Overview of Home Testing for Sleep Apnea

Home sleep testing is increasingly used to diagnose sleep disorders such as obstructive sleep apnea (OSA). Why might you be told to have a home sleep study? What are the benefits and drawbacks of having a home sleep test compared to an in-center polysomnogram? Learn about the use of home sleep studies, what to expect with your study, and what the next steps in your diagnosis and treatment might be.

Man snoring loudly while his partner covers her head in a pillow

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How to Get a Home Sleep Study

First, you might wonder why you are required to get a sleep study in the first place. These tests are used to identify various sleep disorders. Though symptoms and a proper physical examination may point to the cause of your sleep problems, a test is required to formally establish the diagnosis (and, ultimately, for insurance to pay for the treatments).

Board-certified sleep healthcare providers are generally responsible for ordering sleep tests. These professionals often see patients complaining of sleep disorders and with their training can review the studies and recommend the most appropriate therapy. The American Academy of Sleep Medicine recommends that sleep studies, including home sleep studies, be administered by an accredited sleep center, supervised by a board-certified sleep medicine physician or a board-eligible sleep medicine provider who hasn’t yet had the opportunity to take the board exam.

Not everyone should have a home sleep study. It is only useful for diagnosing obstructive sleep apnea. This testing should be ordered when there is suspicion of at least a moderate to severe degree of OSA. The testing is also used occasionally to assess the effectiveness of treatments of sleep apnea such as an oral appliance or surgery.

If other medical conditions are present that may compromise the diagnostic accuracy, home sleep testing is not considered appropriate. It also is not used to diagnose other sleep disorders beyond sleep apnea. Some of these medical contraindications to home sleep testing include:

  • Significant cardiopulmonary disease, such as heart failure or chronic obstructive pulmonary disease
  • Neuromuscular disease that may weaken respiratory muscles
  • Non-obstructive sleep-disordered breathing, such as central sleep apnea
  • Severe insomnia
  • Parasomnias, such as sleepwalking or night terrors
  • Narcolepsy
  • History of stroke
  • Chronic opiate medication use

Finally, home sleep testing may be used occasionally in individuals who are unable to have a diagnostic polysomnogram in a center due to immobility, safety, critical illness, or other conflicts. Importantly, home sleep testing is not appropriate for children.

Benefits and Drawbacks

Home sleep studies are an excellent way to rule-in sleep apnea among the properly selected population. If there is a high suspicion of the disorder, it can be a simple confirmative test that allows the patient to proceed to the treatment phase of care. However, a negative test may not rule out the disorder. If a negative home sleep test occurs (with an apnea-hypopnea index or AHI below 5), a diagnostic polysomnogram in a sleep center is typically required.

There are a number of reasons that patients prefer to have a home sleep test, including:

  • It is typically less expensive, costing hundreds of dollars compared to the thousands of dollars an in-center test may cost.
  • It is more convenient, allowing you to sleep at home rather than in an unfamiliar environment.
  • It is more comfortable, with fewer wires and access to the comforts of home.
  • There is more access to the testing. Sleep centers may not be accessible due to location or even scheduling. Home testing devices can be sent home from the healthcare provider’s office and are sometimes even mailed out.

The gold standard for the diagnosis of all sleep disorders remains the attended diagnostic polysomnogram in a sleep center. This includes additional measures of sleep stages and sleep fragmentation via EEG, heart rhythm via EKG, and leg or arm sensors for movements; all of which may not be included with common home testing. Moreover, if you have mild sleep apnea, the home test may simply miss the diagnosis.

What to Expect

Once your healthcare provider determines that you need to have a home sleep study, you will be instructed on how to use the device at home. Often a medical assistant, respiratory therapist, or sleep technician provides these instructions. You will be shown how to apply the required sensors. Typically, this will include a belt that wraps around the chest or stomach to measure respiratory effort, a nasal oxygen cannula fitted in the nose that measures airflow, and an oximeter applied to the fingertip that records pulse rate and blood oxygen levels. Depending on the device used, there may be some variation in these basic features. Once you are properly fitted, you should also receive guidance on how to turn the device on and off.

When you are getting ready to go to bed at home, you reapply the sensors and turn on the device as you were instructed. If you wake to go to the bathroom in the night, you can probably keep most of the sensors in place. In the morning, some devices will notify you with a light or reading to inform you that sufficient data were collected. As a general rule, at least several hours of recording are needed for an adequate test. Some healthcare providers will recommend that patients do two (and even up to three) nights of testing to ensure a successful test is completed.

Next Steps

After you return the device, the sleep healthcare provider will download, review, and interpret the data, and generate a summary report of the results. If the home sleep test reveals inadequate data or is negative for sleep apnea, an in-center test may be necessary to identify the condition. At a follow-up appointment in the sleep clinic, these results will be reviewed with you and next steps will be discussed.

If the test does show sleep apnea, treatment options will be reviewed, including the use of continuous positive airway pressure (CPAP), oral appliances, weight loss, positional therapy, surgery, and possibly other therapies.

Home sleep testing can be an attractive option to identify sleep apnea in those who are highly suspected of having the condition and who do not have any contraindications or other suspected sleep disorders. If you are interested in getting a home sleep study and pursuing treatment, start by seeing a sleep specialist who can provide you a comprehensive evaluation, guidance in testing, and support through the treatment process.

1 Source
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  1. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(03):479-504. doi:10.5664/jcsm.6506

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.