Diagnostic accuracy of Home sleep apnea testing (HSAT) in Thai population

Abstract

Objective: Obstructive sleep apnea (OSA) is a potential serious disorder with a rising prevalence in Thailand. However, underdiagnosis is common as a result of limited diagnostic resources. Home sleep apnea testing (HSAT) has been introduced to replace standard polysomnography (PSG) in certain circumstances. The present study aimed to evaluate the diagnostic accuracy of this uncomplicated ambulatory test. Materials and Methods: Adult patients without significant cardiopulmonary disease presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA were recruited from the Siriraj Sleep Center in Bangkok. Participants were asked to do a sleep test at home using the HSAT device the day after they had an in-hospital standard PSG. Results: Eighty-nine participants were recruited between August 2018 and October 2019, but the data were complete in 80 patients. The prevalence of OSA as identified in the PSG was 95%. The diagnostic accuracy of the HSAT was 85%, with an intraclass correlation coefficient of 0.79 (95% CI 0.70 to 0.87) for both tests. For the severity classification, misclassifications that may affect diagnostic phenotyping and therapeutic decision was encountered in 12 patients (15%). Conclusion: The HSAT had good accuracy for patients with an increased risk of moderate to severe OSA. However, false-negative tests and an underestimation of disease severity should be considered.