Preliminary Report: Validity of Symptom Analysis and Daytime Polysomnography in Diagnosis of Sleep Apnea

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Abstract
The aim of this study was twofold: first, to see if the prevalence of the sleep apnea syndrome (SAS) in a given population could be fairly estimated by our patient questionnaire, mainly based upon the 1979 American Sleep Association definition of SAS; and second, to investigate whether the severity of SAS could be similarly accurately measured by daytime polysomnography (DPSG), as an alternative to the more demanding all-night polysomnography (NPSG). Of 42 patients consecutively examined due to rhonchopathy, 18 had the clinical diagnosis of SAS, which was based on the three symptoms—snoring, sleep disturbances and diurnal hypersomnia—if reported to occur habitually. In 11 patients the diagnosis was established by NPSG [apnea index (AI) > 10]. However, in only 10 of the 18 cases NPSG indicated the diagnosis giving a positive predictive value of 56%. When comparing DPSG versus NPSG in 36 patients, the AI ranged from −23 to +65, and the mean AI value was found to be twice as high in the former (mean difference 9.0 ± 18.4; p < 0.01). The positive predictive value of DPSG was 63% (10/ 16). Both the self-report and DPSG were burdened with some 25% false-positive results, and DPSG gave far too variable AI values to be reliable in staging the disease. On the other hand, the negative predictive values were high, 96% (23/24) and 100% (20/20), respectively, indicating their usefulness for screening purposes.

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