Respiratory polygraphy (RP) is widely used in primary care to investigate suspected obstructive sleep apnea (OSA), particularly when access to polysomnography (PSG) is limited. However, RP may underestimate disease severity by failing to detect non-desaturating obstructive events associated with cortical micro-arousals, leading to discordance between respiratory indices and clinical symptoms.To assess whether integrating non-cortical physiological indicators into RP interpretation improves detection of obstructive respiratory events associated with micro-arousals, and to evaluate agreement between enriched RP and PSG-derived respiratory indices in a primary care context.We conducted a retrospective single-center observational study including seven adult ambulatory PSG recordings. Each recording underwent two independent analyses: standard PSG scoring according to American Academy of Sleep Medicine criteria, and an RP-based analysis simulating a primary care setting enriched with two additional obstructive event categories. EOSD type 1 corresponded to non-desaturating hypopnea-like events, and EOSD type 2 to respiratory effort–related events. A suspected micro-arousal was identified in RP when at least three non-cortical indicators were present (ventilatory recovery, airflow normalization, respiratory effort changes, pulse wave attenuation, heart rate acceleration). Event-level diagnostic performance was assessed using sensitivity and positive predictive value (PPV) with exact 95% confidence intervals. Index-level agreement was evaluated using intraclass correlation coefficients (ICC) and Bland–Altman analysis.Enriched RP identified 1,064 PSG-confirmed respiratory micro-arousals, with an overall PPV of 91.1% (95% CI 89.3–92.7) and a sensitivity of 91.5% (95% CI 89.8–93.0). EOSD type 2 showed the highest predictive performance (PPV 93.6%, 95% CI 91.5–95.3). Agreement between RP-derived and PSG-derived indices was excellent, with ICC values of 0.982 for EOSD 1 versus non-desaturating hypopneas and 0.987 for EOSD 2 versus respiratory effort–related micro-arousals. Bland–Altman analyses showed minimal bias and narrow limits of agreement.Integrating non-cortical indicators substantially improves RP interpretation by reducing under-detection of clinically relevant obstructive events and improving concordance with PSG.Enriched respiratory polygraphy provides reliable and clinically meaningful estimates of obstructive respiratory event burden. This pragmatic approach supports more accurate OSA assessment in primary care, particularly in isolated settings where polysomnography is not accessible.   MeSH : Sleep apnea syndromes; Primary health care; Polysomnography