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-h monitoring with a full electroencephalogram montage (for non-rapid eye movement parasomnias or epilepsy) or a 24-h monitoring with a sleep montage (for patients with rapid eye movement [REM] sleep behavior disorder). 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 nondiagnostic 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 artifact 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. Statement of Significance The present study demonstrates that diagnosing sleep-related motor behaviors using home video-polysomnography is feasible. In particular, one recording night is often sufficient for a diagnosis of REM sleep behavior disorder, while two consecutive nights provide good diagnostic efficacy for disorders of arousal, for which the home environment may increase the likelihood of capturing habitual episodes. Careful work by the sleep lab staff is essential for the success of the recordings, ensuring tracings with minimal artifacts. Future studies may further minimize technical issues by incorporating video tutorials or telemonitoring to address critical technical challenges. In conclusion, home video-polysomnography may serve as a valuable implement at the sleep expert's disposal, providing lower costs and shorter waiting lists than in-lab video-polysomnography.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. Statement of Significance The present study demonstrates that diagnosing sleep-related motor behaviors using home video-polysomnography is feasible. In particular, one recording night is often sufficient for a diagnosis of REM sleep behavior disorder, while two consecutive nights provide good diagnostic efficacy for disorders of arousal, for which the home environment may increase the likelihood of capturing habitual episodes. Careful work by the sleep lab staff is essential for the success of the recordings, ensuring tracings with minimal artifacts.Future studies may further minimize technical issues by incorporating video tutorials or telemonitoring to address critical technical challenges. In conclusion, home video-polysomnography may serve as a valuable implement at the sleep expert's disposal, providing lower costs and shorter waiting lists than in-lab video-polysomnography.