Long-term night-to-night variability of sleep-disordered breathing using a radar-based home sleep apnea test: a prospective cohort study

Study Objectives: Night-to-night variability of sleep-disordered breathing limits the diagnostic accuracy of a single measurement. Multiple recordings using a reliable, affordable method could reduce the uncertainty and avoid misdiagnosis, which could be possible with radar-based home sleep apnea testing (HSAT). Methods: We recruited consecutive patients with suspected sleep-disordered breathing and performed contactless radar-based HSAT with automated scoring (Sleepiz One; Sleepiz AG, Zurich, Switzerland) over 10 nights. During the first night, patients were simultaneously measured with peripheral arterial tonometry. Results: Twenty-four of the 28 included patients could achieve a minimum of 4 measurements. The failure rate was 16% (37 of 238 measurements). The apnea-hypopnea index (AHI) and oxygen desaturation index were consistently lower with radar-based HSAT compared with peripheral arterial tonometry. The variability of the AHI was considerable, with a standard error of measurement of 5.2 events/h (95% confidence interval [CI]: 4.6 -5.7 events/h) and a minimal detectable difference of 14.4 events/h (95% CI: 12.7 -15.9 events/h). Alcohol consumption partially accounted for the variability, with an AHI increase of 1.7 events/h (95% CI: 0.6 -2.8 events/h) for each standard drink. Based on a single measurement, 17% of patients were misdiagnosed and 32% were misclassified for sleep-disordered breathing severity. After 5 measurements, the mean AHI of the measured nights stabilized with no evidence of substantial changes with additional measurements. Conclusions: Night-to-night variability is considerable and stable over 10 nights. HSAT using radar-based methods over multiple nights is feasible and well tolerated by patients. It could offer lower costs and allow for multiple-night testing to increase accuracy. However, validation and reducing the failure rate are necessary for implementation in the clinical routine. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Recording of Multiple Nights Using a New Contactless Device (Sleepiz One Connect) in