When are home sleep tests (HSTs) indicated in patients with suspected obstructive sleep apnea (OSA)?

Answer

In patients in whom OSA is suspected based on history and/or physical examination findings, overnight recordings using HST monitors can be used to confirm the diagnosis of OSA.

Although its conclusions are debatable, the American Academy of Sleep Medicine (AASM) recommends portable monitoring only for patients free of significant comorbid conditions and with a high pretest probability of moderate to severe OSA.^[44]

A sample patient intake form used at the Head and Neck Surgery Sleep Clinic at the University of California at San Diego is seen below.

UCSD sleep-disordered breathing intake form.

View Media Gallery

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000 Apr 12. 283(14):1829-36. [Medline].
Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000 May 11. 342(19):1378-84. [Medline].
Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000 Feb 19. 320(7233):479-82. [Medline]. [Full Text].
Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation. 1998 Jun 2. 97(21):2154-9. [Medline].
Trupp RJ, Hardesty P, Osborne J, Shelby S, Lamba S, Ali V, et al. Prevalence of sleep disordered breathing in a heart failure program. Congest Heart Fail. 2004 Sep-Oct. 10(5):217-20. [Medline].
Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med. 1999 Oct. 160(4):1101-6. [Medline].
Laaban JP, Pascal-Sebaoun S, Bloch E, Orvoën-Frija E, Oppert JM, Huchon G. Left ventricular systolic dysfunction in patients with obstructive sleep apnea syndrome. Chest. 2002 Oct. 122(4):1133-8. [Medline].
Dyken ME, Somers VK, Yamada T, Ren ZY, Zimmerman MB. Investigating the relationship between stroke and obstructive sleep apnea. Stroke. 1996 Mar. 27(3):401-7. [Medline].
Good DC, Henkle JQ, Gelber D, Welsh J, Verhulst S. Sleep-disordered breathing and poor functional outcome after stroke. Stroke. 1996 Feb. 27(2):252-9. [Medline].
Parra O, Arboix A, Bechich S, García-Eroles L, Montserrat JM, López JA, et al. Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med. 2000 Feb. 161(2 Pt 1):375-80. [Medline].
Vgontzas AN, Bixler EO, Chrousos GP. Sleep apnea is a manifestation of the metabolic syndrome. Sleep Med Rev. 2005 Jun. 9(3):211-24. [Medline].
Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005 Mar 24. 352(12):1206-14. [Medline].
Stergiou GS, Triantafyllidou E, Cholidou K, Kollias A, Destounis A, Nasothimiou EG, et al. Asleep home blood pressure monitoring in obstructive sleep apnea: a pilot study. Blood Press Monit. 2013 Feb. 18(1):21-6. [Medline].
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993 Apr 29. 328(17):1230-5. [Medline].
Antic NA, Buchan C, Esterman A, Hensley M, Naughton MT, Rowland S, et al. A randomized controlled trial of nurse-led care for symptomatic moderate-severe obstructive sleep apnea. Am J Respir Crit Care Med. 2009 Mar 15. 179(6):501-8. [Medline].
Ramachandran SK, Josephs LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology. 2009 Apr. 110(4):928-39. [Medline].
Ballester E, Solans M, Vila X, Hernandez L, Quintó L, Bolivar I, et al. Evaluation of a portable respiratory recording device for detecting apnoeas and hypopnoeas in subjects from a general population. Eur Respir J. 2000 Jul. 16(1):123-7. [Medline].
Redline S, Tosteson T, Boucher MA, Millman RP. Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device. Chest. 1991 Nov. 100(5):1281-6. [Medline].
Whittle AT, Finch SP, Mortimore IL, MacKay TW, Douglas NJ. Use of home sleep studies for diagnosis of the sleep apnoea/hypopnoea syndrome. Thorax. 1997 Dec. 52(12):1068-73. [Medline]. [Full Text].
