Testing patients for obstructive sleep apnea (OSA) with Level 3 polysomnography is noninferior to Level 1 polysomnography, according to research published in the Annals of Internal Medicine

The researchers found that the change in Functional Outcomes of Sleep Questionnaire score was not inferior for L3 or L4 versus L1 (mean difference [MD], 0.01 [95 percent confidence interval, ?0.47 to 0.49; P = 0.96] and ?0.46 [95 percent confidence interval, ?0.94 to 0.02; P = 0.058], respectively; noninferiority margin [NIM], ?1.0). Change in Epworth Sleepiness Scale score was not inferior for L3 versus L1 (MD, 0.08; 95 percent confidence interval, ?0.98 to 1.13; P = 0.89), but was inconclusive for L4 versus L1 (MD, 1.30; 95 percent confidence interval, 0.26 to 2.35; P = 0.015) (NIM, 2.0). There was less improvement in the Sleep Apnea Symptoms Questionnaire (P = 0.018), less continuous positive airway pressure use (P = 0.04), and lower physician diagnostic confidence for L4 versus L1 (P = 0.003).

“The results support manually scored L3 testing in routine practice,” the authors write. “Poorer outcomes with L4 testing may relate, in part, to reduced physician confidence.”

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