Expert consensus for the use of home sleep apnea test in the diagnosis of obstructive sleep apnea in adults

Abstract

With the advancement of home sleep apnea test (HSAT) technology and the increase of encouraging evidence of home-based management approach for obstructive sleep apnea (OSA), HSAT devices using different types of biosignal acquisition technology are more and more widely used for the diagnosis of OSA in adults. HSAT for the diagnosis of OSA should be performed in combination with a comprehensive clinical and sleep evaluation. HSAT can be used as a diagnostic tool for uncomplicated OSA with a high pretest probability of moderate to severe OSA. A negative HSAT result cannot exclude the diagnosis of OSA for subjects with high clinical suspicion. Polysomnography (PSG) is preferred for the diagnosis of OSA in patients with significant comorbid medical conditions. The clinical application of HSAT in the diagnosis of complicated OSA needs to refer to the severity of clinical condition, comorbid disease, personal preference, local medical insurance policy and the accessibility of medical resources. HSAT may be indicated for the diagnosis of OSA in patients for whom attended PSG is not possible by virtue of immobility, safety, or critical illness. HSAT can be used for the screening of OSA in subjects with cardiocerebrovascular diseases. Follow-up HSAT or PSG is recommended to evaluate therapeutic response with non-positive airway pressure (PAP) interventions. Follow-up HSAT or PSG can be used for reassessment for patients with clinically significant weight fluctuation, persistent or recurrent symptoms under good PAP adherence, emergence or changes in cardiovascular diseases. Due to limitations of current automatic scoring algorithms that restrict the diagnostic accuracy, it is mandatory to review the raw data of type 3 devices. The selection of HSAT equipment, interpretation of monitoring results and the development of management plan should be under the guidance of physicians with sleep medicine training. Consumer-grade technologies are not appropriate for the clinical diagnosis of OSA due to lack of validation.