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Peer-reviewedCC BY-NC-SASaudi journal of medicine & medical sciences

Technical Performance and Automated-manual Scoring Agreement in Type III Home Sleep Apnea Testing: A Single-center Study from Saudi Arabia.

  • Sultan Aldhabei1,2
  • Raghad Alhajaji2
  • Salih A Aleissi3
  • Hamza O Dhafar3
  • Samar Z Nashwan3
  • Mohammad Alrashed4
  • Abdullah Aldhuwaihy4
  • Talal Alghadir4
  • Mohammed H Alhumud5
  • Ahmed T Alhawamdeh4
  • Ahmed S Bahammam3,6
6 affiliations
  1. 1Department of Medicine, College of Medicine, Najran University, Najran, Saudi Arabia.
  2. 2Sleep Medicine Department, King Saud University Medical City, Riyadh, Saudi Arabia.
  3. 3Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia.
  4. 4Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
  5. 5Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
  6. 6The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.
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Abstract

Background

Obstructive sleep apnea (OSA) is a prevalent disorder that carries significant health risks. Home sleep apnea testing (HSAT) is a cost-effective alternative to in-lab polysomnography for diagnosing OSA.Objectives

To evaluate the technical performance and automated-manual scoring agreement of type III HSAT in a Saudi population with a high pretest probability of OSA, and to establish a local performance baseline that can inform future multicenter and cross-regional comparisons.Methods

This retrospective study included adults with a high pretest probability of moderate-severe OSA who underwent type III HSAT at a tertiary sleep center in Riyadh, Saudi Arabia. Automated HSAT recordings (Nox T3 device) were re-scored manually by a blinded sleep technologist. Key outcomes included technical success and agreement between automated and manual scoring of respiratory indices.Results

A total of 173 participants were included, of which 128 (74.4%) had OSA. HSAT was technically successful in 90.7% of cases. Automated apnea-hypopnea index demonstrated high overall concordance with manual scoring (CCC = 0.919; 95% CI: 0.893-0.940), with minimal mean bias. The apnea index (CCC = 0.993; 95% CI: 0.990-0.995) and oxygen desaturation index (CCC = 0.973; 95% CI: 0.964-0.980) demonstrated excellent concordance, while the hypopnea index showed moderate concordance (CCC = 0.820; 95% CI: 0.764-0.864) with modest automated underestimation. In technically failed cases, nasal airflow showed the poorest signal quality (mean ± SD, 58.4% ± 27.4%) followed by pulse oximetry (86.7% ± 25.1%).Conclusion

Among adults from Saudi Arabia, type III HSAT had a high technical success rate and strong overall agreement between automated and manual scoring. These findings support the use of HSAT as a reliable diagnostic alternative in appropriately selected adults with a high pretest probability of OSA.

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Cite

BibTeXRIS
BibTeX
@article{aldhabei2026technical,
  title = {{Technical Performance and Automated-manual Scoring Agreement in Type III Home Sleep Apnea Testing: A Single-center Study from Saudi Arabia.}},
  author = {Sultan Aldhabei and Raghad Alhajaji and Salih A Aleissi and Hamza O Dhafar and Samar Z Nashwan and Mohammad Alrashed and Abdullah Aldhuwaihy and Talal Alghadir and Mohammed H Alhumud and Ahmed T Alhawamdeh and Ahmed S Bahammam},
  journal = {Saudi journal of medicine \& medical sciences},
  year = {2026},
  month = oct,
  doi = {10.4103/sjmms.sjmms_100_26},
  url = {https://europepmc.org/article/MED/42974588},
  note = {CC BY-NC-SA},
}
RIS
TY  - JOUR
TI  - Technical Performance and Automated-manual Scoring Agreement in Type III Home Sleep Apnea Testing: A Single-center Study from Saudi Arabia.
AU  - Sultan Aldhabei
AU  - Raghad Alhajaji
AU  - Salih A Aleissi
AU  - Hamza O Dhafar
AU  - Samar Z Nashwan
AU  - Mohammad Alrashed
AU  - Abdullah Aldhuwaihy
AU  - Talal Alghadir
AU  - Mohammed H Alhumud
AU  - Ahmed T Alhawamdeh
AU  - Ahmed S Bahammam
PY  - 2026
DA  - 2026/10/14
JO  - Saudi journal of medicine & medical sciences
DO  - 10.4103/sjmms.sjmms_100_26
UR  - https://europepmc.org/article/MED/42974588
AB  - Background  Obstructive sleep apnea (OSA) is a prevalent disorder that carries significant health risks. Home sleep apnea testing (HSAT) is a cost-effective alternative to in-lab polysomnography for diagnosing OSA.Objectives  To evaluate the technical performance and automated-manual scoring agreement of type III HSAT in a Saudi population with a high pretest probability of OSA, and to establish a local performance baseline that can inform future multicenter and cross-regional comparisons.Methods  This retrospective study included adults with a high pretest probability of moderate-severe OSA who underwent type III HSAT at a tertiary sleep center in Riyadh, Saudi Arabia. Automated HSAT recordings (Nox T3 device) were re-scored manually by a blinded sleep technologist. Key outcomes included technical success and agreement between automated and manual scoring of respiratory indices.Results  A total of 173 participants were included, of which 128 (74.4%) had OSA. HSAT was technically successful in 90.7% of cases. Automated apnea-hypopnea index demonstrated high overall concordance with manual scoring (CCC = 0.919; 95% CI: 0.893-0.940), with minimal mean bias. The apnea index (CCC = 0.993; 95% CI: 0.990-0.995) and oxygen desaturation index (CCC = 0.973; 95% CI: 0.964-0.980) demonstrated excellent concordance, while the hypopnea index showed moderate concordance (CCC = 0.820; 95% CI: 0.764-0.864) with modest automated underestimation. In technically failed cases, nasal airflow showed the poorest signal quality (mean ± SD, 58.4% ± 27.4%) followed by pulse oximetry (86.7% ± 25.1%).Conclusion  Among adults from Saudi Arabia, type III HSAT had a high technical success rate and strong overall agreement between automated and manual scoring. These findings support the use of HSAT as a reliable diagnostic alternative in appropriately selected adults with a high pretest probability of OSA.
SN  - 1658-631X
SN  - 2321-4856
ER  -