Outpatient polygraphy – adequate for diagnosing and indicating OSAS-therapy according to the guideline?

Introduction:

According to the new S3-guideline „unrestorative sleep“ it's possible to make the diagnose OSAS and initiate a therapy in patientes with a pathological high AHI of > 15/h by outpatient polygraphy (PG) and a high pretest probability. Aim of this study was to evaluate the diagnostic accuracy and indication of treatment for PG in comparison with inpatient polysomnography (PSG) according to the guideline.

Methods:

The external performed PG-reports of 844 patients in 2007 – 2017 were compared to the corresponding PSG-reports from our sleep laboratory and evaluated regarding the degree of severity and indication for respiratory therapy according to the new S3-guideline.

Results:

OSAS severity was defined correct in 45% by PG. Especially the mild and moderate OSAS was accurately classified in 31% with the PG.

In accordance with the new S3-guideline in 2% (n = 5/226) of the patients an OSAS-therapy would have been initiated falsely. The needed therapy would not have been indicated in 15% of all OSAS patients and in 25% of the patients with moderate OSAS.

Conclusion:

Although the ambulatory PG can be used to initiate respiratory therapy with an AHI > 15/h and high pretest probability, it is not suitable for reliably assessing the severity. For this reason, carrying out a PSG in the sleep laboratory is still sensible before initiation of a severity-related therapy or to exclude an OSAS in the case of borderline findings.

Publication History

Publication Date:
18 April 2018 (online)