Sleep Medicine

Canadian guideline maintains PSG as pediatric OSA standard, with narrow role for level 3 HSAT

This guideline reaffirms in-lab polysomnography as the recommended standard for diagnosing pediatric obstructive sleep apnea. A review of 250 studies of alternative assessments found limited data, with frequent exclusion of comorbid children and those under two years. No alternative test qualifies as a replacement for PSG in children based on current evidence. Level 3 home sleep apnea testing is acceptable only for otherwise healthy children over five when PSG access is effectively absent. 1

Night-to-night OSA variability independently associates with prevalent MACCEs

This study linked multi-night OSA data from an under-mattress sensor with self-reported non-fatal MACCEs in over 3,000 adults. Moderate-to-severe OSA showed higher odds of MACCEs than no OSA, although confidence intervals included unity. Higher night-to-night AHI variability (75th vs 25th percentile) was associated with 34% higher odds of MACCEs, independent of mean AHI and confounders. These findings suggest that instability of OSA severity may be clinically relevant for cardiovascular risk, beyond average AHI alone. 2

Systematic review finds few robust predictors of CBT-I outcomes

This review synthesized 103 reports evaluating pre-treatment predictors and moderators of insomnia outcomes after CBT-I and related interventions. Among 195 candidate predictors or moderators, over 90% were rarely studied and seldom showed significant associations. More consistent predictors of greater improvement included shorter insomnia duration, higher baseline insomnia severity, and longer objective sleep duration. Positive treatment attitudes, lower depression, and absence of mental disorders, fatigue, and pain also predicted better outcomes. 3