title: Polysomnography performed in the unattended home versus the attended laboratory setting--Sleep Heart Health Study methodology.
abstract: OBJECTIVE
  To compare polysomnographic recordings obtained in the home and laboratory setting.
  
  
  METHODS
  Multicenter study comparing unsupervised polysomnography performed in the participant's home with polysomnography supervised at an academic sleep disorders center, using a randomized sequence of study setting. Sleep Heart Health Study (SHHS) standardized polysomnographic recording and scoring techniques were used for both settings.
  
  
  METHODS
  64 of 76 non-SHHS participants recruited from 7 SHHS field sites who had both a laboratory and home polysomnogram meeting acceptable quality criteria.
  
  
  RESULTS
  Median sleep duration was greater in the home than in the laboratory (375 vs 318 minutes, respectively, P < .0001) as was sleep efficiency (86% vs 82%, respectively, P < .0024). Very small, but significant increases in percentage of rapid eye movement sleep and decreases in stage 1 sleep were noted in the laboratory. Employing multiple definitions of respiratory disturbance index (RDI), median RDI was similar in both settings (for example, RDI with 3% desaturation: home 12.4, range 0.6-67; laboratory 9.5, range 0.1-93.4, P = .41). Quartile analysis of laboratory RDI showed moderate agreement with home RDI measurements. Based on the mean of laboratory and home RDI and using a cutpoint of 20, there was a biphasic distribution, with the RDI 3% above 20 being more common in the recordings performed in the laboratory than in the home and below 20 being more common in the recordings performed in the home than in the laboratory. These differences could not be attributed to quality of recording, age, sex, or body mass index.
  
  
  CONCLUSIONS
  Using SHHS methodology, median RDI was similar in the unattended home and attended laboratory setting with differences of small magnitude in some sleep parameters. Differences in RDI between settings resulted in a rate of disease misclassification that is similar to repeated studies in the same setting.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN, USA. iberx001@tc.umn.edu
authors.forename: Conrad
authors.initials: C
authors.lastname: Iber
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.forename: Adele M
authors.initials: AM
authors.lastname: Kaplan Gilpin
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Gottlieb
authors.forename: David
authors.initials: D
authors.lastname: Rapoport
authors.forename: Helaine E
authors.initials: HE
authors.lastname: Resnick
authors.forename: Mark
authors.initials: M
authors.lastname: Sanders
authors.forename: Philip
authors.initials: P
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D019411:Clinical Laboratory Techniques; D015331:Cohort Studies; D006304:Health Status; D006699:Home Care Services; D006801:Humans; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods*; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000453:epidemiology; D012895:Sleep, REM / Q000502:physiology*