Conventional Polysomnography vs. Home Testing for Obstructive Sleep Apnea

In recent years, home testing for obstructive sleep apnea (OSA) has gained momentum. In this randomized trial, researchers in Spain randomized 430 patients with suspected moderate-to-severe OSA to receive either conventional overnight polysomnography (PSG) in a hospital or overnight testing at home. Home testing was limited to measuring oxygen saturation, airflow, and thoracic and abdominal movement. Enrollment criteria included (1) snoring or apneas observed by a partner, (2) a score ≥10 on the Epworth Sleepiness Scale (scoring range, 0–24), and (3) no obvious other disorder that might cause daytime sleepiness. After testing, recommendations for treatment with continuous positive airway pressure (CPAP) were made according to established guidelines. Patients also received advice on sleep hygiene and weight reduction.

Based on overnight test results, CPAP was recommended for 68% of PSG patients and 53% of home-testing patients. At 6 months, mean decreases in the Epworth score (the primary outcome) were 4.9 points in the hospital-based PSG group and 4.2 points in the home-testing group — a nonsignificant difference. Most secondary outcomes also were similar in the two groups. Testing and treatment cost twice as much in the PSG group than in the home-testing group.