Unattended home-based polysomnography for sleep disordered breathing: Current concepts and perspectives

SummaryRecently, portable sleep recording devices became an accepted alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis in patients with a high pre-test probability of moderate to severe OSA but home polysomnography (H-PSG) was not recommended because there were insufficient data.The present review has analysed six prospective randomized crossover studies comparing H-PSG to in-lab PSG.These studies convincingly showed that H-PSG allows complete sleep evaluation. The quality of patients' sleep tends to be better at home. H-PSG is accurate for OSA diagnosis and the failure rate is low despite the absence of supervision. In addition, it could offer a final and comprehensive diagnosis for many other sleep disorders.It is also likely that H-PSG can reduce PSG-related costs but complete cost-effectiveness analyses are not yet available.Recently, remotely attended H-PSG via telemonitoring has been tested and may reduce H-PSG failure rate.In conclusion, H-PSG can be used to rule-in and rule out OSA in suspected patients, even in the presence of co-morbidities and is an alternative when simplified sleep testing is negative.Future developments should target simplification of technical aspects of H-PSG, together with remote monitoring, in order to obtain good quality H-PSG performed in adequate conditions.