Home Sleep Apnea Test: How It Works, Accuracy And Results

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Illustration for Home Sleep Apnea Test: How It Works, Accuracy and Results: a bedside table with a small recorder box and cable beside a glass of water at dusk

A home sleep apnea test is a small recorder you wear for a night to check for obstructive sleep apnea. It tracks your breathing, blood oxygen and heart rate while you sleep in your own bed. The American Academy of Sleep Medicine (AASM) says it is meant for adults with signs of a higher risk of moderate to severe sleep apnea and no other conditions that rule it out (AASM position statement). It is a good tool, but it has limits. This guide explains how it works, who it suits, how accurate it is and what the results mean. It is for education only and does not replace a doctor.

Have your result? Use the AHI calculator to see where a score falls.

What Is A Home Sleep Apnea Test?

A home sleep apnea test (HSAT) is a simplified sleep study you do yourself. It checks for obstructive sleep apnea, where the airway narrows or closes during sleep and breathing keeps stopping and starting. A medical provider must order it after taking your history and doing an exam, in person or by telemedicine. The AASM says it should not be used to screen people with no symptoms (AASM position statement). MedlinePlus notes that a home study uses fewer sensors than a lab study and diagnoses obstructive sleep apnea only (MedlinePlus). If you are not sure whether you have symptoms, start with sleep apnea screening tests.

How Does A Home Sleep Test Work?

Most kits are mailed to you or picked up from a clinic, and you put the sensors on yourself using the instructions (Sleep Foundation). Cleveland Clinic describes a typical setup with four sensors: a nasal prong that measures airflow, a fingertip clip that measures oxygen, and two belts around the chest and belly that measure breathing effort (Cleveland Clinic). A common type, called Type 3, records two breathing measures, blood oxygen and one heart measure (Sleep Foundation).

Home Test Versus Lab Study Sensors Two columns. A home test records airflow, breathing effort from belts, blood oxygen and heart rate. A lab study adds brain waves, eye movement and muscle activity, which show when you are asleep. What Each Test Records Home Sleep Test Airflow at the nose Chest and belly effort Blood oxygen Heart measure In-Lab Sleep Study Everything in the home test Brain waves (EEG) Eye movement (EOG) Muscle activity (EMG) Sources: AASM position statement, Cleveland Clinic, Sleep Foundation.

At Home Sleep Study: What You Do

  1. Get an order. A provider orders the test and you collect or receive the kit (Sleep Foundation).
  2. Keep your usual routine. The Sleep Foundation advises your normal sleep schedule and avoiding caffeine and alcohol that day (Sleep Foundation).
  3. Put on the sensors at bedtime. Follow the kit instructions and switch on the recorder (Cleveland Clinic).
  4. Sleep as you normally would. There is no technician, so check that nothing has slipped before you drift off.
  5. Return the kit. Send or bring it back unless it is a disposable device. The clinic then reviews the results with you (Sleep Foundation).

Five Steps of a Home Sleep Test A five step path: get a provider order, keep your routine, wear the sensors, sleep, then return the kit for review. From Order to Result 1 OrderProvider signs 2 RoutineUsual bedtime 3 SensorsFour to wear 4 SleepIn your bed 5 ReturnClinic reviews Sources: Sleep Foundation, Cleveland Clinic.

What A Home Sleep Test Does Not Measure

A home test usually has no sensors for brain waves, eye movement or muscle activity, which are needed to tell sleep from wake (AASM position statement). So it cannot show sleep stages, total sleep time or awakenings (Sleep Foundation). Learn more in stages of sleep.

This matters for the score. A lab study reports the apnea-hypopnea index (AHI), which counts events per hour of actual sleep. Most home tests report a respiratory event index (REI), based on recording time instead (AASM position statement). Time in bed is longer than time asleep, so severity can be underestimated and the result can falsely reassure (Sleep Foundation). The AASM also notes that home tests cannot detect breathing events that are only tied to brief brain arousals (AASM position statement).

Who Should Take A Home Test And Who Needs A Lab?

The AASM position is that a home test is for uncomplicated adults with signs and symptoms of an increased risk of moderate to severe sleep apnea. They should have no other conditions or sleep disorder risks that would rule it out (AASM position statement). Cleveland Clinic says significant lung disease, heart failure, a neurological condition or other sleep problems generally call for an in-lab test (Cleveland Clinic). A review of the evidence agrees that a lab study is the reference standard when someone has other sleep disorders, unstable medical conditions or complex breathing problems (El Shayeb et al. 2014).

