title: Effect of Manual Editing of Total Recording Time: Implications for Home Sleep Apnea Testing.
abstract: Type 3 home sleep apnea tests may underestimate the apnea-hypopnea index (AHI) due to overestimation of total sleep time (TST). We aimed to evaluate the effect of manual editing of the total recording time (TRT) on the TST and AHI.
  
  
  
  Thirty 15-channel in-home polysomnography studies (AHI 0 to 30 events/h) scored using American Academy of Sleep Medicine criteria were rescored by two blinded polysomnologists after data from electroencephalogram, electrooculogram, and electromyogram were masked. In method 1, periods of probable wakefulness and artifact were manually edited and removed from analysis. Method 2 identified TST as the TRT without manual editing. Pairedt-tests were used to compare the TST and AHI between these methods. Sensitivity and specificity of each method were calculated for gold standard AHI cutoffs of ≥ 5 and ≥ 15 events/h.
  
  
  
  TST (mean [standard deviation, SD]) by polysomnography, method 1, and method 2 was 366.0 (70.1), 447.1 (59.0), and 542 (61.9) min, respectively. The corresponding AHI was 12.5 (8.2), 10.8 (7.0), and 9.1 (6.1) events/h, respectively. Compared to polysomnography, both alternative methods overestimated the TST (method 1: mean difference [SD] 81.1 [56.1] min, method 2: 176.0 [89.7] min; both p < 0.001) and underestimated the AHI (method 1: mean difference [SD] -1.6 [3.3], method 2: -3.3 [3.9]; both p < 0.001). The sensitivity was 100% and 70.0% for method 1, and 91.3% and 40.0% for method 2 for identifying sleep-disordered breathing using AHI cutoffs of ≥ 5 and ≥ 15 events/h, respectively.
  
  
  
  Manual editing of TRT reduces the overestimation of TST and improves the sensitivity for identifying studies with sleep-disordered breathing.
  
  
  
  A commentary on this article appears in this issue on page 9.
authors.affiliation: Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors.forename: Ying Y
authors.initials: YY
authors.lastname: Zhao
authors.affiliation: Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jia
authors.initials: J
authors.lastname: Weng
authors.affiliation: Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Mobley
authors.affiliation: Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.|Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Medicine, University of Virginia, Charlottesville, VA.
authors.forename: Younghoon
authors.initials: Y
authors.lastname: Kwon
authors.affiliation: Northwestern University, Chicago, IL.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Zee
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
authors.affiliation: Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA.|Harvard Medical School, Boston, MA.|Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000295:instrumentation* / Q000379:methods* / Q000706:statistics & numerical data; D017286:Polysomnography / Q000295:instrumentation* / Q000379:methods* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*; D013997:Time Factors
keywords: apnea-hypopnea index; home sleep apnea tests; monitoring time; sleep-disordered breathing; total recording time; total sleep time