Home sleep apnea testing for obstructive sleep apnea in adults
- Nancy Collop, MD
Nancy Collop, MD
- Editor-in-Chief — Sleep Medicine
- Section Editor — Sleep Related Breathing Disorders
- Professor of Medicine and Neurology
- Director, Emory Sleep Center, Emory University
Home sleep apnea testing (HSAT), also referred to as out-of-center sleep testing or portable monitoring, is a diagnostic test used to diagnose obstructive sleep apnea (OSA), a disorder characterized by repetitive episodes of apnea or reduced inspiratory airflow due to upper airway obstruction during sleep. It has evolved as an alternative to overnight, attended, in-laboratory polysomnography (PSG) in selected patients.
Advantages of HSAT include its convenience (it can be performed in the patient's home or in a hospital room) and its potential to lower costs, since most HSAT devices are less costly than complete polysomnography systems and the attendance of a technologist is not required. A disadvantage is that for most of these devices, fewer physiologic variables are measured than with PSG, which can lead to misinterpretation of the results. Other advantages and disadvantages are listed in the table (table 1).
The United States Centers for Medicare and Medicaid Services (CMS) guidelines state that results from HSAT can be used to support a prescription for positive airway pressure therapy . The American Academy of Sleep Medicine (AASM) has also released clinical practice guidelines to guide clinicians in the use of HSAT [2-4].
The use of HSAT in the diagnostic evaluation of suspected OSA is reviewed here. The diagnostic approach to a patient with suspected OSA is described separately. (See "Clinical presentation and diagnosis of obstructive sleep apnea in adults".)
TYPES OF MONITORING DEVICES
Four types of sleep study monitoring devices have been defined [2,5]. Type 1 is an in-laboratory polysomnogram that cannot be performed at home. All others (types 2, 3, and 4) are portable devices that are considered as “adequate” for home sleep testing.
- Department of Health and Human Services, Center for Medicare and Medicaid Services. Decision Memo for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA). CAG#0093R. March 13, 2008.
- Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007; 3:737.
- Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5:263.
- 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; 13:479.
- Ferber R, Millman R, Coppola M, et al. Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice. Sleep 1994; 17:378.
- Collop NA, Tracy SL, Kapur V, et al. Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med 2011; 7:531.
- Choi JH, Kim EJ, Kim YS, et al. Validation study of portable device for the diagnosis of obstructive sleep apnea according to the new AASM scoring criteria: Watch-PAT 100. Acta Otolaryngol 2010; 130:838.
- Pang KP, Gourin CG, Terris DJ. A comparison of polysomnography and the WatchPAT in the diagnosis of obstructive sleep apnea. Otolaryngol Head Neck Surg 2007; 137:665.
- Yalamanchali S, Farajian V, Hamilton C, et al. Diagnosis of obstructive sleep apnea by peripheral arterial tonometry: meta-analysis. JAMA Otolaryngol Head Neck Surg 2013; 139:1343.
- Man GC, Kang BV. Validation of a portable sleep apnea monitoring device. Chest 1995; 108:388.
- White DP, Gibb TJ, Wall JM, Westbrook PR. Assessment of accuracy and analysis time of a novel device to monitor sleep and breathing in the home. Sleep 1995; 18:115.
- Sériès F, Marc I, Cormier Y, La Forge J. Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome. Ann Intern Med 1993; 119:449.
- de Oliveira ACT, Martinez D, Vasconcelos LFT, et al. Diagnosis of obstructive sleep apnea syndrome and its outcomes with home portable monitoring. Chest 2009; 135:330.
- Zeidler MR, Santiago V, Dzierzewski JM, et al. Predictors of Obstructive Sleep Apnea on Polysomnography after a Technically Inadequate or Normal Home Sleep Test. J Clin Sleep Med 2015; 11:1313.
- El Shayeb M, Topfer LA, Stafinski T, et al. Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ 2014; 186:E25.
- Qaseem A, Dallas P, Owens DK, et al. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from theAmerican College of Physicians. Ann Intern Med 2014; 161:210.
- Bianchi MT, Goparaju B. Potential Underestimation of Sleep Apnea Severity by At-Home Kits: Rescoring In-Laboratory Polysomnography Without Sleep Staging. J Clin Sleep Med 2017; 13:551.
- Home Sleep Apnea Testing Reference Manual, The American Academy of Sleep Medicine, Darien, IL 2015.
- Berry RB, Brooks R, Gamaldo CE, et al for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.4, www.aasmnet.org, American Academy of Sleep Medicine, Darien, IL 2017.
- Berry RB, Brooks R, Gamaldo C, et al. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med 2017; 13:665.
- Ancoli-Israel S, Mason W, Coy TV, et al. Evaluation of sleep disordered breathing with unattended recording: the Nightwatch System. J Med Eng Technol 1997; 21:10.
- Cirignotta F, Mondini S, Gerardi R, et al. Unreliability of automatic scoring of MESAM 4 in assessing patients with complicated obstructive sleep apnea syndrome. Chest 2001; 119:1387.
- Dingli K, Coleman EL, Vennelle M, et al. Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 2003; 21:253.
- Øverland B, Bruskeland G, Akre H, Skatvedt O. Evaluation of a portable recording device (Reggie) with actimeter and nasopharyngeal/esophagus catheter incorporated. Respiration 2005; 72:600.
- Yin M, Miyazaki S, Ishikawa K. Evaluation of type 3 portable monitoring in unattended home setting for suspected sleep apnea: factors that may affect its accuracy. Otolaryngol Head Neck Surg 2006; 134:204.
- Yin M, Miyazaki S, Itasaka Y, et al. A preliminary study on application of portable monitoring for diagnosis of obstructive sleep apnea. Auris Nasus Larynx 2005; 32:151.
- Lux L, Boehlecke B, Lohr KN. Effectiveness of portable monitoring devices for diagnosing obstructive sleep apnea: Update of a systematic review [Internet]. AHRQ Technology Assessments 2004. http://www.ncbi.nlm.nih.gov/pubmed/26065047 (Accessed on August 14, 2015).
- Chesson AL Jr, Berry RB, Pack A, et al. Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. Sleep 2003; 26:907.
- Williams AJ, Yu G, Santiago S, Stein M. Screening for sleep apnea using pulse oximetry and a clinical score. Chest 1991; 100:631.
- Douglas NJ, Thomas S, Jan MA. Clinical value of polysomnography. Lancet 1992; 339:347.
- Gyulay S, Olson LG, Hensley MJ, et al. A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea. Am Rev Respir Dis 1993; 147:50.
- TYPES OF MONITORING DEVICES
- In-laboratory devices
- - Type 1 devices (overnight polysomnogram)
- Home devices
- - Type 2 devices
- - Type 3 devices
- Limitations compared with PSG
- - Type 4 devices
- Alternative classification
- - Limitations
- PULSE OXIMETRY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS