Institute for Continuing Education

Split Night Polysomnography

Course Objectives

Upon successful completion of this module, you will be able to:

• Describe the pathophysiology of obstructive sleep apnea including upper airway collapse mechanisms, consequences of intermittent hypoxemia and sleep fragmentation, and the physiological rationale for positive airway pressure therapy.
• Explain current AASM guidelines and Medicare criteria for split-night polysomnography including diagnostic threshold requirements, minimum diagnostic time, CPAP titration standards, and appropriate patient selection.
• Apply technical protocols for split-night studies including real-time decision-making for conversion from diagnostic to therapeutic phases, proper CPAP titration methodology, and optimization of therapeutic pressure determination within time constraints.
• Identify advantages and limitations of split-night versus full-night diagnostic and titration studies including considerations of cost-effectiveness, patient access, diagnostic accuracy, titration adequacy, and quality of therapeutic outcome data.
• Recognize clinical scenarios where split-night studies are appropriate versus situations requiring full-night diagnostic polysomnography or alternative testing pathways including obesity hypoventilation syndrome, complex sleep-disordered breathing, and inadequate split-night outcomes.
• Evaluate split-night study quality including assessment of adequate diagnostic data, therapeutic titration success criteria, recognition of split-night failures requiring repeat studies, and documentation standards for clinical interpretation and insurance coverage.
• Integrate the sleep technologist's critical role in split-night studies including real-time severity assessment, patient education during protocol transition, technical troubleshooting under time pressure, and communication with interpreting physicians for optimal clinical outcomes.

Course Information

Obstructive sleep apnea (OSA) is a common disorder associated with serious health consequences, increased health-care utilization, and economic burden. With greater public and medical attention to sleep disorders, the volume of referrals for sleep studies over the last decade has increased by approximately 12-fold. Despite the steep growth of infrastructure to diagnose and treat OSA, access to such services remains a sizeable problem, and demand overwhelms capacity. To expedite diagnosis of sleep apnea and prescription of treatment, one strategy adopted by sleep specialists is to employ split-night polysomnography, a strategy that encompasses both diagnosis of OSA and initiation of positive pressure therapy in a single night.

The current reference standard for evaluating sleep-disordered breathing is polysomnography. However, it is by no means the ultimate “gold standard.” Polysomnography is subject to error involved with data measurement, artifact, and interpretation. Additionally, polysomnographic testing may misclassify patients based on night-tonight variability, a well-recognized phenomenon.