Abstract Introduction Polysomnography (PSG) performed in sleep laboratories is the diagnostic gold standard, but laboratory schedules, unfamiliar surroundings, and equipment burden may distort natural sleep. Home PSG systems could capture more representative sleep while preserving full signal fidelity. The Onera Sleep Test System (STS) is a patient applied, patch-based, type II PSG system, which enables studies to be performed unattended at the patient’s home. Sleep timing, architecture, respiratory indices and the patients’ experience using the patch-based device were compared in the home and laboratory environments. Methods In a two-phase, multicenter study across seven German sleep clinics, adults referred for PSG first underwent in-lab patch-based PSG (N=344) and eligible participants then completed a home PSG within one week (N=204). A subset of studies (N=52) had a full lab and home sleep night for a comparison of sleep and respiratory metrics Results Differences in sleep patterns were found between the two environments (lights-off 23:00 home vs 22:10 lab; lights-on 06:33 home vs 05:33 lab). In the scored subset, home nights showed longer total sleep time (409.5 ± 74.5 vs 378.2 ± 71.8 min, p=0.033), more REM sleep (91.1 ± 28.1 vs 76.7 ± 28.4 min, p=0.024) and more REM cycles (5.04 ± 1.76 vs 4.33 ± 1.70, p=0.049), higher sleep efficiency (88.9% ± 9.0 vs 80.9% ± 11.9, p 0.001), lower WASO (24.3 ± 24.1 vs 54.8 ± 45.1 min, p 0.001), shorter REM onset latency (85.5 ± 47.7 vs 108.2 ± 64.7 min, p=0.008), and a lower arousal index (1.86 ± 1.64 vs 2.89 ± 2.11, p=0.003). Respiratory metrics and body position did not differ significantly between settings. 73% of subjects indicated that their sleep in the lab was “worse than home”. Device feedback was favorable: 84% judged size “just right,” 6% reported any concerns, 67% reported no issues at home, and 92% felt confident placing the device. Conclusion These findings support home PSG to obtain more representative sleep architecture without compromising detection of sleep-disordered breathing. Support (if any) The study was funded by Onera Health and managed by the CRO Maxis Medical.
Schobel et al. (2026) studied this question.