A sleep study, at home or in the lab

Which test you get is decided, not chosen

There are two ways to diagnose obstructive sleep apnea: an in-lab sleep study, called polysomnography, and a home sleep apnea test. Which is appropriate is a clinical decision made after a full sleep evaluation. It is not a preference and it is not something you can buy for yourself.

The AASM’s 2017 diagnostic testing guideline is explicit on one point that gets ignored constantly: questionnaires and prediction algorithms must not be used to diagnose sleep apnea without one of these two tests. A score on a website is a reason to be evaluated, not a diagnosis.

When a home test is appropriate

A home sleep apnea test with a technically adequate device may be used for uncomplicated adults whose signs and symptoms indicate an increased risk of moderate-to-severe obstructive sleep apnea.

The guideline defines that increased risk specifically: excessive daytime sleepiness and at least two of the following three.

• Habitual loud snoring.
• Witnessed apnea, gasping or choking.
• Diagnosed hypertension.

A technically adequate recording means a minimum of four hours of adequate oximetry and airflow, across an attempt covering your usual sleep period. If a single home test comes back negative, inconclusive or technically inadequate, the guideline recommends going on to an in-lab study rather than stopping there.

When the lab is required

A home test is not appropriate for everyone, and this is the part most sites leave out. The guideline gives a strong recommendation to use in-lab polysomnography rather than a home test where there is:

• significant cardiorespiratory disease;
• potential respiratory muscle weakness from neuromuscular disease;
• awake hypoventilation, or suspicion of sleep-related hypoventilation;
• chronic opioid use;
• a history of stroke;
• severe insomnia.

The lab is also the right test where there is concern about a non-respiratory sleep disorder such as a central disorder of hypersomnolence, a parasomnia or a sleep-related movement disorder, or where something about the home setting makes an adequate recording unlikely.

A note on device technology

A technically adequate home device uses either nasal pressure with chest and abdominal effort belts and oximetry, or peripheral arterial tonometry with oximetry and actigraphy. The AASM recognised the second as an adequate technology; it has never endorsed a particular brand, and it publicly corrected a manufacturer who implied otherwise.

Either way, a home test is less sensitive than an in-lab study and can underestimate severity. A negative home test in someone who still has symptoms is a reason to go to the lab, not a reason to stop.

What testing costs

Your cost depends on your plan and on which test is ordered. For scale rather than as a quote, the 2025 Medicare national allowed amounts are about $608 for an attended in-lab study and about $637 for a study with positive airway pressure titration. Unattended home testing is substantially lower. Under Medicare Part B you would generally pay 20 per cent after your deductible where the study is medically necessary.

Those are Medicare’s national allowed amounts, not this practice’s charges and not what you will be billed. Commercial plans frequently require prior authorisation for both in-lab and home testing.

Sources

1. Kapur VK et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea. J Clin Sleep Med 2017;13(3):479–504. https://europepmc.org/article/MED/28162150
2. AASM diagnostic testing guideline, at-a-glance summary. https://aasm.org/wp-content/uploads/2017/07/DTO-Guidelines-at-a-Glance-2.pdf
3. AASM clarification regarding endorsement of a home testing product. https://aasm.org/clarification-and-apology-to-the-aasm-regarding-march-16-press-release-by-itamar-medical/
4. Medicare coverage of sleep studies. https://www.medicare.gov/coverage/sleep-studies

Related pages

• Home sleep study →
• Ring sleep study →
• Sleep apnea →
• CPAP therapy →
• Cost, insurance and referrals →