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Current Sleep Medicine Reports

Open Access 15-04-2024 | Polysomnography | REVIEW

A Systematic Review on the Technical Feasibility of Home-Polysomnography for Diagnosis of Sleep Disorders in Adults

Authors: M. Braun, M. Stockhoff, M. Tijssen, S. Dietz-Terjung, S. Coughlin, C. Schöbel

Published in: Current Sleep Medicine Reports

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Abstract

Purpose of Review

The increasing demand for sleep diagnostic studies represents a challenge for many healthcare systems. Home polysomnography (hPSG), either set up by a technician or self-applied by the patient, provides comprehensive sleep signals and has the potential to replace in-lab sleep studies in a large number of cases.The aim of this study is to assess the existing evidence regarding the technical feasibility of hPSG in a systematic review. A systematic literature search was conducted in MEDLINE, PubMed, and Google Scholar to identify relevant research. Using a priori-defined inclusion criteria, studies were reviewed by three researchers, and a quality assessment was conducted. Relevant data were extracted, and the pooled failure rate with hPSG was computed. Additional subgroup analyses were conducted to further assess factors influencing technical feasibility.

Recent Findings

Thirty studies totaling 14,465 patients were included (mean sample size 482 ± 1289 participants). Common deployment models for hPSG were at-home application by a technician (58%) and technician-led in-hospital set-up (31%), followed by at-home self-application by the patient (11%). Technical failure rate across the studies ranged from 0 to 23.4%, with a pooled failure rate of 7.8% (95% CI 5.5–10.1%). Depending on deployment models, failure rates varied slightly. Failures of hPSG were largely related to signal acquisition. No studies reported adverse events from hPSG. Patient preferences were assessed by eleven studies, with 56% (range 22–95%) preferring hPSG over in-lab recording.

