PURPOSE:Split-night polysomnography is commonly used to diagnose OSA and titrate continuous positive airway pressure (CPAP), thereby improving sleep lab efficiency. The use of split-night polysomnography in Upper Airway Resistance Syndrome (UARS) has not been described. We sought to determine if split-night polysomnography could be effectively used in UARS without diminishing diagnostic accuracy or quality of CPAP titration.
METHODS:Consecutive patients diagnosed with UARS by esophageal manometry during an attended overnight polysomnography were included. Split-night studies were performed if patients met predefined criteria. During diagnostic polysomnogram, patients exhibiting more than 40 respiratory-effort related arousals in the first 120 minutes (RERA >20/hour) underwent CPAP titration, provided there were three hours of remaining test time. We compared demographic, polysomnographic and CPAP titration data between those undergoing traditional (separate diagnostic and CPAP titration studies) and split-night polysomnography.
RESULTS:We included 100 consecutive patients (60% male, mean age 41.2±7.4 years), 46 were split-night polysomnographies. Groups were similar at baseline. As expected, those meeting criteria for split-night studies had more significant disease as measured by esophageal pressure nadir (-30.4 ± 8.5 vs. -20.3 ± 6.3 cm H2O, p<0.001) and higher respiratory-effort related arousal indices (35.8 ± 18.0 vs. 14.9 ± 8.6, p<0.001). There were no differences in polysomnography quality. Final CPAP pressure, respiratory events on the final CPAP pressure and initial CPAP tolerance did not differ between groups. Among those not undergoing split-night studies, the mean time between diagnostic polysomnography and CPAP titration was 71.9 ± 49.0 days.
CONCLUSION:Split-Night polysomnography can be effectively utilized to diagnose UARS and initiate CPAP therapy. Using esophageal manometry and defined criteria similar to that for OSA, nearly half of patients with UARS were able to successfully undergo split-night studies, with no detriment in CPAP titration quality. This practice can reduce the number of studies needed and obviate the inherent delay in initiating CPAP therapy.
CLINICAL IMPLICATIONS:Split-night polysomnography is an effective and efficient means to diagnose and initiate treatment in UARS.
DISCLOSURE:Anita Shah, No Financial Disclosure Information; No Product/Research Disclosure Information