Jiménez Gómez A, Golpe Gómez R, Carpizo Alfayate R, de la Roza Fernández C, Fernández Rozas S, García Pérez MM. [The validation of a portable 3-channel recording system (Oxyflow, Edentec) for the diagnosis of the sleep apnea syndrome]. Arch Bronconeumol. 2000 Jan. 36(1):7-12. [Medline].
Man GC, Kang BV. Validation of a portable sleep apnea monitoring device. Chest. 1995 Aug. 108(2):388-93. [Medline].
Bradley PA, Mortimore IL, Douglas NJ. Comparison of polysomnography with ResCare Autoset in the diagnosis of the sleep apnoea/hypopnoea syndrome. Thorax. 1995 Nov. 50(11):1201-3. [Medline]. [Full Text].
Fleury B, Rakotonanahary D, Hausser-Hauw C, Lebeau B, Guilleminault C. A laboratory validation study of the diagnostic mode of the Autoset system for sleep-related respiratory disorders. Sleep. 1996 Jul. 19(6):502-5. [Medline].
Kiely JL, Delahunty C, Matthews S, McNicholas WT. Comparison of a limited computerized diagnostic system (ResCare Autoset) with polysomnography in the diagnosis of obstructive sleep apnoea syndrome. Eur Respir J. 1996 Nov. 9(11):2360-4. [Medline].
Gugger M. Comparison of ResMed AutoSet (version 3.03) with polysomnography in the diagnosis of the sleep apnoea/hypopnoea syndrome. Eur Respir J. 1997 Mar. 10(3):587-91. [Medline].
Mayer P, Meurice JC, Philip-Joet F, Cornette A, Rakotonanahary D, Meslier N, et al. Simultaneous laboratory-based comparison of ResMed Autoset with polysomnography in the diagnosis of sleep apnoea/hypopnoea syndrome. Eur Respir J. 1998 Oct. 12(4):770-5. [Medline].
Dingli K, Coleman EL, Vennelle M, Finch SP, Wraith PK, Mackay TW, et al. Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J. 2003 Feb. 21(2):253-9. [Medline].
Ballester E, Solans M, Vila X, Hernandez L, Quintó L, Bolivar I, et al. Evaluation of a portable respiratory recording device for detecting apnoeas and hypopnoeas in subjects from a general population. Eur Respir J. 2000 Jul. 16(1):123-7. [Medline].
Claman D, Murr A, Trotter K. Clinical validation of the Bedbugg in detection of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2001 Sep. 125(3):227-30. [Medline].
Reichert JA, Bloch DA, Cundiff E, Votteri BA. Comparison of the NovaSom QSG, a new sleep apnea home-diagnostic system, and polysomnography. Sleep Med. 2003 May. 4(3):213-8. [Medline].
Bar A, Pillar G, Dvir I, Sheffy J, Schnall RP, Lavie P. Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies. Chest. 2003 Mar. 123(3):695-703. [Medline].
Pittman SD, Ayas NT, MacDonald MM, Malhotra A, Fogel RB, White DP. Using a wrist-worn device based on peripheral arterial tonometry to diagnose obstructive sleep apnea: in-laboratory and ambulatory validation. Sleep. 2004 Aug 1. 27(5):923-33. [Medline].
Ayas NT, Pittman S, MacDonald M, White DP. Assessment of a wrist-worn device in the detection of obstructive sleep apnea. Sleep Med. 2003 Sep. 4(5):435-42. [Medline].
Zou D, Grote L, Peker Y, Lindblad U, Hedner J. Validation a portable monitoring device for sleep apnea diagnosis in a population based cohort using synchronized home polysomnography. Sleep. 2006 Mar 1. 29(3):367-74. [Medline].
Su S, Baroody FM, Kohrman M, Suskind D. A comparison of polysomnography and a portable home sleep study in the diagnosis of obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):844-50. [Medline].
Wang Y, Teschler T, Weinreich G, Hess S, Wessendorf TE, Teschler H. [Validation of microMESAM as screening device for sleep disordered breathing]. Pneumologie. 2003 Dec. 57(12):734-40. [Medline].
Chen H, Lowe AA, Bai Y, Hamilton P, Fleetham JA, Almeida FR. Evaluation of a portable recording device (ApneaLink) for case selection of obstructive sleep apnea. Sleep Breath. 2009 Aug. 13(3):213-9. [Medline].
