title: Agreement Between Results of Home Sleep Testing for Obstructive Sleep Apnea with and Without a Sleep Specialist.
abstract: Obstructive sleep apnea is a prevalent yet underdiagnosed condition associated with cardiovascular morbidity and mortality. Home sleep testing offers an efficient means for diagnosing obstructive sleep apnea but has been deployed primarily in clinical samples with a high pretest probability. The present study sought to assess whether obstructive sleep apnea can be diagnosed with home sleep testing in a nonreferred sample without involvement of a sleep medicine specialist.
  
  
  
  A study of community-based adults with untreated obstructive sleep apnea was undertaken. Misclassification of disease severity according to home sleep testing with and without involvement of a sleep medicine specialist was assessed, and agreement was characterized using scatter plots, Pearson's correlation coefficient, Bland-Altman analysis, and the κ statistic. Analyses were also conducted to assess whether any observed differences varied as a function of pretest probability of obstructive sleep apnea or subjective sleepiness.
  
  
  
  The sample consisted of 191 subjects, with more than half (56.5%) having obstructive sleep apnea. Without involvement of a sleep medicine specialist, obstructive sleep apnea was not identified in only 5.8% of the sample. Analyses comparing the categorical assessment of disease severity with and without a sleep medicine specialist showed that in total, 32 subjects (16.8%) were misclassified. Agreement in the disease severity with and without a sleep medicine specialist was not influenced by the pretest probability or daytime sleep tendency.
  
  
  
  Obstructive sleep apnea can be reliably identified with home sleep testing in a nonreferred sample, irrespective of the pretest probability of the disease.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md.
authors.forename: R Nisha
authors.initials: RN
authors.lastname: Aurora
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md.
authors.forename: Nirupama
authors.initials: N
authors.lastname: Putcha
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md.
authors.forename: Rachel
authors.initials: R
authors.lastname: Swartz
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md; Department of Epidemiology, Johns Hopkins University, Baltimore, Md. Electronic address: npunjabi@jhmi.edu.
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods*; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000145:classification / Q000175:diagnosis*; D056508:Sleep Medicine Specialty
keywords: Diagnosis; Home sleep testing; Obstructive sleep apnea