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Medical Devices and Equipment

Home Sleep Apnea Testing for the Diagnosis of Obstructive Sleep Apnea

Educational Objective
To understand how to interpret the results of diagnostic tests and apply them clinically.

1 Credit CME

JAMA

Published Online: January 10, 2023

JAMA Diagnostic Test Interpretation

Article Information and Disclosures

Scott Hoff, MD¹;

Nancy Collop, MD¹

Author Affiliations

¹Emory Sleep Center, Emory University, Atlanta, Georgia

Read article on JAMA Network

JAMA Clinical Guidelines Synopsis

Diagnostic Testing for Obstructive Sleep Apnea in Adults

Babak Mokhlesi, MD, MSc; Adam S. Cifu, MD
Review

Diagnosis and Management of Obstructive Sleep Apnea

Daniel J. Gottlieb, MD, MPH; Naresh M. Punjabi, MD, PhD
US Preventive Services Task Force

USPSTF Recommendation: Screening for Obstructive Sleep Apnea in Adults

US Preventive Services Task Force; Carol M. Mangione, MD, MSPH; Michael J. Barry, MD; Wanda K. Nicholson, MD, MPH, MBA; Michael Cabana, MD, MA, MPH; David Chelmow, MD; Tumaini Rucker Coker, MD, MBA; Karina W. Davidson, PhD, MASc; Esa M. Davis, MD, MPH; Katrina E. Donahue, MD, MPH; Carlos Roberto Jaén, MD, PhD, MS; Martha Kubik, PhD, RN; Li Li, MD, PhD, MPH; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; John M. Ruiz, PhD; James Stevermer, MD, MSPH; John B. Wong, MD
US Preventive Services Task Force

USPSTF Report: Screening for Obstructive Sleep Apnea in Adults

Cynthia Feltner, MD, MPH; Ina F. Wallace, PhD; Shannon Aymes, MD, MPH; Jennifer Cook Middleton, PhD; Kelli L. Hicks, MD, MPH; Manny Schwimmer, MPH; Claire Baker; Casey P. Balio, PhD; Daniel Moore, MPH; Christiane E. Voisin, MSLS; Daniel E. Jonas, MD, MPH
JAMA Patient Page

Patient Information: Screening for Obstructive Sleep Apnea

Jill Jin, MD, MPH

Read Case Take Quiz Answer

A 50-year-old woman with hypertension and epilepsy reported loud snoring associated with a 22.7-kg (50-lb) weight gain over the past 2 years. She described infrequent abrupt awakenings with a sensation of breathlessness but reported no witnessed apnea. She had fatigue but no headaches or excessive daytime sleepiness. Her blood pressure was 182/97 mm Hg, oxygen saturation was 98%, and body mass index was 51.3 (calculated as weight in kilograms divided by height in meters squared). The remainder of her physical examination findings were normal. Laboratory evaluation revealed a serum bicarbonate level of 24 mEq/L (reference range, 23-29 mEq/L). The patient underwent home sleep testing using a home sleep test device. Results are presented in the Table.

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B. Initiate continuous positive airway pressure (CPAP) therapy

Obstructive sleep apnea (OSA) affects approximately 17% of women and 34% of men in the US, and it is diagnosed with a sleep study, performed either at home or in a laboratory.¹ The diagnosis of OSA is based on the apnea-hypopnea index (AHI), consisting of the number of apnea and hypopnea events per hour of sleep. The presence of OSA is defined by an index level greater than 5 and is classified as mild (5-14.9 events/hour), moderate (15-29.9 events/hour), or severe (30 or more events/hour).¹ The risk of OSA can be assessed based on medical history and pretest prediction models, such as STOP-Bang.²

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Article Information

Corresponding Author: Nancy Collop, MD, Emory Sleep Center, Emory University, 12 Executive Park Dr NE, Atlanta, GA 30329 (nancy.collop@emory.edu).

Conflict of Interest Disclosures: Dr Collop reported grants from Huxley Medical, honorarium from Sunrise for advisory board meeting, and royalties as an author and editor from UpToDate including authorship of a section on home sleep testing, outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References

Gottlieb DJ , Punjabi NM . Diagnosis and management of obstructive sleep apnea: a review. JAMA. 2020;323(14):1389-1400. doi:10.1001/jama.2020.3514 PubMed Google Scholar Crossref

Chen L , Pivetta B , Nagappa M , et al. Validation of the STOP-Bang questionnaire for screening of obstructive sleep apnea in the general population and commercial drivers: a systematic review and meta-analysis. Sleep Breath. 2021;25(4):1741-1751. doi:10.1007/s11325-021-02299-y PubMed Google Scholar Crossref

Kapur VK , Auckley DH , Chowdhuri S , et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479-504. doi:10.5664/jcsm.6506 PubMed Google Scholar Crossref

Pépin JL , Tamisier R , Borel JC , Baguet JP , Lévy P . A critical review of peripheral arterial tone and pulse transit time as indirect diagnostic methods for detecting sleep disordered breathing and characterizing sleep structure. Curr Opin Pulm Med. 2009;15(6):550-558. doi:10.1097/MCP.0b013e3283318585 PubMed Google Scholar Crossref

Smith MT , McCrae CS , Cheung J , et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2018;14(7):1209-1230. doi:10.5664/jcsm.7228 PubMed Google Scholar Crossref

El Shayeb M , Topfer LA , Stafinski T , Pawluk L , Menon D . Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ. 2014;186(1):E25-E51. doi:10.1503/cmaj.130952 PubMed Google Scholar Crossref

Massie F , Van Pee B , Bergmann J . Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests. J Clin Sleep Med. 2022;18(3):871-876. doi:10.5664/jcsm.9744 PubMed Google Scholar Crossref

Ichikawa M , Akiyama T , Tsujimoto Y , Anan K , Yamakawa T , Terauchi Y . Diagnostic accuracy of home sleep apnea testing using peripheral arterial tonometry for sleep apnea: a systematic review and meta-analysis. J Sleep Res. 2022;31(6):e13682. doi:10.1111/jsr.13682 PubMed Google Scholar Crossref

Ioachimescu OC , Allam JS , Samarghandi A , et al. Performance of peripheral arterial tonometry-based testing for the diagnosis of obstructive sleep apnea in a large sleep clinic cohort. J Clin Sleep Med. 2020;16(10):1663-1674. doi:10.5664/jcsm.8620 PubMed Google Scholar Crossref

Centers for Medicare and Medicaid Services. Physician fee schedule look-up tool. Accessed October 28, 2022. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.