A Review of the Current Status of Home Sleep Apnea Testing vis-à-vis In-lab Polysomnography: Is Old Still Gold?

Obstructive sleep apnea (OSA) affects almost one billion people worldwide and is a major cause of morbidity and mortality.However, most patients with OSA remain undiagnosed and untreated.In-lab polysomnography attended by a sleep technologist is the gold standard intervention for the diagnosis of OSA and titration of positive airway pressure (PAP) therapy.However, in-lab polysomnography is expensive, labor-intensive, and associated with long wait times.Further, patients are observed for only one night outside their normal sleep environment which may adversely affect the quality of sleep and not capture night-to-night variability.Hence, various portable devices have been developed to perform home sleep apnea testing (HSAT) at lower costs than in-lab polysomnography.In this review article, we compare the relative merits and demerits of HSAT vis-à-vis in-lab polysomnography.We delve into the current evidence for the efficacy, shortcomings, and costs of the different types of sleep studies.We summarize the current guidelines for sleep apnea testing.We conclude with the Indian perspective on the various types of sleep studies available.