A Single-Night Sleep Study Can Misdiagnose Sleep Apnea Up to Half the Time

The recent study, “Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea” by Bastien Lechat and colleagues, sheds light on the limitations of single-night assessments in diagnosing obstructive sleep apnea (OSA).

OSA is a common sleep disorder in which breathing repeatedly stops and starts throughout the night. It’s typically diagnosed using a sleep study that measures the apnea-hypopnea index (AHI)—the number of times per hour that a person experiences reduced or blocked airflow. Current clinical practice to diagnose OSA requires a single, overnight, in-laboratory or in-home polysomnography or polygraphy study.

The researchers looked at data from over 67,278 individuals aged 18 to 90 who had used the Withings sleep mat, a non-invasive, under-mattress sensor. In addition to the vast number of participants, the researchers were able to monitor an average of approximately 170 nights of data per participant between July 2020 and March 2021. This extensive data collection resulted in more than 11.6 million nights of sleep data–the largest standardized, objective assessment of OSA collected to date.

The study found that the global prevalence of moderate to severe OSA, defined as a nightly mean apnea-hypopnea index (AHI) of more than 15 events per hour, was 22.6% (95% confidence interval: 20.9–24.3%). Notably, the research highlighted significant night-to-night variability in OSA severity. When relying on a single night’s data, the likelihood of misdiagnosis ranged from approximately 20% and up to 50% for those with mild to moderate OSA. Increasing the number of monitoring nights improved diagnostic accuracy, with misdiagnosis error rates decreasing and stabilizing after 14 nights of monitoring.

The substantial variability of OSA suggests that single-night assessments may not provide a comprehensive picture of an individual’s sleep patterns, leading to possible misclassifications. However, fourteen nights of polysomnography in a sleep lab or clinic is not feasible. Tools like the Withings sleep mat offer a non-invasive, cost-effective means of multinight in-home monitoring leading to more accurate and reliable diagnosis of OSA. By offering an accessible way to capture more nights of sleep data, clinicians can reduce misdiagnosis and create a shift in how sleep disorders are screened for and tracked.

1. Lechat, Bastien et al. “Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea.” American journal of respiratory and critical care medicine vol. 205,5 (2022): 563-569. doi:10.1164/rccm.202107-1761OC

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