Abstract Rationale Comorbid insomnia and sleep apnea (COMISA) is associated with poor health outcomes, and the condition remains underdiagnosed, partly because of the limitations of contact-based monitoring methods such as polysomnography (PSG) and wearable devices. Millimeter-wave radar (MWR) might represent a non-contact alternative for the simultaneous assessment of sleep-disordered breathing and sleep duration. Objective To assess the accuracy of MWR in estimating the respiratory event index (REI) and sleep duration and identify the optimal post-movement exclusion windows for each metric to enhance concordance with PSG-derived standards. Methods Sixty-two adults underwent overnight PSG alongside MWR recording. REI and the estimated sleep duration (ESD) were calculated by excluding data within 1, 2, or 3 min following large body movements. Agreements between REI and PSG-derived AHI and between ESD and PSG-derived total sleep time (TST) were evaluated using Bland-Altman analysis. Results The 3-min exclusion window yielded the smallest bias and narrowest limits of agreement for REI mean bias = +0.1 events/h; 95% confidence interval (CI) = −8.2 to 8.4, closely matching PSG-derived AHI (18.9 ± 16.9 events/h vs. 19.0 ± 14.4 events/h). Conversely, the 1-min exclusion window provided the best agreement for sleep duration (mean bias = −26 min; 95% CI = -72 to 20), aligning with PSG-derived TST (422 ± 80 min vs. 396 ± 71 min). These findings support metric-specific optimization, namely a 3-min exclusion window for REI and a 1-min window for ESD (Figure 1). Bland-Altman analysis further confirmed that tailored exclusion windows enhanced concordance with PSG metrics. Conclusions MWR enables the simultaneous, non-contact estimation of sleep-disordered breathing and the objective sleep duration with clinically acceptable concordance with PSG. This radar-based approach could facilitate low-burden screening and management of COMISA, positioning MWR as a viable alternative to wearable devices for COMISA screening and management in both clinical and home environments. This abstract is funded by: a project, JPNP23019, subsidized by the New Energy and Industrial Technology Development Organization (NEDO), KYOTO Industrial Support Organization 21
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