The diagnosis and treatment of Obstructive Sleep Apnea (OSA) is undergoing a paradigm shift particularly regarding home sleep testing (HST). Supported by many organizations like the American Academy of Sleep Medicine (AASM)1 and many insurance companies, home sleep assessment is witnessing great adoption by practitioners and patients alike as it can facilitate easier access to specialized care and improve patient quality of life.
There are a number of portable monitors that can be used in HST (as a baseline evaluation, or to evaluate the efficacy of OSA treatment whether it is OA, CPAP, or others). It is important that a facility select the right HST monitor from all the available options. Hence some of the important criteria to watch for while selecting a portable sleep monitor for your practice are:
- Recording of the proper physiological data by traditional sleep lab methodology (available channels in a monitor)
- Ease of use
Recording of Proper Physiological Data:
Per the American Academy of Sleep Medicine (AASM) clinical guidelines, the proper OSA evaluation requires portable monitoring that records at least:
- Airflow (pressure-based)
- Pulse oximetry
- Heart rate
- Respiration effort measured via Respiratory Inductive Plethysmography (Type III monitor).
Other parameters that are strongly recommended are snore, temperature-based airflow (thermistor) for apnea confirmation and body position for positional apnea estimation. Some devices also record muscle activity (EMG channel), which could be of particular help to dentists during OA titration since it can evaluate bruxism.
Ease of Use:
Clearly, a system that is small, light and allows for easy self-administration of the sleep test in the home is preferred, as it avoids a sleep technologist from having to go to the patient’s house, saving time and money. Typically hook-up of sensors in HST will require: Wrapping a RIP belt around the chest, placing and securing a pulse ox on the patient’s index finger, and wearing a nasal cannula. This is only minimally invasive and painless. Sometimes a thermistor may be used along with the nasal cannula to confirm apneas.
Ease of use and data quality are doubly assured if the portable sleep monitor is designed with checks in place to indicate proper placement of the sensors (some monitors have light and others have sound indicators). Additionally, a monitor that includes anautomatic check for validity of prior night sleep data would be particularly helpful as it can afford a fast way to repeat the study if needed (maybe due to a disconnected sensor). Selecting a monitor with a pre-programmed ON/OFF time can ensure proper data recording even if the patient forgets to hit the start button.
In summary, choosing the right portable sleep monitor that offers ease of use for the patient, and appropriate physiological data for the physician’s facility, while using sleep lab methodology, is the first step in deploying Home Sleep Testing the right way.
References: 1. Collop N, 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):737–747.