Like any other test, sleep studies – at home and in laboratory – have flaws. These flaws are corrected by matching the test result to the clinical suspicion, which is based on the history taken by the provider. Home sleep tests (HSTs) while democratizing sleep testing are increasingly being managed by non-sleep specialists.
Through research studies, HSTs underestimate severity of sleep disordered breathing by 30-40% and nearly 20% of HSTs are false negative studies. A false negative result means the patient has a problem that the test failed to capture. Even the gold standard for sleep testing, the in-laboratory study, can result in a false negative result due to the first night effect.
While the growing awareness of sleep and its impact on health is encouraging, I see patients through our sleep telemedicine service who report treatment deferment for mild sleep apnea or no further testing was offered despite high-risk symptoms of sleep apnea. These patients then spend years with deteriorating health driven by undiagnosed sleep apnea, until they talk to a sleep specialist online. Consider that an estimated 85% of sleep apnea patients remain undiagnosed in this country, and you can begin to understand my concern. This is a very treatable disease, in the right hands.
The population most at risk of remaining untreated (or mis-treated) are women and African Americans. I am all for more home testing as it reduces delay to care, however, we must pursue repeat testing if the test results do not match our clinical judgement. Furthermore, a mild sleep study result in the setting of sleep-related symptoms or the presence of other medical conditions (co-morbidities) deserves a trial of therapy.
Newer home sleep testing technologies will help mitigate the issue of false negative studies through multi-night testing, however, the results need to always match the providers clinical judgement – otherwise we are failing our patients. Reach out to an online sleep specialist if you have concerns or questions.
Breathe well, sleep soundly.
Written by: Avinesh S Bhar, MD
About the author
Dr. Bhar is fellowship-trained and board-certified in sleep, critical care and pulmonary medicine. He has been in practice for over seven years and established a telemedicine practice founded on personalized, convenient, and cost-effective sleep and pulmonary care.
At Sliiip, our pulmonary and sleep telemedicine practice allows for video consultation, diagnosis, and follow up care – from the comfort of anywhere. Our online sleep doctor, Dr. Bhar, believes that high-quality care only comes from a trustful physician-patient relationship.
To find out more about our services simply visit our website, or call 478-238-3552.
