Home Sleep Tests for Obstructive Sleep Apnea (OSA)

A suggested algorithm for using home sleep testing (HST) in adult patients suspected of having obstructive sleep apnea (OSA). Note that HST should not be used in pediatric patients. *Significant comorbid medical disorders include conditions such as moderate to severe pulmonary disease, neuromuscular disease, and congestive heart failure which may degrade the accuracy of the home sleep test. Patients who have low baseline oxygen saturation or are on supplemental oxygen are also poor candidates for a home sleep test. Note that hypertension and diabetes mellitus are not contraindications for obtaining a home sleep test. See manuscript text for discussion on decision making in obese patients. †Comorbid sleep disorders include conditions such as central sleep apnea, periodic limb movement disorder, insomnia, parasomnias, circadian rhythm disorders, narcolepsy, and REM sleep behavior disorder. Central sleep apnea is often seen in patients with heart failure and those on narcotic medications. ‡Causes of hypoventilation include neuromuscular disease, restrictive lung disease, and use of narcotic medications. Patients with an elevated body mass index are also at risk for hypoventilation. PSG, polysomnography. (Adapted with permission from Collop et al.²⁶)