Home-based Video-Polysomnography for Sleep-Related Motor Behaviors: Development, Feasibility, and Diagnostic Performance at the Bologna Sleep Center

Study Objectives For most sleep disorders, in-laboratory video-polysomnography (VPSG) is currently considered the gold diagnostic standard. However, a growing need for more accessible diagnostic tools has been highlighted. This study aims to describe the experience of the Bologna Sleep Center in evaluating sleep-related motor behaviors using home VPSG. Methods Consecutive patients referred to the Bologna Sleep Center between April 2016 and May 2024 for suspected sleep-related motor behaviors were recorded. Based on clinical suspicion, patients underwent either a 48-hour monitoring with a full EEG montage (for NREM parasomnias/epilepsy) or a 24-hour monitoring with a sleep montage (for REM sleep Behavior Disorder patients). Patients were equipped in the sleep lab by expert sleep technicians, who also provided instructions for continuing the recording in the home setting. A technical evaluation of recording quality was conducted on the first 50 recordings. Results We included 305 patients, resulting in a total of 489 home VPSGs. Overall, 82% of the recordings were diagnostic (either confirming or excluding the clinical suspicion), while 18% were non-diagnostic due to insufficient evidence to confirm a diagnosis or technical issues. A detailed technical evaluation of the quality of the tracings in the first 50 recordings revealed a mean artefact percentage of 8% on polygraphic channels. Conclusions Home VPSG demonstrated good diagnostic accuracy and exhibited limited technical issues that do not significantly interfere with its diagnostic capability. Recording in the patient’s natural environment may increase the likelihood of capturing habitual episodes.