Validation of sleep-staging accuracy for an in-home sleep electroencephalography device: A comparison with simultaneous polysomnography in patients with obstructive sleep apnea

Abstract

Abstract Efforts to simplify standard polysomnography (PSG) in laboratories, especially for obstructive sleep apnea (OSA), and to assess its agreement with portable electroencephalogram (EEG) devices are limited. We aimed to evaluate the agreement between a portable EEG device and type I PSG in patients with OSA and examined the EEG-based arousal index's ability to estimate apnea severity. We enrolled 77 Japanese patients with OSA who underwent simultaneous type I PSG and portable EEG monitoring. Combining pulse rate, oxygen saturation (SpO2), and EEG data improved sleep staging accuracy. Bland-Altman plots, paired t-tests, and receiver operating characteristics curves were used to assess agreement and screening accuracy. Significant small biases were observed for total sleep time, sleep latency, awakening after falling asleep, sleep efficiency, N1, N2, and N3 rates, and arousal index. All variables showed > 95% agreement in the Bland-Altman analysis, with interclass correlation coefficients ranging from 0.76–0.982, indicating high inter-instrument validity. The EEG-based arousal index demonstrated sufficient power for screening AHI ≥ 15 and AHI ≥ 30. Portable EEG device showed strong agreement with type I PSG in patients with OSA. Additionally, the EEG-based arousal index yielded promising results in predicting apnea severity. This suggests that patients with OSA may assess their condition at home.