbidities where additional information on hypoxemia and OSA endotypes may be clinically indicated and informative,” the researchers wrote. “Further prospective work in randomly selected populations is required to investigate the generalizability of the current findings.”