0573 False Negative Home Sleep Apnea Tests in Women vs. Men

Abstract Introduction Home sleep apnea testing (HSAT) is routinely used to diagnose obstructive sleep apnea (OSA). Traditional flow-based HSATs measure specific cardiac and pulmonary parameters but do not determine wake vs sleep due to lack of EEG monitoring. The American Academy of Sleep Medicine’s (AASM) recommended scoring for respiratory events includes events associated with a 3% drop in oxygen saturation or an arousal from sleep. Respiratory events associated only with arousals will be missed on flow-based HSATs. Based on their apnea-hypopnea index (AHI), women typically have less desaturation-based and more arousal-based OSA, despite similar symptom burden, when compared to men. Oxygen desaturation-based scoring criteria may lead to underdiagnosis of OSA in women compared to men with flow-based HSAT testing. Methods This was an IRB approved retrospective chart review study. Patients who underwent a flow-based HSAT in 2023-24 at our institution were included. HSATs that were technical failures were excluded. A total of 820 patients qualified. Of those with a negative HSAT (respiratory event index (REI) 4% < 5), basic demographic data, medical comorbidities, patient-reported sleep symptoms, ESS and REI4% were collected. Of those who had a polysomnogram (PSG) after a negative HSAT, the AHI and/or respiratory disturbance index were collected. Results 28.7% of 820 flow-based HSATs were negative for OSA. 35.8% of women vs. 18.8% of men had negative test (p< 0.001). Of 235 negative HSATs, only 18.3% of patients had a follow-up PSG (18% women vs 17% men). Women who had a PSG following a negative HSAT tended to be heavier (BMI 34.3 kg/m2 women vs. 30.3 kg/m2 men, p=0.04) and appeared sleepier (ESS 9.4 women vs 8.4 men, p=0.28) than men who had a follow-up PSG. Of those who had follow-up PSGs, 90% of women had an AHI3% > 5 (16% had an AHI4% > 5) and 100% of men had an AHI3% > 5 (36% had an AH4% > 5). Conclusion Flow-based HSATs are twice as likely to be negative in women vs men by REI4% scoring criteria. If follow-up in-lab PSG testing is performed, the majority of women and men will meet the AASM definition for OSA. Support (if any)