bjbj Sleep Apnea Tips #4 Home Testing for Obstructive Sleep Apnea Hello again. My name is Dr. Ronald Popper, and I'm a board certified Sleep Medicine Specialist and the Medical Director of the Southern California Pulmonary and Sleep Disorders Medical Center in Thousand Oaks California. Today I'd like to speak to you about the use of home sleep testing. Home sleep testing has recently been approved by the American Academy of Sleep Medicine for use in board certified sleep centers such as ours in patients who either refuse to come in for a sleep study, don't want to come in for a sleep study, or whose insurance refuses to pay for a full polysomnographic in lab sleep center study. Even though this is the gold standard, there are situations in which a home sleep study is appropriate. So who are the best candidates for these types of devices? Home sleep testing is best utilized in patients who have a pre-testing high probably of having obstructive sleep apnea syndrome. The should not have other comorbid medical conditions such as congestive heart failure, atrial fibrillation, previous history of a heart attack; they should not have diabetes, chronic lung disease, or chronic neural muscular disorder. Home sleep testing should not be used as a screening tool in patients who don't have symptoms of excessive daytime sleepiness or other complications of nighttime sleep disruption. Home sleep testing is not appropriate in patients who have signs or symptoms of other sleep disturbances such as narcolepsy, restless limbs and periodic limb movements during sleep, or central sleep apnea where those patients are most appropriately studied in a sleep center and undergoing a full polysomnographic evaluation. So this is what a patient is going to look like when they are all hooked up for a home sleep test. What is involved here is the use of a catheter with two prongs that fit in the nostrils to measure airflow with or without nasal pressure which gives an indication of whether the patient is breathing. In addition, I have a belt around my chest and abdominal walls to measure movement of my chest and abdomen, which is an indicator of respiratory effort. On my finger, I have a pulse oximeter. This little device will measure both my heart rate and my oxygen level. Utilizing this equipment will allow me to make the diagnosis in patients who have obstructed sleep apnea syndrome. This device will be able to give patients a diagnosis of obstructive sleep apnea syndrome in the comfort of their own bed, in their own home, without having to go to a sleep center. Patients who have a clearly positive home sleep study don't have to come to a sleep center to be re-diagnosed using a full in lab polysomnographic evaluation. They can then be referred directly for treatment on the basis of an abnormal home sleep test. It's important to know how your test is scored and who is doing your interpretation. The American Academy of Sleep Medicine certifies sleep centers who perform home sleep testing. They are held to a much higher standard than unaccredited sleep centers. Computerized scoring of home sleep testing leads to both an over diagnosis as well as an under diagnosis of obstructive sleep apnea syndrome. The only way to avoid this problem is to have a board certified sleep specialist review the actual raw data generated by the home testing device. This isn't done in most unaccredited sleep centers. They simply take the report generated by the computer and it is sent to the referring physician. At our center, I personally review all the raw data and determine the validity of the test. If a patient has a home sleep test and it is negative for sleep apnea, but I still have a high clinical suspicion that they have that diagnosis, the only way to prove this is to bring them into the lab for a full sleep center polysomnographic evaluation. So again to summarize, the ideal candidate for a home sleep test is a patient who after a thorough clinical evaluation has a moderate to high probability of having obstructive sleep apnea syndrome and they don't have other comorbid medical conditions such as congestive heart failure, atrial fibrillation, a prior heart attack, diabetes, chronic lung disease, or chronic neuromuscular disorders. If that description fits you, you may be an appropriate candidate for a home sleep test. Please feel free to go on to my website, learn more about sleep apnea and home sleep testing. Stay tuned for future videos that will provide additional helpful tips on various sleep disorders. And remember, sleep well tonight for a better day tomorrow.