Sleep Assessment: In-hospital Sleep Test vs Home-based Sleep Test

by Dr. Kenny Pang
A quick comparison of the two types of sleep assessments used in diagnosing sleep disorders.

Sleep assessments help diagnose sleep disorder(s) in a person. There are two main types of sleep tests:

  1. An in-hospital overnight sleep test (in-patient)
  2. A home-based overnight sleep test (done in the patient’s home).

Sleep tests are ordered based on the type of sleep disorder a person is suspected to have. 

The in-hospital sleep test is comprehensive and monitors numerous parameters. Although the in-hospital overnight sleep test is useful, it suffers from several disadvantages:

  • limited resources 
  • limited recording beds 
  • high cost 
  • long waiting lists 
  • intensive labour requirements (it requires an overnight sleep technician)
  • it is difficult for elderly or chronically ill patients to travel to the hospital and to spend the night in the sleep laboratory  
  • many patients often find the polysomnographic (PSG) equipment too cumbersome 
  • first night effect (due to a new environment, patients might not be able to sleep at all).

Due to these shortcomings, many sleep specialists have moved away from asking the patient to stay in the hospital for the sleep test and have, instead, considered other locales in which to monitor the patient’s sleep, such as the comfort of one’s own home.  

The ideal home-based sleep test device should be: 

  • affordable
  • accessible
  • easy to use
  • safe for the patient
  • accurate

It should be operable by relatively unskilled people, even at home by the patient himself. An example is the wrist-worn device known as the Watch PAT (which stands for peripheral arterial tonometry) that is used to detect obstructive sleep apnea / apnoea (OSA). 

The PAT or peripheral arterial tonometry technology represents a unique and relatively new concept of non-invasive measurement of stress levels that appears to be very accurate for detecting apneic events during sleep. Dr Pang K.P. and his researchers have found that the wrist-worn Watch PAT is similar to and as accurate as the in-hospital overnight sleep test. Many other initiated authors have also found a good correlation between the Watch PAT and the overnight sleep study in the hospital.  

The paradigm has shifted from the cumbersome in-hospital laboratory overnight sleep test to the convenient, cheaper and accurate home-based device, such as the Watch PAT. Notably, the Watch PAT is already FDA-approved in the United States of America, and most insurance companies in the USA recognise its advantages and support its use.

However, home-based sleep tests may not be for everyone. For example, unsuitable candidates for home testing include patients with congestive heart failure or seizures and those who might need overnight nurse monitoring as well. These people may be recommended for a more detailed, monitored sleep test in the hospital or laboratory. 

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