Home tests are also not used for narcolepsy or central sleep apnea (Sleep Foundation). Your doctor chooses the test that fits your symptoms and health.

How Accurate Is A Home Sleep Test?

A review of 59 studies with 5,026 patients found that Type 3 home devices had a sensitivity of 0.79 to 0.97 and a specificity of 0.60 to 0.93, depending on the AHI cut-off used (El Shayeb et al. 2014). In plain terms, they find most people who have moderate to severe apnea, but they are less sure for mild cases (Sleep Foundation). The same review found a technical failure rate of 10.25 percent for home tests, against 0.44 percent for in-lab testing, and said the evidence for people with other health conditions is limited (El Shayeb et al. 2014).

Home Test Accuracy at a Glance Three cards from the 2014 CMAJ review. Sensitivity 0.79 to 0.97. Specificity 0.60 to 0.93. Technical failure 10.25 percent at home versus 0.44 percent in the lab. Type 3 Home Tests in Studies 0.79-0.97sensitivity 0.60-0.93specificity 10.25% vs 0.44%failure, home vs lab Source: El Shayeb et al. 2014, CMAJ.

What The Results Mean

MedlinePlus lists a normal AHI for adults as under 5 events per hour (MedlinePlus). The NHS bands are 5 to 14 for mild, 15 to 30 for moderate and over 30 for severe (NHS). Home tests may give a REI instead of an AHI, and the two are not identical, so ask which one your report shows. A trained doctor should review the raw data and not rely only on an automatic score (AASM). See the AHI calculator for how the number is worked out.

Sleep Apnea Severity Bands Four bands of breathing events per hour: under 5 is the normal range, 5 to 14 is mild, 15 to 30 is moderate and over 30 is severe. Events per Hour Under 5Normal range 5 to 14Mild 15 to 30Moderate Over 30Severe Sources: NHS and MedlinePlus.

Can You Get A Home Sleep Test Without A Doctor?

In the US, the Sleep Foundation says a prescription is required. A provider orders the test or refers you to a specialist, and many companies offer a virtual visit for this step (Sleep Foundation). The AASM says only a medical provider can diagnose sleep apnea (AASM position statement). The Sleep Foundation puts the cost at roughly $150 to $500, and insurance may cover some or all of it, usually with a specialist’s prescription (Sleep Foundation). Check with your plan.

What Happens After A Positive Result?

The NHS says the main treatment for obstructive sleep apnea is a CPAP machine, which pumps air through a mask while you sleep and works best when used every night (NHS). For mild cases, changes such as weight loss, stopping smoking and drinking less alcohol may be enough. Other options include a mouthguard-style device and surgery (NHS). MedlinePlus says CPAP works well for most people (MedlinePlus). Read sleep apnea treatment and sleep apnea health risks next. For the full picture, see sleep apnea.

Quick Takeaways

  • A home test needs a provider’s order and suits adults at higher risk with no other conditions.
  • It records breathing, oxygen and heart rate, not sleep stages.
  • A negative or unclear result may still lead to a lab study.
  • Results are reviewed by a doctor, not just a machine score.

When To See A Doctor

The NHS advises seeing a GP if you always feel very tired in the day, since untreated sleep apnoea can be serious (NHS). MedlinePlus lists loud snoring, breath-holding followed by gasps or snorts, restless sleep and daytime sleepiness as common signs (MedlinePlus). Tell your doctor about your symptoms, health conditions and medicines so they can pick the right test.

Related reading: how to read sleep study results, how to get used to CPAP, when to see a sleep specialist, sleep apnea symptoms and alternatives to CPAP.

FAQs About Home Sleep Apnea Tests

Can A Home Test Miss Sleep Apnea?

Yes. It can be less accurate in mild cases, and a score based on time in bed can read low (Sleep Foundation). A negative or unclear result may lead to a lab study.

What If A Sensor Falls Off During The Night?

Sensors can slip without anyone noticing. Cleveland Clinic says about 7 to 8 percent of home tests fail, often from a malfunction or a misplaced sensor, and you may then get a retry device or a lab referral (Cleveland Clinic).

Is A Home Test As Good As A Lab Study?

Not for every person. It works well for adults likely to have moderate to severe apnea and no other conditions. A lab study stays the reference when health is complex (El Shayeb et al. 2014).

Does The Home Test Show Sleep Stages?

No. It has no brain wave sensors, so it cannot show deep or REM sleep (Sleep Foundation). See what is REM sleep and what is deep sleep.

Will Insurance Pay For It?

It may, partly or fully, and plans often require a specialist’s prescription (Sleep Foundation). Ask your insurer before you book.

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