How are home sleep studies different from laboratory-based studies?

home sleep studyIs one better than the other?  Why are different types of sleep studies used? There are a range of different types of sleep studies that can be done. Which is best, depends upon the clinical situation and the question that is looking to be answered.  In general, if the clinical question is trying to confirm a diagnosis of significant obstructive sleep apnea in someone at high clinical risk, then a home sleep study can be used to confirm a diagnosis of obstructive sleep apnoea.  However, if the risk of sleep apnea is lower or the clinical question requires evaluation of sleep quality then a more detailed sleep study, such as one performed in a sleep laboratory, will better answer those questions.

What is the difference between home and laboratory-based sleep studies?

In general, home sleep studies measure less that is measured in a laboratory-based study, and also allow people to sleep in their own home rather than a strange environment. This can make home sleep studies simpler, less costly and less daunting. But, this trade off comes at a cost of obtaining less detailed information which can make getting an accurate diagnosis more difficult, particularly for conditions apart from sleep apnea.

The main differences between home and laboratory-based sleep studies are:

  • The number of variables that are measured – Home sleep studies usually measure around 8 variables with a focus on cardiac and respiratory variables. In contrast a laboratory-based study measures 13-16 variables. This means less wires need to be attached for a home sleep study as can be seen in the photo below.
home sleep study

Left – Home sleep study. Right – Laboratory-based sleep study.

For a comprehensive list of the variables measured during a sleep study, see this post on having a sleep study.

  • Technicians in attendance – in a sleep laboratory environment qualified sleep technicians place electrodes at the start of the night. During the night they can monitor recordings in real time, and can re-place electrodes during the night if signals are poor.
  • Sleep at home versus in a laboratory – Most people feel that they sleep better at home than in a strange environment such as a sleep-laboratory. The trade off is that in the home, there are lots of sources of electrical interference and other things that can disturb sleep, like children and pets.

So which test is best for me?

The answer to this is really to think about what are you trying to achieve from having a sleep study.  If you and your doctor think you are at high risk of having obstructive sleep apnea and the aim is to confirm that diagnosis, then this can usually be done using a home-based sleep study.  The advantages of this are that it is simpler to perform, often cheaper and easier to access and your primary care practitioner may be able to refer you directly for this.

However, if the clinical question is something different, such as “why am I feeling so tired?”, looking at movements or abnormal behaviours during sleep or get a sense of sleep quality, a laboratory-based sleep test will be needed.  Although laboratory-based sleep studies can be more expensive and difficult to access and generally require prior review by a sleep specialist, it is important to not automatically take the perceived simpler route of having a home-based sleep study as it may not give you the answer that you and your doctor are looking for and could be a waste of your time and effort.

It is important to note that a sleep study is not a medical opinion.  It is a test that helps you and your doctor make a diagnosis and then determine a management plan for your problems.  Quite often I will see people arrange to have a sleep study, thinking this will give them the equivalent of a medical opinion on their diagnosis and treatment.  However, it is important to remember that a sleep study is a test and decisions about diagnosis and treatment are made in consultation with your doctor rather than being just on the basis of a test.

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