[Home studies] are less cumbersome to set up, so patients often sleep more naturally. —Edward M. Weaver, MD, MPH
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September 2020
Costs are certainly lower for home studies—home-based sleep tests may cost as little as one third of the price of an in-lab sleep study, according to estimates from Johns Hopkins Medicine. Yet, there’s concern that cost may drive both patients and insurers to push for home tests.
“In-lab sleep testing is more expensive to the system for sure, as it requires personnel to monitor patients through the night, much more sophisticated equipment, adequate space, and more disposable supplies,” Dr. Weaver said. “The out-of-pocket cost to patients is also higher, because it’s usually a percentage of the charge.”
“For many years now, insurance companies generally wanted almost all patients to get home sleep apnea tests instead of in-laboratory polysomnograms,” said Dr. Kezirian. Despite the strong recommendation by the AASM that only patients with a high likelihood of OSA should be prescribed a home test, “the reality is that insurers want the home studies for many patients, except those with significant cardiac or pulmonary disease or other sleep disorders that can be evaluated only with an in-laboratory sleep study.”
The Right Fit
Which patients are good candidates for home sleep testing? The AASM guideline recommends either laboratory polysomnography or home sleep apnea testing to diagnose uncomplicated adult patients with signs and symptoms that indicate increased risk of moderate to severe OSA. If a patient’s home test produces a negative or inconclusive result, or is technically inadequate, lab-based polysomnography is recommended. The guideline strongly recommends lab over home testing for patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to a neuromuscular condition, awake hypoventilation or suspicion of sleep-related hypoventilation, chronic opioid use, history of stroke, or severe insomnia. In a 2018 statement, the AASM updated its guidance to state that a home testing prescription should be based on the patient’s medical history and a face-to-face or telemedicine visit with a medical provider.
“Even if a patient orders the tests online, they still need to get the results from the company that provided the patients with the machine,” said Dr. Takashima. “Typically, they’ll have a board-certified sleep doctor review the data and provide the results to patients. There are some companies that use automated reports, but the margin for error for automated results is significantly higher.”
The choice you make should be based on diagnosis and treatment goals for each individual patient. “I always advocate for the best treatment that looks at the body as a whole,” said Dr. Takashima. “A disease process can affect other areas of the body, so it’s always best to see a qualified sleep specialist.”