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

Year: 2026

Type: article

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.

Source: Saudi Journal of Medicine and Medical Sciences

DOI: 10.4103/sjmms.sjmms_100_26