Summary

Based on the research identified for this review, home PSG is safe and technically feasible with relatively low failure rates. Further research is required to better understand decision-making with this tool in comparison to other sleep diagnostic procedures.
Appendix
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Literature
1.
Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687–98.PubMedPubMedCentralCrossRef
2.
Chattu VK, Manzar MdD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The global problem of insufficient sleep and its serious public health implications. Healthcare. 2018;7(1):1–16.
3.
Grandner MA, Hale L, Moore M, Patel NP. Mortality associated with short sleep duration: the evidence, the possible mechanisms, and the future. Sleep Med Rev. 2010;14(3):191–203.PubMedCrossRef
4.
5.
Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus CL, Vaughn BV. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.2. Am Acad Sleep Med [Internet]. 2015; Available from: www.aasmnet.org
6.
7.
Bruyneel M, Ninane V. Unattended home-based polysomnography for sleep disordered breathing: current concepts and perspectives. Sleep Med Rev. 2014;18(4):341–7.PubMedCrossRef
8.
• Korkalainen H, Nikkonen S, Kainulainen S, Dwivedi AK, Myllymaa S, Leppänen T, et al. Self-applied home sleep recordings: the future of sleep medicine. Sleep Med Clin. 2021;16(4):545–56. Advances in analysis techniques and wearable monitoring technologies have the potential to ease access to sleep diagnostic testing by enabling large scale at-home application.PubMedCrossRef
9.
10.
11.
Fry JM, DiPhillipo MA, Curran K, Goldberg R, Baran AS. Full polysomnography in the home. Sleep. 1998;21(6):635–42.PubMedCrossRef
12.
Redline S, Sanders MH, Lind BK, Quan SF, Iber C, Gottlieb DJ, et al. Methods for obtaining and analyzing unattended polysomnography data for a multicenter study. Sleep Heart Health Research Group Sleep. 1998;21(7):759–67.
13.
Mykytyn IJ, Sajkov D, Neill AM, Mc Evoy RD. Portable computerized polysomnography in attended and unattended settings. Chest. 1999;115(1):114–22.PubMedCrossRef
14.
Portier F, Portmann A, Czernichow P, Vascaut L, Devin E, Benhamou D, et al. Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome. Am J Respir Crit Care Med. 2000;162(3 Pt 1):814–8.PubMedCrossRef
15.
Gagnadoux F, Pelletier-Fleury N, Philippe C, Rakotonanahary D, Fleury B. Home unattended vs hospital telemonitored polysomnography in suspected obstructive sleep apnea syndrome: a randomized crossover trial. Chest. 2002;121(3):753–8.PubMedCrossRef
16.
Iber C, Redline S, Gilpin AMK, Quan SF, Zhang L, Gottlieb DJ, et al. Polysomnography performed in the unattended home versus the attended laboratory setting—sleep heart health study methodology. Sleep. 2004;27(3):536–40.PubMedCrossRef
17.
BaHammam AS. Signal failure of type 2 comprehensive unattended sleep studies in patients with suspected respiratory sleep disordered breathing. Sleep Breath. 2005;9(1):7–11.PubMedCrossRef
18.
Kurth ME, Sharkey KM, Millman RP, Corso RP, Stein MD. Insomnia among methadone-maintained individuals: the feasibility of collecting home polysomnographic recordings. J Addict Dis. 2009;28(3):219–25.PubMedPubMedCentralCrossRef
19.
Mehra R, Stone KL, Varosy PD, Hoffman AR, Marcus GM, Blackwell T, et al. Nocturnal arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS Sleep) study. Arch Intern Med. 2009;169(12):1147–55.PubMedPubMedCentralCrossRef
20.
Bruyneel M, Sanida C, Art G, Libert W, Cuvelier L, Paesmans M, et al. Sleep efficiency during sleep studies: results of a prospective study comparing home-based and in-hospital polysomnography. J Sleep Res. 2011;20(1pt2):201–6.PubMedCrossRef
21.
Campbell AJ, Neill AM. Home set-up polysomnography in the assessment of suspected obstructive sleep apnea. J Sleep Res. 2011;20(1 Pt 2):207–13.PubMedCrossRef
22.
Chung F, Liao P, Sun Y, Amirshahi B, Fazel H, Shapiro CM, et al. Perioperative practical experiences in using a level 2 portable polysomnography. Sleep Breath. 2011;15(3):367–75.PubMedCrossRef
23.
Bruyneel M, Van den Broecke S, Libert W, Ninane V. Real-time attended home-polysomnography with telematic data transmission. Int J Med Inf. 2013;82(8):696–701.CrossRef
24.
Rohling L, Blankvoort C, Mattern-Coren E, De Weerd A. Medical technology assessment of polysomnography, type 2: Full PSG at home – Difference of two unattended PSG at home systems. Sleep Med. 2013;1(14):e245.CrossRef
25.
Banhiran W, Chotinaiwattarakul W, Chongkolwatana C, Metheetrairut C. Home-based diagnosis of obstructive sleep apnea by polysomnography type 2: accuracy, reliability, and feasibility. Sleep Breath. 2014;18(4):817–23.PubMedCrossRef
26.
Crescimanno G, Greco F, Marrone O. Monitoring noninvasive ventilation in neuromuscular patients: feasibility of unattended home polysomnography and reliability of sleep diaries. Sleep Med. 2014;15(3):336–41.PubMedCrossRef
27.
Knauert MP, Yaggi HK, Redeker NS, Murphy TE, Araujo KL, Pisani MA. Feasibility study of unattended polysomnography in medical intensive care unit patients. Heart Lung. 2014;43(5):445–52.PubMedPubMedCentralCrossRef
28.
Bruyneel M, Libert W, Ameye L, Ninane V. Comparison between home and hospital set-up for unattended home-based polysomnography: a prospective randomized study. Sleep Med. 2015;16(11):1434–8.PubMedCrossRef
