title: Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea.
abstract: OBJECTIVE
  Esophageal manometry (Pes) is the gold standard to detect repetitive episodes of increased respiratory effort followed by arousal (RERAs). Because RERAs are not included in the apnea-hypopnea index (AHI), we often refer patients with symptoms of sleep disordered breathing (SDB) and AHI < 5 for a second polysomnogram (PSG) with Pes. Often, the second PSG will demonstrate AHI > 5, confirming a diagnosis of OSA. We speculate that in most cases of suspected SDB, Pes does not add further diagnostic data and that night-to-night variability in OSA severity results in a first false-negative study.
  
  
  METHODS
  We conducted a retrospective review of PSGs between 2008 and 2012 in adults with initial PSG negative for OSA followed by a second study (with or without Pes) within 6 mo.
  
  
  RESULTS
  Of 125 studies that met inclusion criteria, a second study was completed with Pes in 105 subjects. SDB was diagnosed in 73 subjects (68.5%) completing a second PSG with Pes: 49 (46.7%) received a diagnosis based on AHI, and 24 (22.8%) received a diagnosis based on Pes (p = 0.003). There were no statistically significant differences in the mean AHI change between the two PSGs in subjects who completed the second study with or without Pes.
  
  
  CONCLUSIONS
  In patients with symptoms of SDB and initial PSG with AHI < 5, the majority met criteria for OSA on second PSG by AHI without additional information added by Pes. Because Pes is not widely available and is somewhat invasive, a repeat study without Pes may be sufficient to diagnose SDB.
authors.affiliation: Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.
authors.forename: Virginia
authors.initials: V
authors.lastname: Skiba
authors.affiliation: Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.
authors.forename: Cathy
authors.initials: C
authors.lastname: Goldstein
authors.affiliation: Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.|Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Helena
authors.initials: H
authors.lastname: Schotland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*; D055815:Young Adult
keywords: obstructive sleep apnea; polysomnography; sleep apnea/hypopnea syndrome; sleep disordered breathing; upper airway resistance sleep apnea syndrome