title: Predictors of Obstructive Sleep Apnea on Polysomnography after a Technically Inadequate or Normal Home Sleep Test.
abstract: OBJECTIVE
  Home sleep testing (HST) is an accepted alternative to polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA) in high-risk populations. Clinical guidelines recommend PSG in cases where the HST is technically inadequate (TI) or fails to establish the diagnosis of OSA in patients with high pretest probability. This retrospective study evaluated predictors of OSA on PSG within patients who had a TI or normal HST.
  
  
  METHODS
  Electronic medical records were reviewed on 1,157 patients referred for HST at our sleep center. Two hundred thirty-eight patients had a TI or normal HST with subsequent PSG. Age, BMI, Epworth score, HST result, and PSG-based apnea-hypopnea index (AHI) were abstracted.
  
  
  RESULTS
  Two hundred thirty-eight consecutive patients with either a normal HST (n = 127) or TI HST (n = 111) underwent subsequent PSG. Of 127 who had a normal HST, 76% had a normal PSG and 24% had OSA (23 mild, 6 moderate, 1 severe). Of 111 who had a TI HST, 29% had a normal PSG and 71% had OSA (43 mild, 19 moderate, 17 severe). Individuals younger than 50 years old with a normal HST were more likely to have a normal PSG. Older age predicted diagnosis of OSA on PSG among individuals with a TI HST.
  
  
  CONCLUSIONS
  In this retrospective analysis of a clinical sample, when the HST is interpreted as normal in a younger patient population, the subsequent PSG is likewise normal in majority of the patients, although significant OSA is sometimes discovered. When a HST is read as TI, the majority of patients have OSA.
authors.affiliation: VA Greater Los Angeles Healthcare System, Pulmonary/Critical Care and Sleep Medicine.|David Geffen School of Medicine at the University of California, Los Angeles.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Zeidler
authors.affiliation: VA Central California Healthcare System and University of California, San Francisco Fresno Medical Education Program.
authors.forename: Vicente
authors.initials: V
authors.lastname: Santiago
authors.affiliation: David Geffen School of Medicine at the University of California, Los Angeles.|VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Dzierzewski
authors.affiliation: VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Mitchell
authors.affiliation: VA Greater Los Angeles Healthcare System, Pulmonary/Critical Care and Sleep Medicine.
authors.forename: Silverio
authors.initials: S
authors.lastname: Santiago
authors.affiliation: David Geffen School of Medicine at the University of California, Los Angeles.|VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Martin
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*
keywords: home sleep test; obstructive sleep apnea; polysomnography