Obstructive sleep apnea (OSA) is an exceedingly common sleep disorder. It is estimated that one in five adults in the United States have OSA. OSA has been linked to many health conditions including high blood pressure, heart disease, and stroke.
OSA was traditionally diagnosed using an in-laboratory sleep test requiring the patient to spend the night in a sleep center. It is an expensive test necessitating special equipment, dedicated software for data processing, and trained technicians to conduct and score the sleep test. Subsequently, a sleep medicine provider interprets the data and provides a diagnosis and treatment plan. Under this model, OSA has been vastly under diagnosed.
This has led to the emergence of home sleep testing (HST) which is a cost-effective alternative to in-lab diagnostic sleep testing. An increasing number of insurance companies require HST as the first step in the evaluation of high-risk OSA patients. Furthermore, the American Academy of Sleep Medicine (AASM) has endorsed home testing as an alternative method to in-lab testing in patients who are highly likely to have moderate to severe OSA based on clinical assessment. However, it must be emphasized that the AASM recommends HST be conducted in conjunction with a comprehensive clinical sleep assessment (typically done via an AASM-accredited sleep center). Individuals presenting for HST who also have other sleep disorders (such as insomnia, narcolepsy) or medical comorbidities (such as neuromuscular disease, congestive heart failure, advanced lung disease) should not undergo HST and instead must be evaluated using an in-lab sleep study.
Although HST is a popular and convenient choice to evaluate patients for OSA, it must be used in conjunction with a comprehensive clinical sleep assessment via an AASM-accredited sleep lab.
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Neomi Shah, MD is Associate Professor, Pulmonary, Critical Care and Sleep Medicine Division, Icahn School of Medicine at Mount Sinai.