Tonelli de Oliveira AC, Martinez D, Vasconcelos LF, Gonçalves SC, Lenz MC, Fuchs SC, et al. Diagnosis of obstructive sleep apnea syndrome and its outcomes with home portable monitoring. Chest. 2009 Feb. 135(2):330-6. [Medline].
Santos-Silva R, Sartori DE, Truksinas V, Truksinas E, Alonso FF, Tufik S, et al. Validation of a portable monitoring system for the diagnosis of obstructive sleep apnea syndrome. Sleep. 2009 May 1. 32(5):629-36. [Medline]. [Full Text].
Yagi H, Nakata S, Tsuge H, Yasuma F, Noda A, Morinaga M, et al. Significance of a screening device (Apnomonitor 5) for sleep apnea syndrome. Auris Nasus Larynx. 2009 Apr. 36(2):176-80. [Medline].
Ayappa I, Norman RG, Seelall V, Rapoport DM. Validation of a self-applied unattended monitor for sleep disordered breathing. J Clin Sleep Med. 2008 Feb 15. 4(1):26-37. [Medline]. [Full Text].
Rosen IM, Kirsch DB, Carden KA, Malhotra RK, Ramar K, Aurora RN, et al. Clinical Use of a Home Sleep Apnea Test: An Updated American Academy of Sleep Medicine Position Statement. J Clin Sleep Med. 2018 Dec 15. 14 (12):2075-2077. [Medline].
Ghegan MD, Angelos PC, Stonebraker AC, Gillespie MB. Laboratory versus portable sleep studies: a meta-analysis. Laryngoscope. 2006 Jun. 116(6):859-64. [Medline].
Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, 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 Dec 15. 3(7):737-47. [Medline]. [Full Text].
Bruyneel M, Van den Broecke S, Libert W, Ninane V. Real-time attended home-polysomnography with telematic data transmission. Int J Med Inform. 2013 Mar 23. [Medline].
Phurrough S, Jacques L, Spencer F, Stiller J, Brechner R. Decision Memo for Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA). Centers for Medicare & Medicaid. 3/13/2008. 1-35. [Full Text].
Ayappa I, Norman RG, Suryadevara M, Rapoport DM. Comparison of limited monitoring using a nasal-cannula flow signal to full polysomnography in sleep-disordered breathing. Sleep. 2004 Sep 15. 27(6):1171-9. [Medline].
Stierer T, Punjabi NM. Demographics and diagnosis of obstructive sleep apnea. Anesthesiol Clin North America. 2005 Sep. 23(3):405-20, v. [Medline].
Nuber R, Vavrina J, Karrer W. [Predictive value of nocturnal pulse oximetry in sleep apnea screening]. Schweiz Med Wochenschr Suppl. 2000. 116:120S-122S. [Medline].
Sériès F, Kimoff RJ, Morrison D, Leblanc MH, Smilovitch M, Howlett J, et al. Prospective evaluation of nocturnal oximetry for detection of sleep-related breathing disturbances in patients with chronic heart failure. Chest. 2005 May. 127(5):1507-14. [Medline].
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 Sep 15. 119(6):449-53. [Medline].
Gyulay S, Olson LG, Hensley MJ, King MT, Allen KM, Saunders NA. A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea. Am Rev Respir Dis. 1993 Jan. 147(1):50-3. [Medline].
Hamada M, Iida M. Home monitoring using portable polygraphy for perioperative assessment of pediatric obstructive sleep apnea syndrome. Tokai J Exp Clin Med. 2012 Sep 20. 37(3):66-70. [Medline].
Pavone M, Cutrera R, Verrillo E, Salerno T, Soldini S, Brouillette RT. Night-to-night consistency of at-home nocturnal pulse oximetry testing for obstructive sleep apnea in children. Pediatr Pulmonol. 2013 Mar 26. [Medline].
Dernaika T, Tawk M, Nazir S, Younis W, Kinasewitz GT. The significance and outcome of continuous positive airway pressure-related central sleep apnea during split-night sleep studies. Chest. 2007 Jul. 132(1):81-7. [Medline].
Kirk V, Baughn J, D'Andrea L, Friedman N, Galion A, Garetz S, et al. American Academy of Sleep Medicine Position Paper for the Use of a Home Sleep Apnea Test for the Diagnosis of OSA in Children. J Clin Sleep Med. 2017 Oct 15. 13 (10):1199-1203. [Medline].

