Convenient Home Sleep Apnea Testing Costs Less with Pros and Cons

Diagnosis of Sleep Apnea at Home May Work Well for Select Conditions

Home sleep apnea testing (HSAT) is more convenient than an in-lab sleep study, but costs and limitations of the testing are important factors to consider
Home sleep apnea testing (HSAT) is more convenient than an in-lab sleep study, but costs and limitations of the testing are important factors to consider. Jeff T. Green / Stringer / Getty Images

Almost no one sleeps better in a sleep laboratory for an overnight sleep study compared to at home. Clearly there are better ways to sleep than being tangled up in wires with someone watching you and feeling pressure to sleep. Many patients question the results of their testing when they have a bad night of sleep. What is the alternative? Fortunately, home sleep apnea testing may be an attractive consideration.

What is home sleep apnea testing (HSAT)? Consider this convenient option, whether it might be appropriate to diagnose your sleep disorder, and the costs and limitations associated with home sleep studies.

What Is Home Sleep Apnea Testing?

As the name implies, home sleep apnea testing is the administration of a sleep study in the comfort of your home for the diagnosis of obstructive sleep apnea. There are various devices available for this testing. These might be accessed through a sleep specialist, primary care provider, or even independent for-profit companies.

Most home sleep apnea testing measures parameters useful to detect sleep-disordered breathing. Though devices vary, many detect blood oxygen levels with an oximeter, heart rate, breathing effort with a stretchy abdominal belt, snoring vibrations, and airflow through the nose with an oxygen cannula. Some devices record further measures, such as limited brain waves via EEG for sleep staging, sleep position, and even movements.

Is Home Sleep Apnea Testing Right for Me?

There are specific criteria that are used to identify patients who can undergo home sleep apnea testing. These guidelines will maximize the success of the test and ensure the proper diagnosis.

Currently, it is recommended that pediatric patients still undergo an attended diagnostic polysomnogram.

Therefore, HSAT is restricted to those people who are 18 years or older. Those with a high likelihood of moderate to severe sleep apnea based on presenting symptoms and contributory anatomy should be selected for home testing. Some of the most important symptoms include:

  • Loud snoring
  • Witnessed apnea (pauses in breathing during sleep)
  • Excessive daytime sleepiness (Epworth score >10)
  • Nocturia (waking frequently to urinate)
  • Bruxism (teeth grinding or clenching)
  • Fragmented sleep with insomnia
  • Obesity
  • Middle to older age (Including post-menopausal women)

It is often important for a board-certified sleep specialist to evaluate you to determine the appropriate test for you. In some cases, there may be contraindications to home sleep testing.

Conditions That Require In-Lab Sleep Study Evaluations

Due to the nature of the testing and its limitations, the following exclusion criteria are observed. In some cases, the factor may interfere with the proper administration of the test at home. There are also some medical conditions in which a formal sleep study in a testing center is required to properly diagnose the disorder.

The most common reasons to not to have a home sleep apnea test include:

Testing may be considered on a case-by-case basis among patients who are unable to have attended polysomnography due to immobility, safety, or critical illness concerns. Patients who are insured by Medicare may require a higher index of suspicion given the more stringent scoring criteria used with home testing.

Arranging and Performing a Home Sleep Apnea Study

Patients who have been screened and are deemed appropriate for HSAT will proceed with evaluation. After your doctor has ordered the study, a technician or medical assistant will demonstrate how to apply the equipment. You will take it home and perform the test, typically over one or two nights. After the testing has been completed, the device is returned to be downloaded so the doctor can review the data and make a diagnosis and treatment recommendations. By having the test performed by a board-certified sleep specialist who can interpret the results, you can more quickly meet with a doctor who will direct your care and begin therapy to resolve your sleep apnea.

The Pros and Cons of Home Sleep Apnea Testing

There are certain obvious benefits to having a home sleep apnea test. One of the biggest attractions is the greater convenience of being able to sleep in your own bed at home. If you are a responsible caretaker for another person, including children, this may make things easier. There are fewer wires required for measurement, which makes the testing less intrusive and more comfortable. The testing is generally less expensive, often costing just several hundred dollars compared to the more than $1000 that in-lab studies frequently cost. Due to the increasing availability, it might be done more quickly with a speedy turnaround to start treatment.

Before choosing to have a home sleep apnea test, you should also consider the potential cons to this testing. As noted, this testing is used to diagnose obstructive sleep apnea alone. It is not appropriate for the evaluation of central sleep apnea, insomnia, restless legs syndrome, circadian disorders, parasomnias, narcolepsy, seizures, and other disorders.

If the test comes back as negative, with a normal result, this may not necessarily be accurate. Mild sleep apnea may be missed. This is especially important in younger women and people of normal body weight. Any time spent awake will reduce the average number of sleep apnea events observed per hour of recording. This could change the diagnosis or lead to a false sense of normalcy. If something goes wrong in the application of the sensors or the measurements recorded, the test may have to be repeated.

Generally, if the home sleep apnea test fails to diagnose sleep apnea, an in-lab test will be recommended to definitively evaluate the condition. If central sleep apnea is detected with a home sleep apnea test, an attended titration study for bilevel therapy is often needed. If the test does show sleep apnea, it will be easy to move along to treatment, such as CPAP therapy or the use of an oral appliance.

If you are interested in learning more about home sleep apnea testing as an option, find a board-certified sleep specialist near you and get evaluated to finally get the diagnosis, therapy, and quality rest that you need.

Source:

Collop NA et al. “Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients.” Journal of Clinical Sleep Medicine. 2007;3(7):737-747.

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