Self-Applied Electrode Set Provides a Clinically Feasible Solution Enabling EEG Recording in Home Sleep Apnea Testing

Home sleep apnea testing (HSAT) without electroencephalography (EEG) recording is increasingly used as an alternative to in-laboratory polysomnography for the diagnosis of obstructive sleep apnea (OSA). However, without EEG, electrooculography (EOG), and chin electromyography (EMG) recordings, the OSA severity may be significantly underestimated. Although several ambulatory EEG systems have been recently introduced, no patient-applied systems including EEG, EOG, and chin EMG suitable for home polysomnography are currently in clinical use. We have recently developed and pre-clinically tested a self-applied ambulatory electrode set (AES), consisting of frontal EEG, EOG, and EMG, in subjects with possible sleep bruxism. Now, in this clinical feasibility study, we investigated the signal scorability and usability of the AES as a self-administered sleep assessment approach supplementing the conventional HSAT device. We also investigated how the diagnostic parameters and OSA severity changed when utilizing the AES. Thirty-eight patients (61 % male, 25–78 years) with a clinical suspicion of OSA conducted a single-night, self-administered HSAT with a portable polysomnography device (Nox A1, Nox Medical, Reykjavik, Iceland) supplemented with AES. Only one AES recording failed. The use of AES signals in data analysis significantly affected the median apnea-hypopnea index (AHI), increasing it from 9.4 to 12.7 events/h (
$p < 0.001$
) compared to the conventional HSAT. Also, in eight patients, the OSA severity class changed to one class worse. Perceived ease of use was well in line with that previously found among healthy volunteers. These results suggest that the AES provides an easy, clinically feasible solution to record EEG as a part of conventional HSAT.