Phenotyping REM OSA by means of peripheral arterial tone-based home sleep apnea testing and polysomnography: A critical assessment of the sensitivity and specificity of both methods.

The clinical relevance of rapid eye movement sleep-related obstructive sleep apnea (REM OSA) is supported by its associated adverse health outcomes and impact on optimal treatment strategies. To date, no assessment of REM OSA phenotyping performance has been conducted for any type of sleep testing technology. The objective of this study was to assess this for polysomnography and peripheral arterial tone-based home sleep apnea testing (PAT HSAT). In a dataset comprising 261 participants, the sensitivity and specificity of the agreement on REM OSA phenotyping was assessed for two independent scorings of polysomnography and a synchronously administered PAT HSAT. The sensitivity and specificity of REM OSA phenotyping were 0.87 and 0.89, respectively, for the polysomnography inter-scorer comparison, and 0.68 and 0.97 for the PAT HSAT on a single-night basis, using the conventional minimum required rapid eye movement sleep time of 30 min. Polysomnography-based REM OSA phenotyping was found to be sensitive and specific even for a single-night testing protocol. Peripheral arterial tone-based REM OSA phenotyping showed a lower sensitivity but a slightly higher specificity compared to polysomnography. In order to increase performance and conclusiveness of peripheral arterial tone-based REM OSA phenotyping, a multi-night protocol of 2-5 nights could be considered. Finally, the minimum required rapid eye movement sleep time could be lowered from the conventional 30 min to 15 min without significantly lowering REM OSA phenotyping sensitivity and specificity, while increasing the level of phenotyping conclusiveness.