Diagnosing Sleep Apnea? Home Sleep Test vs. Traditional Sleep Clinic

Summary

Home sleep testing is a very convenient, proven, and cost effective method for diagnosing sleep apnea, especially when there’s loud snoring; restlessness; unrefreshing sleep; daytime sleepiness; or medical conditions such as high blood pressure, atrial fibrillation, and weight gain.  In very rare cases, a traditional sleep lab test may be recommended.

Background

According to the American Academy of Sleep Medicine, there are two types of medical diagnostic studies used to diagnose sleep apnea [1,2]. Historically, the more traditional approach is called polysomnography (PSG). It involves going to a sleep lab, usually situated in a hospital or clinic. The test includes measurement of brain waves with multiple electrodes placed on the scalp; sensors under the nose to capture breathing; sensors on the face to measure muscle movements; more sensors on the chest, legs, and finally a video recording of the night’s sleep. Unsurprisingly, this gives rise to numerous logistical and comfort-related challenges, including - long waiting times, difficulty sleeping in an uncomfortable and unknown environment, as well as requiring patients to be connected to various cables in order to monitor multiple distinct body functions. Because this test is done in a facility it is much more costly than home sleep tests. The average price of an in-lab sleep test is $3,000, with prices ranging from $1,000-3,000, depending on the type of insurance.

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The alternative choice is a Home Sleep Test (HST), which, in contrast to polysomnography, is a low cost, simple, high-comfort option. BlueSleep offers shipment of HST after a virtual consultation, which can be booked on the website the same-day, usually within just an hour.

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The HSTs most commonly offered by BlueSleep are called the NightOwl and WatchPat. Research has proven their efficacy compared with polysomnography. If you have an appetite for data, you can read the scientific article. [3]. The NightOwl is a device the size of a coin which is placed on the tip of your finger - like a miniature sleep apnea lab at your disposal. The NightOwl Companion app allows you to pair the device with your phone and send sleep data directly to your physician. The WatchPat has a finger, wrist and chest monitor. Although these HSTs are self-administered sleep tests, they offer the same level of diagnostic capability while allowing you to conveniently conduct the tests from your own home. In essence, the Home Sleep Tests measure body motion (actigraphy); blood oxygen levels; changes in pulse volume (PAT); and a scale used to measure obstructive sleep apnea (OSA) severity called AHI or Apnea-hypopnea Index. A Home Sleep Test costs roughly $600, 4x times less than an in-lab test.

When is a HST recommended?

• If you’re an adult with signs and symptoms that indicate an increased risk of moderate to severe OSA [1], this includes daytime sleepiness, snoring, interrupted sleep, feeling unrested in the morning, development of medical conditions such as atrial fibrillation, high blood pressure, significant weight gain, and more.
• To monitor your response to our treatments. BlueSleep offers repeat testing to ensure efficacy of the treatment. The repeat test is available for the NightOwl test (up to 10 nights), but not the WatchPat, a single-use test.
• If you cannot physically go to a sleep clinic due to immobility, safety or critical illness, make sure to ask for a home sleep test [2].

How does BlueSleep ensure the HST will be accurate for each patient?

BlueSleep performs a sleep evaluation during a patient’s first consultation with a board-certified sleep specialist or physician assistant. The provider assesses the patient’s eligibility to make sure that you qualify for home testing. The doctors base their decisions on factors like your age, weight, habits, and sleep history. If you’re approved for the NightOwl, the doctor writes you a prescription for the device. All HSTs results are reviewed by our sleep specialists, and we follow up with a detailed analysis of the results with recommendations for treatment if necessary. A positive HST is required for insurance to pay for treatment such as an Oral Advancement Therapy (OAT) or CPAP, so it's important to complete the test.

Are there patients that do not qualify for a HST and need to go to a sleep clinic?

The short answer is yes; however, we make sure to analyze each individual patient to identify the best candidates. Here are a few reasons why a home sleep test may not be the best option for you:

• If you have significant comorbid medical conditions, or rather a disease or medical condition that is simultaneously present with another. This includes significant cardiopulmonary (heart or lung) disease, respiratory muscle weakness due to neuromuscular conditions, which would make it difficult to self administer the test. [1,2]
• If the results of one or more home sleep tests are inconclusive, then a PSG may be recommended. [1]

References

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(3):479–504.
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2. 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(7):737–747
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3. Massie F, Mendes de Almeida D, Dreesen P, Thijs I, Vranken J, Klerkx S. An Evaluation of the NightOwl Home Sleep Apnea Testing System. J Clin Sleep Med. 2018 Oct 15;14(10):1791-1796. doi: 10.5664/jcsm.7398. PMID: 30353811; PMCID: PMC6175785.