Expert panel perspectives on multi-night testing for obstructive sleep apnoea: A Delphi study

This is the authors' abstract. We don't add key points for this paper.

:Obstructive sleep apnoea (OSA) is typically diagnosed with single-night sleep studies, yet night-to-night variability may lead to diagnostic misclassification and affect treatment decisions. The clinical role of multi-night testing remains uncertain. We conducted a two-round modified Delphi study involving 13 international sleep medicine experts to explore consensus on indications, timing, conduction, and interpretation of multi-night testing. Structured questionnaires and anonymised feedback were employed across rounds. Consensus was defined as ≥70% agreement. Consensus was achieved on 12 of 17 statements (71%). Experts supported multi-night testing in cases of suspected night-to-night-variability in OSA, borderline apnoea–hypopnoea index (AHI), or when clinical impressions are incongruent with test results. A three-night protocol was considered a practical balance between diagnostic yield and feasibility. The mean AHI across valid nights was endorsed to guide treatment decisions. Experts also supported limiting the interval between test nights to one month to minimise physiological confounders. No consensus was reached regarding the suitability of simplified tools (e.g. oximetry) are appropriate for extended monitoring, and uncertainty remains about how best to integrate multi-night data into clinical decision-making. Expert opinion supports selective multi-night testing in diagnostically uncertain OSA cases. A three-night protocol and mean AHI-based treatment recommendation thresholds were endorsed. These findings highlight the limitations of single-night assessments and identify priority areas for future research and standardisation before broad implementation into clinical practice. • Expert consensus highlights selective scenarios where multi-night testing may be informative in OSA • Three-night monitoring was commonly viewed by experts as a pragmatic compromise when variability is suspected • Mean AHI across nights was considered by some experts for informing treatment-related decisions • No consensus was reached on the role of simplified tools in multi-night assessment • Night-to-night variability underscores limitations of single-night threshold-based classification