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Objective Brain Age Index (BAI), calculated from sleep electroencephalography(EEG), has been proposed as a biomarker of brain health. This study quantifiesnight-to-night variability of BAI and establishes probability thresholds forinferring underlying brain pathology based on a patient's BAI.  Methods 86 patients with multiple nights of consecutive EEG recordings wereselected from Epilepsy Monitoring Unit patients whose EEGs reported as beingwithin normal limits. BAI was calculated for each 12-hour segment of patientdata using a previously described algorithm, and night-to-night variability inBAI was measured.  Results The within-patient night-to-night standard deviation in BAI was 7.5years. Estimates of BAI derived by averaging over 2, 3, and 4 nights hadstandard deviations of 4.7, 3.7, and 3.0 years, respectively.  Conclusions Averaging BAI over n nights reduces night-to-night variability ofBAI by a factor of the square root of n, rendering BAI more suitable as abiomarker of brain health at the individual level.  Significance With increasing ease of EEG acquisition including wearabletechnology, BAI has the potential to track brain health and detect deviationsfrom normal physiologic function. In a clinical setting, BAI could be used toidentify patients who should undergo further investigation or monitoring.

Night-to-Night Variability of Sleep Electroencephalography-Based Brain Age Measurements