By Efrat Magidov
Obstructive sleep apnea (OSA) is a common condition, with multiple potential neurocognitive, cardiovascular, and metabolic consequences. Efficacious treatment is available, and the diagnosis procedure and its availability keep improving. The use of home sleep apnea testing (HSAT), also known as portable monitoring (PM), for the diagnosis of OSA is continuing to grow as a viable option for sleep professionals. Currently, available HSAT devices are user-friendly, easily portable, and most importantly- reliable. Numerous randomized studies comparing ambulatory and laboratory-based approaches have generally found HSAT non-inferior to a laboratory approach in adults with OSA, especially in patients with a high likelihood of moderate-severe disease. Consequently, HSAT is growing to be the go-to approach for patients with a high likelihood of OSA without other significant medical conditions.
HSAT is a favorable approach also due to the convenience it offers. HSAT allows patients to avoid the overnight stay at the sleep center, with fewer attached wires and access to the comforts of home. HSAT also provides 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 doctor’s office, and thus offer a quicker diagnostic turn-around time. Moreover, since In-lab testing requires paying for space, technicians, and scoring, HSAT is typically more cost-efficient for both the patients and the healthcare system. However, despite all these numerous advantages of HSAT over laboratory-based testing, most ambulatory devices still have some notable limitations:
- Most commonly used home testing devices do not record sleep duration. Practitioners are therefore reliant on total recording time rather than total sleep time to calculate time-derived indices such as apnea-hypopnea index (AHI). If the patients sleep poorly or have comorbid insomnia or even nocturia, the frequent awake periods (in which it is not likely for respiratory events to occur) can lead to a material underestimation of AHI and consequently misdiagnosis and misclassifications (add UPenn reference).
- Not all HSAT devices record body position therefore overlooking diagnosis of supine predominant OSA and assessment of positional therapy (i.e. avoiding certain supine postures as a primary OSA relief strategy).
- Most HSAT devices don’t have a reliable assessment of arousals. Since a growing body of studies demonstrates the effects of restorative sleep time and fragmentation on various health issues, this absence is notable.
- Many HSAT devices require the patients to correctly set up a complex device on themselves. This equipment, including nasal cannula, chest and abdominal belts, EMG sensors and oximetry finger clamp can be detached during sleep, or be placed incorrectly, which leads to faulty results or no results, meaning significant disorders can be missed in up to 20% of times (add test completion reference).
In the future, HSAT might be the dominant approach to diagnosing and monitoring patients regularly, easily, and economically. Therefore it is crucial for the ambulatory devices to optimally account for all the mentioned limitations.
The use of home sleep apnea testing (HSAT), also known as portable monitoring (PM), for the diagnosis of OSA is continuing to grow as a viable option for sleep professionals. Currently, available HSAT devices are user-friendly, easily portable, and most importantly- reliable.
WatchPAT is easy to use, effective, and accurate HSAT device for OSA diagnosis. To date, WatchPAT with its innovative peripheral arterial tone (PAT) signal is the only FDA-approved HSAT device that measures true sleep time, all sleep stages (wake/arousal, light sleep, deep sleep, and REM sleep) and body position without the use of EEG. You may learn more about WatchPAT and our comprehensive “Total Sleep Solution” for Cardiology practices in www.cardiosleepsolutions.com
Malhotra, A., Orr, J. E., & Owens, R. L. (2015). On the cutting edge of obstructive sleep apnoea: where next? The Lancet Respiratory Medicine, 3(5), 397-403.
Hilbert, J., & Yaggi, H. K. (2018). Patient-centered care in obstructive sleep apnea: A vision for the future. Sleep medicine reviews, 37, 138-147.