Split-Night Sleep Apnea Diagnosis

Sleep apnea studies usually take place over two different nights, but now many sleep centers are doing split-night sleep studies in an effort to save time and money. During the first part of the night, sleep specialists diagnose obstructive sleep apnea, and during the second half, they determine the appropriate level of positive airway pressure.

In traditional treatments, during the first night doctors perform a polysomnography (PSG), a diagnostic study that measures the apnea-hypopnea index (AHI). They may also perform a PSG if the patient has a respiratory disturbance index (RDI) of at least 20 events per hour, regardless of symptoms, or an AHI/RDI of 10 events per hour associated with excessive daytime somnolence. Once obstructive sleep apnea (OSA) has been confirmed, the patient returns for a second night, during which the doctor performs therapeutic PSG titration with either continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) to levels that eliminate or significantly reduce the number of respiratory abnormalities.

Now, according to Dr. Stephen Baez, a medical specialist at AllMed HealthCare (Portland, OR, USA), split-night studies are gaining in popularity. For a split-night study to work, the patient must fall asleep promptly and demonstrate an elevated RDI of at least 40 events early in the evening. Only 25-30% of patients meet these guidelines. When they are met, the patient is awakened and fitted with a CPAP mask, which is adjusted to eliminate the respiratory events. If the patient fails to meet the split-night sleep study guidelines, the doctor follows traditional procedures for a two-night sleep study. Split-night studies are now incorporated into the guidelines for the treatment of OSA published by the American College of Chest Physicians (ACCP).

AllMed HealthCare is an independent review organization serving insurance payers, providers, third-party administrators, and claims managers.



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