Indian Journal of Sleep Medicine

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VOLUME 17 , ISSUE 4 ( October-December, 2022 ) > List of Articles

REVIEW ARTICLE

A Review of the Current Status of Home Sleep Apnea Testing vis-à-vis In-lab Polysomnography: Is Old Still Gold?

J. C. Suri, Jagdish Chander Suri, Tejas Menon Suri

Keywords : Home sleep apnea testing, Obstructive sleep apnea, Polysomnography, Portable sleep study, Sleep-disordered breathing

Citation Information : Suri J C, Suri JC, Suri TM. A Review of the Current Status of Home Sleep Apnea Testing vis-à-vis In-lab Polysomnography: Is Old Still Gold?. Indian Sleep Med 2022; 17 (4):99-102.

DOI: 10.5005/jp-journals-10069-0106

License: CC BY-NC 4.0

Published Online: 29-04-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Obstructive sleep apnea (OSA) affects almost one billion people worldwide and is a major cause of morbidity and mortality. However, most patients with OSA remain undiagnosed and untreated. In-lab polysomnography attended by a sleep technologist is the gold standard intervention for the diagnosis of OSA and titration of positive airway pressure (PAP) therapy. However, in-lab polysomnography is expensive, labor-intensive, and associated with long wait times. Further, patients are observed for only one night outside their normal sleep environment which may adversely affect the quality of sleep and not capture night-to-night variability. Hence, various portable devices have been developed to perform home sleep apnea testing (HSAT) at lower costs than in-lab polysomnography. In this review article, we compare the relative merits and demerits of HSAT vis-à-vis in-lab polysomnography. We delve into the current evidence for the efficacy, shortcomings, and costs of the different types of sleep studies. We summarize the current guidelines for sleep apnea testing. We conclude with the Indian perspective on the various types of sleep studies available.


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  1. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis. Lancet Respir Med 2019;7(8):687–698. DOI: 10.1016/S2213-2600(19)30198-5.
  2. George CFP. Sleep apnea, alertness, and motor vehicle crashes. Am J Respir Crit Care Med 2007;176(10):954–956. DOI: 10.1164/rccm.200605-629PP.
  3. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009;373(9657):82–93. DOI: 10.1016/S0140-6736(08)61622-0.
  4. Byun J-H, Kim KT, Moon H-J, et al. The first night effect during polysomnography, and patients’ estimates of sleep quality. Psychiatry Res 2019;274:27–29. DOI: 10.1016/j.psychres.2019.02.011.
  5. Stöberl AS, Schwarz EI, Haile SR, et al. Night-to-night variability of obstructive sleep apnea. J Sleep Res 2017;26(6):782–788. DOI: 10.1111/jsr.12558.
  6. Ferber R, Millman R, Coppola M, et al. Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice. Sleep 1994;17(4):378–392. DOI: 10.1093/sleep/17.4.378.
  7. 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(1):E25–E51. DOI: 10.1503/cmaj.130952.
  8. Escourrou P, Grote L, Penzel T, et al. The diagnostic method has a strong influence on classification of obstructive sleep apnea. J Sleep Res 2015;24(6):730–738. DOI: 10.1111/jsr.12318.
  9. 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(11):1313–1318. DOI: 10.5664/jcsm.5194.
  10. Wimms AJ, Kelly JL, Turnbull CD, et al. Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): A multicentre, randomised controlled trial. Lancet Respir Med 2020;8(4):349–358. DOI: 10.1016/S2213-2600(19)30402-3.
  11. 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. PMID: 18198809.
  12. Iftikhar IH, Finch CE, Shah AS, et al. A meta-analysis of diagnostic test performance of peripheral arterial tonometry studies. J Clin Sleep Med 2022;18(4):1093–1102. DOI: 10.5664/jcsm.9808.
  13. West SD, Jones DR, Stradling JR. Comparison of three ways to determine and deliver pressure during nasal CPAP therapy for obstructive sleep apnoea. Thorax 2006;61(3):226–231. DOI: 10.1136/thx.2005.046300.
  14. Berry RB, Sriram P. Auto-adjusting positive airway pressure treatment for sleep apnea diagnosed by home sleep testing. J Clin Sleep Med 2014;10(12):1269–1275. DOI: 10.5664/jcsm.4272.
  15. Rosen CL, Auckley D, Benca R, et al. A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: The HomePAP study. Sleep 2012;35(6):757–767. DOI: 10.5665/sleep.1870.
  16. Zinchuk A, Yaggi HK. Phenotypic subtypes of OSA: A challenge and opportunity for precision medicine. Chest 2020;157(2):403–420. DOI: 10.1016/j.chest.2019.09.002.
  17. Zinchuk AV, Jeon S, Koo BB, et al. Polysomnographic phenotypes and their cardiovascular implications in obstructive sleep apnoea. Thorax 2018;73(5):472–480. DOI: 10.1136/thoraxjnl-2017-210431.
  18. Wickwire EM. Value-based sleep and breathing: health economic aspects of obstructive sleep apnea. Fac Rev 2021;10:40. DOI: 10.12703/r/10-40.
  19. Deutsch PA, Simmons MS, Wallace JM. Cost-effectiveness of split-night polysomnography and home studies in the evaluation of obstructive sleep apnea syndrome. J Clin Sleep Med 2006;2(2):145–153. PMID: 17557487.
  20. Pietzsch JB, Garner A, Cipriano LE, et al. An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea. Sleep 2011;34(6):695–709. DOI: 10.5665/SLEEP.1030.
  21. Sharma S, Srijithesh PR. Sleeping over a sleep disorder – Awareness of obstructive sleep apnoea as a modifiable risk factor for hypertension and stroke: A survey among health care professionals and medical students. Ann Indian Acad Neurol 2013;16(2):151–153. DOI: 10.4103/0972-2327.112446.
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