August 6, 2014
News Review From Harvard Medical School -- Doctors Say Home Test Fine for Sleep Apnea
Home testing can help to diagnose sleep apnea just as well as an overnight stay in a sleep lab, new guidelines from a major group of doctors say. People with sleep apnea stop breathing, briefly, many times each night. This can cause daytime sleepiness. The condition also has been linked with a higher risk of heart attack and stroke. Sleep apnea is usually diagnosed after overnight monitoring in a sleep lab. But home monitors have been used increasingly because they cost less and can be used by people who are not near a sleep lab. And research suggests the home monitors do the job, the American College of Physicians (ACP) says. ACP doctors provide primary care for adults. The new ACP guidelines say these home studies are fine for diagnosis of sleep apnea in most people. Patients with lung disease, heart failure or neurological disorders should have their sleep studies done in a lab, the ACP says. The journal Annals of Internal Medicine published the study. HealthDay News wrote about it August 5.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Sleep apnea is extremely common. Some estimates suggest it may affect up to 15% of middle-aged and older adults. However, the great majority of people with this ailment don't know they have it.
Diagnosing sleep apnea traditionally requires you to spend a night in a hospital's sleep center, hooked up to various recorders. Portable devices that can detect sleep apnea in the comfort of your own bed offer a convenient alternative. But do they work as well as sleep lab studies? This review suggests the portable home devices work just as well for diagnosing most people.
People with sleep apnea briefly stop breathing dozens or even hundreds of times a night. After each pause, oxygen levels in the bloodstream plummet. This prompts the brain to send out a "breathe now!" signal. The sleeper briefly wakes and gasps for air.
This pattern -- sleep, breath holding and waking to breathe again -- causes daytime sleepiness. Behind the wheel of a car, this can be deadly. Sleep apnea also has the potential to:
Boost blood pressure
Contribute to heart failure or make it worse
Dull thinking skills
And the loud snoring disrupts sleep for bed partners as well.
The American College of Physicians guideline still recommends the overnight stay in a sleep lab as the "best" test for sleep apnea. But, with some exceptions, the guideline supports offering a home test as a good alternative.
Up to 90% of people with the condition don't get diagnosed. Portable home testing could make the diagnosis easier and less costly. And that could lead to many more people getting the treatment they need.
What Changes Can I Make Now?
If you have excessive daytime drowsiness and think you get enough hours of sleep, you likely have sleep apnea. Other symptoms include:
Loud snoring four or more times per week
Someone telling you that you sometimes stop breathing or gasp for air during your sleep
Unrefreshing sleep despite being in bed for 8 or more hours
A large neck (collar size); 17 inches or more in men, 16 inches or more in women
Check with your doctor about which test might be best for you. Some people probably should get tested overnight in a sleep lab. They include people with:
Chronic lung disease
A neurological disorder
Otherwise, home testing with a portable device probably would be adequate.
Portable sleep apnea devices come in many makes and models. The device should be able to monitor:
The amount of oxygen in the bloodstream
Air flow through your nose
Chest movement to detect breathing patterns
Heart rate, ideally with an electrocardiogram to record your heart's electrical activity
What Can I Expect Looking to the Future?
Home testing offers a cheaper and easier diagnostic test than overnight sleep studies. Because of these study results, I expect that doctors now will order home testing more often.