Title Obstructive Sleep Apnea Management with Home Monitoring
Clinical Question For patients diagnosed with obstructive sleep apnea (OSA) and treated with an oral appliance, is a Type 3 home sleep monitor an acceptable alternative to in-lab polysomnography (PSG) for recording baseline OSA severity and treatment outcomes?
Clinical Bottom Line Many FDA approved Type 3 home sleep monitors have been validated and shown to be predictable indicators of OSA severity for patients with a high pretest probability of OSA, but the limitations of this testing method should be considered.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
www.cms.gov/Medicine/Coverage/Trinkalinos/2007VariousSystematic Review
Key resultsThe Center for Medicare & Medicaid Services (CMS) requested this systematic review by the Dept. of Health and Human Services (AHRQ) on home sleep monitor technology. Based on in-depth review of available technology this study concluded that Type 3 home monitors may have ability to predict AHI suggestive of OSA with a high positive predictive value (>10) and low negative likelihood ratios (<0.1).
22003351Collop/2011VariousSystematic Review
Key resultsThe American Academy of Sleep Medicine (AASM) reviewed studies on 21 home sleep test monitors and developed a new categorization system and compared positive likelihood ratio (LR+) and sensitivity. Devices were evaluated on ability to produce LR+ ≥ 5 and sensitivity ≥ 0.825 for a subject with an AHI ≥ 5.
22654195Rosen/2012n=373RCT (Multicenter)
Key resultsThis multi-center study compared portable home sleep monitoring with in-lab PSG for diagnosis and treatment evaluations. Acceptance of treatment, titration CPAP pressures, time to treat and ESS scores did not differ between the 2 arms of the study. Home base sleep monitoring was not inferior to in-lab PSG.
Evidence Search National Library of Medicine (Pub Med) was searched using the following search terms: Obstructive sleep apnea, polysomnography, AHI, out-of-center testing, portable, recording device, monitor, testing device. Internet search was used to find the Tufts University study sponsored by CMS (Trinkalinos 2007).
Comments on
The Evidence
The HST technology systematic review by Trinkalinos et al. is the most comprehensive to date. This review did not consider pediatric patients. The ability of Type 3 monitors to record “AHI suggestive of OSAHS” appeared to be better in studies with sleep technologist support rather than in the home, with higher rates of unsatisfactory reports and corruption of data, likely attributable to user errors.
Applicability Home sleep testing (HST) is becoming increasing used to diagnose patients with OSA and to monitor treatment progress to substitute for the more expensive PSG testing. Many HST devices have been validated. Home-based treatment monitoring strategies have been shown to be not inferior to in-lab PSG. Based on the report by Trinkalinos et al. (2007) CMS has approved coverage of HST for the diagnosis of OSA. The most recent AASM Clinical Guidelines (2011) attempt to guide clinicians in selecting the most appropriate HST device.
Specialty (Public Health) (General Dentistry) (Oral Surgery) (Pediatric Dentistry) (Prosthodontics)
Keywords Obstructive sleep apnea, polysomnography, AHI, out-of-center testing, portable, recording device, monitor, testing device
ID# 2338
Date of submission 04/23/2013
E-mail Verrett@uthscsa.edu
Author Ronald Verrett, DDS
Co-author(s) Trenton A. Tompkins
Co-author(s) e-mail tompkinst@livemail.uthscsa.edu
Faculty mentor John D. Rugh, PhD
Faculty mentor e-mail Rugh@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available