Performance of wrist-worn home sleep apnea testing (watch-PAT) among individuals with chronic insomnia: a comparative study with polysomnography.

BACKGROUND

While comorbid insomnia and sleep apnea are frequently encountered in clinical practice, the accuracy of home sleep apnea testing in this particular scenario has long been overlooked. Our study aims to evaluate the performance of a wrist-worn device in diagnosing sleep apnea among individuals with chronic insomnia.

METHODS

Participants with chronic insomnia suspected of having sleep apnea were consecutively enrolled at a sleep center. Single-night Watch-PAT 200 monitoring was conducted in parallel with attended in-lab polysomnography.

RESULTS

Recordings from 44 participants (41% female, age 49.1 ± 12.7 years) with a wide range of sleep duration (222.9 ~ 461.4 min) and severity of sleep apnea [apnea-hypopnea index (AHI) 0.3 ~ 83.9/h] were analyzed. Using AHIPAT ≥ 15/h as the threshold, the sensitivity, specificity, and area under the receiver operating characteristic curve for identifying moderate-to-severe obstructive sleep apnea (OSA) were 77.3% (95% CI 54.2-91.3%), 100.0% (95% CI 81.5-100.0%), and 0.92 (95% CI 0.80-0.98), respectively. Diagnostic agreement defined by clinically oriented criteria was reached in 36 (82%) subjects. The Watch-PAT overestimated total sleep time and rapid eye movement sleep duration by 19.9 min (limits of agreement -48.1 ~ 87.9 min) and 37.2 min (limits of agreement -26.1 ~ 100.6 min), respectively.

CONCLUSION

Among individuals with chronic insomnia, the wrist-worn home sleep apnea testing maintained acceptable diagnostic performance for identifying moderate-to-severe OSA. Sleep duration and staging parameters provided by the device should be interpreted with caution.