What question did this study set out to answer?

The aim is to evaluate hypoxic burden as a predictor of obstructive sleep apnea (OSA) in patients with initially negative home sleep studies.

May 10, 2026

0619 Hypoxic Burden in Negative Home Sleep Studies: Risk Stratification and Prediction of Later OSA Detection

Key Points

The aim is to evaluate hypoxic burden as a predictor of obstructive sleep apnea (OSA) in patients with initially negative home sleep studies.
Analyzed 4,197 patients with multi-night HSAT testing using 3% and 4% desaturation criteria.
Isolated patients with night-1 negative results (sAHI <5).
Performed subset analysis on hypoxic burden data for predictive assessment of later OSA detection.
With the 3% criterion, none of the 109 night-1 negative patients exhibited high-risk hypoxic burden, but 51.4% were later diagnosed with OSA.
Under the 4% criterion, 14.5% of 332 night-1 negative patients had high-risk hypoxic burden, with 29.8% later diagnosed with OSA.
The findings showed that hypoxic burden can identify patients at risk for OSA even when AHI is below the diagnostic threshold.

Abstract

Abstract Introduction There is promise in analyzing Hypoxic Burden (HB) to potentially identify high-risk patients even when AHI is below the diagnostic threshold. After analyzing 4,197 patients with multi-night HSAT testing using both 3% and 4% desaturation criteria, patients with night-1 negative results (sAHI 5) were isolated. Subset analysis was performed on available HB data. Prevalence of high-risk HB (20% minute/hour) was identified in initially negative patients. Using both desaturation criteria, we assessed HB’s predictive value to later detect OSA (AHI ≥5 on subsequent nights). Methods After analyzing 4,197 patients with multi-night HSAT testing using both 3% and 4% desaturation criteria, patients with night-1 negative results (sAHI 5) were isolated. Subset analysis was performed on available HB data. Prevalence of high-risk HB (20% minute/hour) was identified in initially negative patients. Using both desaturation criteria, we assessed HB’s predictive value to later detect OSA (AHI ≥5 on subsequent nights). Results Using the 3% criterion, 109 patients had a night-1 negative study (sAHI 5), and none exhibited high-risk hypoxic burden (HB 20%). Despite this, 56 patients (51.4%) were later diagnosed with OSA (AHI ≥5) on subsequent nights. In contrast, with the 4% criterion, 332 patients tested negative on night 1, of whom 48 (14.5%) showed high-risk HB despite normal AHI, and 99 (29.8%) later demonstrated OSA. The 4% threshold identified a subgroup with elevated HB despite negative AHI. Overall, HB’s predictive value varied by desaturation criterion, with higher subsequent OSA detection in the 4% negative group. Conclusion Using 4% desaturation criteria, hypoxic burden can identify high-risk patients even when conventional AHI is negative. Among initially negative patients, approximately 15% had HB 20%, indicating significant nocturnal hypoxemia despite AHI 5. Furthermore, 29.8% of these patients were later diagnosed with OSA, suggesting that HB may help flag individuals who would benefit from repeat testing. Incorporating multi-night HSAT with HB assessment could improve risk stratification and reduce false negatives. These findings support HB as a complementary metric for detecting patients at risk for sleep-disordered breathing and its associated cardiovascular consequences. Support (if any)

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