Clinical Practice Guideline for Home Sleep Apnea Testing

A common disorder that causes patients to stop breathing while sleeping is known as Obstructive Sleep Apnea (OSA). This happens when the upper airway becomes blocked, resulting in temporary impairment of airflow during sleep. There are millions of recorded cases of OSA, however, many remain undiagnosed or untreated. While some people disregard the early symptoms of the condition, experts warn of the severe health consequences that may result over time when it is left untreated.

Sleep Apnea correlates to more serious disorders like obesity, stroke, diabetes, high blood pressure, glaucoma, and heart failure. New research results have also posed a warning for pregnant women with sleep apnea, where it was found that they have a higher chance of developing hypertension and prematurely giving birth.

Even patients who have low to moderate sleep apnea suffer from its consequences. The condition lowers their work performance and puts them at higher risk for accidents on highways. Considering its effects and numerous health complications, the condition needs concentrated attention from experts and other individuals involved to improve diagnosis and treatment, and ultimately cure the condition. 

Diagnostic testing for obstructive sleep apnea (OSA)

Early diagnosis of OSA is key to its prevention and cure. Being able to detect the possible existence of the condition can help a lot to better the patient’s situation and prevent further complications. Nevertheless, sleep apnea is a rather neglected condition. As a result, the number of undiagnosed and untreated cases increase through the years.

So, it's not a surprise that the public is encouraged to be warier of the common symptoms of OSA. These includes choking, gasping, loud snoring, and daytime sleepiness. If any of its signs and symptoms are observed, it is wise to immediately consult a doctor who will likely recommend patients to sleep medicine specialists. The most common tests used by specialists to detect sleep apnea are Nocturnal Polysomnography and home sleep tests.

The American Academy of Sleep Medicine (AASM) provides a guideline of clinical practice for those adults diagnosed with OSA. Each guideline issued or updated is based on reviewed literature, meta-analyses, and evidence assessment using a specific methodology. It is created by a team of board-certified physicians on sleep medicine and approved by the organization’s board of directors. Published on the Journal of Clinical Sleep Medicine, the guideline produced early in 2017 described the conditions by which polysomnography or home sleep apnea testing should be performed. This is specifically intended for adults suspected with OSA.

First off, experts emphasized that the standard diagnostic test for these patients is a polysomnography. In this test, equipment monitors the heart, brain, lung activity, arm and leg movements, breathing patterns, and blood oxygen level of a patient while sleeping. To ensure high-quality care for diagnosed OSA patients, they also stressed that it be performed with comprehensive evaluation and sufficient follow-up.

Home sleep apnea testing only records airflow, oxygen saturation, and respiratory effort. It makes use of such limited-channel devices, which gathers fewer data. Studies have shown the inadequacy of earlier home sleep apnea testing in providing favorable outcomes to patients with complicated conditions. So, the guideline highly recommends polysomnography for the diagnosis of OSA in patients with cardiorespiratory conditions, chronic opioid medication, stroke, insomnia, and other serious complications. This means that home sleep apnea is not recommended for testing these types of patients.

If home sleep apnea testing is to be administered, the team of experts at AASM requires the administration to be done by an accredited sleep center who will be supervised by a certified physician or a sleep medicine provider.

Appropriate use of Home Sleep Apnea Test (HSAT)

The earlier versions of AASM’s guideline for OSA rules out home sleep apnea testing among the recommended diagnostic tests for sleep apnea patients who also suffer from other severe complications. However, the test still remains valuable for select adults suspected of obstructive sleep apnea. Nevertheless, Dr. Ilene Rosen, president of AASM, emphasizes that the test is only a single factor of a comprehensive sleep evaluation. She also notes the importance of having a certified sleep medicine physician who will review and interpret the raw data.

The newest version of AASM’s guideline on OSA stresses the importance of appropriately conducting HSAT. Here are the highlighted positions published in the Journal of Clinical Sleep Medicine:

• HSAT must be ordered by a physician. Only then will the medical assessment be used to diagnose or evaluate the treatment of OSA. In relation to this, only a certified physician can diagnose the condition.
• The general screening of asymptomatic populations should not include HSAT as a primary tool of evaluation.  
• The patient’s medical history should be a basis for analyzing his or her condition. Furthermore, the patient must be examined by a physician in person or through telemedicine.
• HSAT data should not be the sole basis for diagnosis, assessment, and treatment of OSA patients. Doing so would only jeopardize the patient’s health.
• Any data resulting from HSAT must be interpreted and reviewed by another board-certified physician in sleep medicine. The entire process should also be overseen by a certified medicine physician.

Included in the journal is a position paper, which states that the use of HSAT for children with a diagnosis of OSA is not recommended. Some available literature vouches for the technical feasibility of OSA for these patients in controlled conditions, but a trained clinician should moderate the process.

As of now, there is no sufficient evidence supporting the efficacy of HSAT in assessing children’s breathing difficulty during sleep. Further studies on the matter are underway, but there is currently no strong correlation among the variables.  

Though HSAT is not considered a standard diagnostic test for OSA, this test with the right device and proper application can effectively diagnose OSA among adult patients without severe complications. It can present data on the signs and symptoms of patients with moderate to severe risk of OSA.  

Home remedies for suspected obstructive sleep apnea

There are certain measures you can take if he suspects to have obstructive sleep apnea. Self-care is a good way to deal with the condition, but a doctor’s consultation is still a better way to ensure health care. Here are lifestyle changes you can do that will help one rid himself of sleep apnea:

• Avoid relaxants such as alcohol, tranquilizers, and sleeping pills that may interfere with breathing.
• Smoking worsens OSA, so avoid it at all costs
• Keep a healthy weight and get at least 30 minutes of regular exercise.
• Avoid sleeping on your back as it causes the tongue to block the airway. Instead, sleep on your side.
• Use nasal decongestants to keep nasal passages open. This is best done with a doctor’s prescription as the medicine should only be used short-term.

Whether these points work for you or not, set a doctor’s appointment to ensure that there will be no health complications.

Final thoughts

The three most common warning signs of sleep apnea are gasping, snoring, and choking. If you experience any of these, do not think twice about visiting the doctor to get the proper medications and treatment. Obstructive sleep apnea may not look dangerous at first, but it could lead to complications which will be difficult to deter. If one is undergoing the home sleep apnea test, it is worthy to know that the medical assessment remains effective given the right implementation. Being an informed patient will greatly help you look after your own condition.