Which Sleep Study Is Best for Your Patient?

New algorithm from UH sleep medicine team provides guidance

UH Clinical Update | January 2021

 Nardine Zakhary, DO

During the COVID-19 pandemic, an increasing number of patients have been asking for a home sleep apnea test (HSAT), rather than polysomnogram (PSG) performed in the sleep lab at a hospital or health center. Like other avoidance of medical care during the pandemic, this is less than ideal in terms of patient care.

“Many patients, especially during COVID, say that they want to do the sleep study at home,” says Nardine Zakhary, DO, who recently joined UH as a sleep medicine specialist. “You can get a home sleep study, but it’s not going to give you as much information as an in-lab study.”

When should you order a HSAT vs. a PSG? And who are the best candidates for both? To simplify the process, the sleep medicine team at UH has developed an algorithm to guide decision-making.

As indicated, those patients with traditional risk factors for obstructive sleep apnea, such as obesity and older age, and who also have the following conditions should receive the in-lab PSG.

Underlying conditions that warrant a PSG include:

• Significant cardiopulmonary disease
• Significant neurological disease: neurodegenerative disease, hemorrhagic or ischemic stroke, cognitive dysfunction
• Significant heart failure
• Uncontrolled arrhythmia Chronic opioid use
• Severe insomnia
• Symptoms of other significant sleep disorder: narcolepsy, PLMD, REM sleep behavior disorder

“HSATs have some limitations; they cannot accurately represent certain events and they typically do not provide monitoring for limb movements,” Dr. Zakhary says.

Of note, however, if a patient has a low pretest probability for sleep apnea, that patient should get an in-lab study.

“If the patient were to get a home sleep test, the HSAT might not detect the extent of sleep apnea that the patient has,” she says.

The HSAT should be reserved, Dr. Zakhary says, for those patients judged to have a high pretest probability for obstructive sleep apnea, but with none of the comorbidities mentioned above. Even then, she says, the HSAT may serve more as a screening test, with negative results in certain patients needing confirmation by the in-lab PSG.

“If there is still a high suspicion for sleep apnea after a negative HSAT, an in-lab test should be done,” she says.

For more information about sleep labs at UH or to refer a patient, call 216-844-REST.