29.
Hall MH, Casement MD, Troxel WM, Matthews KA, Bromberger JT, Kravitz HM, et al. Chronic stress is prospectively associated with sleep in midlife women: the SWAN sleep study. Sleep. 2015;38(10):1645–54.PubMedPubMedCentralCrossRef
30.
Lang Carol J, Appleton Sarah L, Andrew Vakulin, Doug McEvoy R, Vincent Andrew D, Wittert Gary A, et al. Associations of undiagnosed obstructive sleep apnea and excessive daytime sleepiness with depression: an Australian population study. J Clin Sleep Med. 2017;13(4):575–82.PubMedPubMedCentralCrossRef
31.
Levendowski D, Dawson D, Levi M, Westbrook P. Agreement between auto-scored vs. edited unattended in-home polysomnography. Sleep Med. 2017;40:e189.
32.
33.
Andrade L, Paiva T. Ambulatory versus laboratory polysomnography in obstructive sleep apnea: comparative assessment of quality, clinical efficacy, treatment compliance, and quality of life. J Clin Sleep Med. 2018;14(8):1323–31.PubMedPubMedCentralCrossRef
34.
Miettinen T, Myllymaa K, Westeren-Punnonen S, Ahlberg J, Hukkanen T, Toyras J, et al. Success rate and technical quality of home polysomnography with self-applicable electrode set in subjects with possible sleep bruxism. IEEE J Biomed Health Inform. 2018;22(4):1124–32.PubMedCrossRef
35.
Yoon DW, Hong IH, Baik I, Shin HW. Evaluation of the feasibility and preference of Nox-A1 type 2 ambulatory device for unattended home sleep test: a randomized crossover study. Sleep Biol Rhythms. 2019;17(3):297–304.CrossRef
36.
Cuesta R, Roebuck T, Ho S, Naughton M, McDermott E, VanBraak E, et al. P028 The Nox A1 ambulatory system is reliable when self-applied. SLEEP Adv. 2021;1(2):A30.CrossRef
37.
•• Punjabi NM, Brown T, Aurora RN, Patel SR, Stosor V, Cho JHJ, et al. Methods for home-based self-applied polysomnography: the multicenter AIDS cohort study. SLEEP Adv. 2022;3(1):zpac011. Results from this research demonstrate the feasibility of unattended home-polysomnography in a large community cohort.PubMedPubMedCentralCrossRef
38.
Tomson H, Bender A, Lambing K, Decock D. The clinical success of 213 self-applied type 2 sleep studies. Sleep Med. 2022;1(100):S304.CrossRef
39.
Zancanella E, do Prado LF, de Carvalho LB, Machado Júnior AJ, Crespo AN, do Prado GF. Home sleep apnea testing: an accuracy study. Sleep Breath. 2022;26(1):117–23.PubMedCrossRef
40.
• Andrillon T, Solelhac G, Bouchequet P, Romano F, Le Brun MP, Brigham M, et al. Revisiting the value of polysomnographic data in insomnia: more than meets the eye. Sleep Med. 2020;66:184–200. Advanced analysis of polysomnographic data using artificial intelligence can increase the understanding of the physiological substrate of insomnia.PubMedCrossRef
41.
Onder NS, Akpinar ME, Yigit O, Gor AP. Watch peripheral arterial tonometry in the diagnosis of obstructive sleep apnea: influence of aging. Laryngoscope. 2012;122(6):1409–14.PubMedCrossRef
42.
Penzel T, Kesper K, Pinnow I, Becker HF, Vogelmeier C. Peripheral arterial tonometry, oximetry and actigraphy for ambulatory recording of sleep apnea. Physiol Meas. 2004;25(4):1025–36.PubMedCrossRef
43.
Pittman SD, Ayas NT, MacDonald MM, Malhotra A, et al. Using a wrist-worn device based on peripheral arterial tonometry to diagnose obstructive sleep apnea: in-laboratory and ambulatory validation. Sleep. 2004;27(5):923–33.PubMedCrossRef
44.
Choi JH, Kim EJ, Kim YS, Choi J, Kim TH, et al. Validation study of portable device for the diagnosis of obstructive sleep apnea according to the new AASM scoring criteria: Watch-PAT 100. Acta Otolaryngol. 2010;130(7):838–43.PubMedCrossRef
45.
Ghegan MD, Angelos PC, Stonebraker AC, Gillespie MB. Laboratory versus portable sleep studies: a meta-analysis. Laryngoscope. 2006;116(6):859–64.PubMedCrossRef
46.
Pan Q, Brulin D, Campo E. Current status and future challenges of sleep monitoring systems: systematic review. JMIR Biomed Eng. 2020;5(1):e20921.CrossRef
47.
48.
Oz S, Dagay A, Katzav S, Wasserman D, Tauman R, Gerston A, et al. Monitoring sleep stages with a soft electrode array: comparison against vPSG and home-based detection of REM sleep without atonia. J Sleep Res. 2023;32(5):e13909.PubMedCrossRef
49.
Schneider H, Haisma N, Mueller S, Oloo M, Tijssen M, Stockhoff M, et al. Patient-reported experience with a wireless patch-based polysomnography system – results from a pilot study. Sleep. 2023;1(46):A240–1.CrossRef
50.
Pelletier-Fleury N, Gagnadoux F, Philippe C, Rakotonanahary D, Lanoé JL, Fleury B. A cost-minimization study of telemedicine The case of telemonitored polysomnography to diagnose obstructive sleep apnea syndrome. Int J Technol Assess Health Care. 2001;17(4):604–11.PubMedCrossRef
51.
Pietzsch JB, Garner A, Cipriano LE, Linehan JH. An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea. Sleep. 2011;34(6):695–709.PubMedPubMedCentral
Metadata
Title
A Systematic Review on the Technical Feasibility of Home-Polysomnography for Diagnosis of Sleep Disorders in Adults
Authors
M. Braun
M. Stockhoff
M. Tijssen
S. Dietz-Terjung
S. Coughlin
C. Schöbel
Publication date
15-04-2024
Publisher
Springer International Publishing
Published in
Current Sleep Medicine Reports
Electronic ISSN: 2198-6401
DOI
https://doi.org/10.1007/s40675-024-00301-z