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Polygraphy vs. polysomnography: missing osas in symptomatic snorers—a reminder for clinicians

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Abstract

Purposes

The purposes of this study are to investigate the usefulness of polygraphy (PG) in diagnosing obstructive sleep apnea (OSA) in sleepy/tired snorers compared to polysomnography (PSG) and, further, to search for suspected respiratory arousals in the PG.

Methods

One hundred eighty-seven adults suffering from sleepiness/tiredness and snoring had undergone ambulant PG and were considered to be normal, using American Academy of Sleep Medicine’s 2007 hypopnea criteria A. After approximately 7 months, in-lab PSG was performed using hypopnea criteria B, where arousals are also recognized. Validated questionnaires (Hospital Anxiety and Depression Scale, self-rated general health) were answered. In a subgroup, the sensitivity and specificity were calculated for flow limitation index (FLI) and flattening index (FlatI) in PG compared with the respiratory distress index (RDI) in PSG.

Results

Despite the normal PG, at PSG, the median RDI was 11.0 (range, 0–89.1). One hundred sixty-eight out of one hundred seventy-eight (90 %) were found to have at least mild OSA and 119/187 (64 %) with moderate–severe OSA according to the RDI values. The sensitivity and specificity were low (<70 %) for FLI and FlatI. Forty-nine percent of the patients rated anxiety at borderline or pathological levels, 35 % rated corresponding depression levels, and 45 % rated poor or fair general health.

Conclusions

PG was insufficient to rule out OSA when the respiratory events were mainly associated with arousals. Almost half of these patients experience low general health and psychiatric problems. We recommend a full-night PSG when PG is “normal”, and patients have symptoms of snoring and sleepiness/tiredness.

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Acknowledgments

We thank Ewa Hansson, secretary at the ENT clinic, for assistance with the registers and Paul Murphy, Leah Steinberg, and Carin Sahlin-Ingridsson, RPSGT, for assistance with the polysomnography scoring.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Oto-Rhino-Laryngology, Karolinska University Hospital, Stockholm, Sweden

    P. Nerfeldt & D. Friberg

  2. Department of Clinical Neurophysiology, Karolinska University Hospital, Stockholm, Sweden

    F. Aoki

  3. Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Huddinge, 141 86, Stockholm, Sweden

    P. Nerfeldt & D. Friberg

  4. Department of Clinical Neuroscience, Division of Clinical Neurophysiology, Karolinska Institutet, Stockholm, Sweden

    F. Aoki

Authors
  1. P. Nerfeldt
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  2. F. Aoki
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  3. D. Friberg
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Correspondence to P. Nerfeldt.

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Nerfeldt, P., Aoki, F. & Friberg, D. Polygraphy vs. polysomnography: missing osas in symptomatic snorers—a reminder for clinicians. Sleep Breath 18, 297–303 (2014). https://doi.org/10.1007/s11325-013-0884-6

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  • DOI: https://doi.org/10.1007/s11325-013-0884-6

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