Indications for HSAT | Indications for in-laboratory polysomnography |
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GOLD: global initiative for chronic obstructive lung disease; HSAT: home sleep apnea testing; NYHA: New York Heart Association; OSA: obstructive sleep apnea.
* Risk of moderate to severe OSA is indicated by the presence of daytime hypersomnolence and habitual loud snoring and witnessed apnea or gasping/choking. Examples of conditions that can "complicate" OSA and in whom HSAT should not be performed include significant cardiorespiratory disease (eg, heart failure, chronic obstructive pulmonary disease), disorders that contribute to hypoventilation (neuromuscular disorders, obesity hypoventilation, opioids, stroke), and other nonrespiratory sleep disorders (eg, narcolepsy, severe insomnia).
¶ Clinicians should be aware that HSAT is suboptimal diagnostically in patients with mild OSA and may be less sensitive for the detection of central respiratory events.
Δ Significant cardiorespiratory disease includes but is not limited to: GOLD stage 2, 3, 4 chronic obstructive pulmonary disease, NYHA class III or IV heart failure.
◊ Severe insomnia can interfere with the accuracy of HSAT.
§ Examples of a mission critical worker is an airline pilot.
¥ Most experts prefer in laboratory polysomnography when following the response to therapy in patients with OSA. This is based upon the rationale that patients who undergo successful treatment with an oral appliance or surgery, or experience weight loss (ie, symptomatic improvement) are reasonably expected to have mild or no OSA which is suboptimally detected on HSAT. HSAT may be an option in those in whom moderate to severe OSA is suspected or those in whom in-laboratory polysomnography is not feasible.