The Correlation of Computerized Scoring in Home Sleep Apnea Tests with Technician Visual Scoring for Assessing the Severity of Obstructive Sleep Apnea

Background: Obstructive sleep apnea (OSA) affects a significant proportion of the global population, with many having moderate or severe forms of the disease. Home Sleep Apnea Testing (HSAT) has become the most common method of diagnosing OSA, replacing in-lab polysomnography. Polysmith software Version 11 by Nihon Kohden allows for the automatic scoring of respiratory events. This study aimed to assess the validity of this technology. Study Objectives: The objective was to assess the accuracy of the Polysmith Software Automatic Scoring Algorithm of HSATs in comparison to that of sleep technicians. Methods: One hundred twenty HSATs were scored by both sleep technicians and Polysmith software. The measured values were the respiratory event index (REI), apneic events, and hypopneic events. Agreement between the two methods was reached by utilizing the Kruskal-Wallis test, Pearson correlation coefficient, and Bland-Altman plot, as well as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The correlation between the REI calculated by the software and technicians proved to be strong overall (r = 0.96, p < 0.0001). The mild OSA group had a moderate correlation (r = 0.45, p = 0.0129). The primary snoring, moderate OSA, and severe OSA groups showed stronger correlations (r = 0.69, p < 0.0001; r = 0.56, p = 0.012; r = 0.71, p < 0.0001). The analysis conducted across all groups demonstrated an average sensitivity of 81%, specificity of 94%, PPV of 82%, and NPV of 94%, with an overall accuracy of 81%. When combining the moderate and severe OSA groups into a single category, the sensitivity was 90%, specificity was 100%, PPV was 100%, and NPV was 91%. Conclusions: OSA can be reliably diagnosed from HSATs with the automated Polysmith software across all OSA disease severity groups, with higher levels of accuracy in moderate/severe OSA and lower levels of accuracy in mild OSA.