Polygraphy vs. polysomnography: missing osas in symptomatic snorers--a reminder for clinicians.
OBJECTIVE
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.
Department of Oto-Rhino-Laryngology, Karolinska University Hospital, Stockholm, Sweden, pia.nerfeldt@karolinska.se.
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P
Nerfeldt
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Aoki
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D
Friberg
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D003937:Diagnosis, Differential; D006970:Disorders of Excessive Somnolence / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods*; D011237:Predictive Value of Tests; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D012913:Snoring / Q000209:etiology* / Q000523:psychology; D055815:Young Adult