Selecting the Appropriate Sleep Study

Laboratory vs Ambulatory Sleep Studies

The following patients may be considered for an ambulatory sleep study:

Patients with a high pre-test probability of moderate to severe OSA.
Patients with no significant co-morbid medical conditions. Examples of co-morbid conditions include moderate-severe pulmonary diseases (cystic fibrosis, pulmonary fibrosis, active asthma, COPD), congestive heart failure and neuromuscular diseases (ALS, multiple sclerosis, Parkinson’s disease).
Patients suspected of having no co-morbid sleep disorders other than OSA.
Patients unable to undergo a PSG.
To monitor response to non-CPAP treatments after the diagnosis has already been made.

	In laboratory-Type 1 PSG	Home Based PSG-Type 2 PSG
Technician	Guaranteed overnight Sleep Technician attendance.	No technician attendance.
Data Credibility	More credible- Technician available overnight to ensure quality data collection and intervene where signals may be questionable.	Less credible- Data loss more likely a possibility due to dislodgement of sensors.
Data Credibility	More accurate determination of positional sleep apnoea with available synchronised video monitoring and CCTV.	Patients are required to apply some sensors and may not provide an optimal signal.
Data Credibility	All equipment applied by an experienced technician.	Acquires same data collection as Type 1 PSG excluding video monitoring.
Indications	Able to detect all sleep disorders. Including: - Treatment titrations which is currently the Gold Standard. - Sleep Movement disorders - parasomnias	Patients under the investigation of Obstructive sleep apnoea.
Indications	n/a	May be indicated in patients to monitor the response of non CPAP treatment for Sleep apnoea.
Contraindications	No absolute contraindications however patient mobility may be a consideration.	Not indicated in patients with significant co-morbid medical conditions that may degrade the accuracy of portable monitoring.
Contraindications	n/a	Patients undergoing positive airway pressure determination.
Attendance	Must be conducted in a sleep laboratory.	May be performed in the comfort of patient’s home. Patients may have domestic duties e.g. young children where home diagnostic may be more practical.
Shift work and abnormal sleep patterns	Attend the clinic between 6.30am to 6.30pm.	May be more appropriate in patients with differing sleep patterns e.g. due to shift work.
Results	Studies show improved outcomes with certified sleep evaluation.	Determination of whether a patient meets criteria for home based monitoring is complex, requiring an understanding of risk factors for OSA and diagnostic criteria for other sleep disorders. Should be performed in conjunction with a comprehensive sleep evaluation.

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