Indications for HSAT or polysomnography

Indications for HSAT

Indications for in-laboratory polysomnography

Diagnostic testing in an adult patient who is at high risk of moderate to severe uncomplicated OSA*
Diagnostic testing in an adult patient in whom in-laboratory testing is not feasible for unresolvable issues^¶
Followup of therapies when symptoms suggest persistent moderate to severe OSA or when in-laboratory polysomnography is not feasible

Diagnostic testing in an adult patient suspected to have mild OSA
Diagnostic testing in an adult patient suspected to have OSA complicated by:
- Conditions that place the patients at risk of non obstructive sleep disordered breathing. For example:
  - Patients with significant cardiorespiratory disease^Δ
  - Respiratory muscle weakness due to neuromuscular condition
  - Awake or possible sleep related hypoventilation (eg, central sleep apnea, obesity hypoventilation)
  - Chronic opioid medication use
  - History of stroke
- Suspected non-OSA sleep disorders (eg, narcolepsy, severe insomnia,^◊ parasomnias, movement disorders)
Diagnostic testing for OSA in a mission-critical employee^§
Diagnostic testing in a patient with suspected OSA in whom:
- Initial HSAT is negative, inconclusive or technically inadequate
- Environmental/personal factors preclude adequate HSAT data (eg, space constraints)
Assessment of initial response to the following therapies:^¥
- Oral appliance therapy
- Surgery for OSA
- Weight loss

HSAT: home sleep apnea testing; OSA: obstructive sleep apnea; GOLD: global initiative for chronic obstructive lung disease; NYHA: New York Heart Association.
* Risk of moderate to severe OSA is indicated by the presence of daytime hypersomnolence, and at least two of the following three criteria: habitual loud snoring, witnessed apnea or gasping/choking, or diagnosed hypertension. 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 non-respiratory 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.

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