Media Gallery

UCSD sleep-disordered breathing intake form.
Sleep study: Mild obstructive sleep apnea (OSA). Oxygen saturation is demonstrated with the red tracing and snoring sound levels with the blue tracing. Each hypopneic episode is identified with a blue vertical line. Each apneic episode is identified with a red vertical line. The patient's total sleep time was 7 hours and 4 minutes. The lowest oxygen saturation was 83%. The patient's apnea index was 0.7 events per hour; the hypopnea index was 4.4 events per hour; and the apnea-hypopnea Index was 5.1 events per hour. The impression is mild OSA.
Sleep study: Moderate obstructive sleep apnea (OSA). The patient's total sleep time was 7 hours and 49 minutes. The lowest oxygen saturation was 83%. The patient's apnea index was 4.1 events per hour; the hypopnea index was 20.3 events per hour; and the apnea-hypopnea index was 24.4 events per hour. All of the patient's apneic events are obstructive. Note the increasing number of both apneas and hypopneas in the latter half of the sleep study, which correlates with an increasing time spent in rapid eye movement (REM) sleep. Apneic and hypopneic episodes do not correlate well with snoring sound level. The impression is moderate OSA.
Sleep study: Severe obstructive sleep apnea (OSA). The patient's total sleep time was 4 hours and 27 minutes. The lowest oxygen saturation was < 70%. The patient's apnea index was 82.4 events per hour; the hypopnea index was 4.3 events per hour; and the apnea-hypopnea index was 86.6 events per hour. Note that the apneic events are all obstructive and that they are nearly continuous during the sleep study. The impression is severe OSA.
Typical set-up for home sleep test. Image courtesy of Kristen Pickard, Embletta.
Image of patient with HST in place. Image courtesy of Kristen Pickard, Embletta.
Table of home sleep manufacturers and websites

of 7

Author

Wendy M Smith, MD Resident Physician, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego Medical Center

Wendy M Smith, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Women's Association

Disclosure: Nothing to disclose.

Coauthor(s)

Terence M Davidson, MD Professor of Surgery, Head and Neck Surgery Division, Associate Dean for Continuing Medical Education, University of California at San Diego School of Medicine; Attending Physician, University of California at San Diego Medical Center

Terence M Davidson, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Rhinologic Society, California Medical Association, American Academy of Sleep Medicine, San Diego County Medical Society

Disclosure: Received honoraria from ResMed Foundation Board for assist the board in awarding scientific and other grants; Received none from ImThera for medical advisor for a sleep apnea company.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;The Physicians Edge;Sync-n-Scale;mCharts<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa;Proforma;Neosoma<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; .

Additional Contributors

Prajoy P Kadkade, MD Assistant Professor of Otolaryngology, Albert Einstein College of Medicine; Attending Physician, Department of Otolaryngology and Communicative Disorders, Director of Otolaryngology, North Shore University Hospital, North Shore-Long Island Jewish Hospital System

Prajoy P Kadkade, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, Medical Society of the State of New York

Disclosure: Nothing to disclose.

When are home sleep tests (HSTs) indicated in patients with suspected obstructive sleep apnea (OSA)?

Answer

Related Questions:

References

Tables

Contributor Information and Disclosures