OBJECTIVES: To assess the diagnostic accuracy of in-laboratory polysomnography(Level I) versus Level II sleep study at home for the diagnosis of Obstructive sleep apnea in adult patient with age group more than 18 years.

METHODS : Meta-analysis of comparative studies of level II versus level I sleep tests in adults with age group greater than 18 years with suspected sleep-disordered breathing were done. We searched 3 research databases (Cochrane, PubMed, & Embase) from Jan 2007 for studies that reported on diagnostic accuracy parameters. Bivariate mixed-effects logistic regression model used to estimate summary of diagnostic accuracy parameters using Revman 5.3. However, STATA 12 were used to estimate the pooled diagnostic accuracy for mild, moderate and severe OSA.

RESULTS: 3 studies involving a total of 320 patients were included in the meta analysis. Summary sensitivity of level II for mild, moderate & severe OSA were 92%, 85% & 75% respectively. Whereas, specificity 66%, 90% & 94% respectively. Positive predictive value for mild, moderate & severe OSA were 87%, 93% & 95% respectively. Negative predictive value for mild, moderate & severe OSA for level II were 78%, 79% & 71% respectively.

CONCLUSIONS: Level II devices scored well for sensitivity, and specificity with a trade-off of increasing specificity and decreasing sensitivity as disease severity increased from mild to severe.