Yonca Çoluk

Giresun University, Faculty of Medicine, Department of Otorhinolaryngology, Giresun, Türkiye

Çoluk Y. Diagnostic Tests in Sleep Apnea. In: Özcan KM, editor. SleepDisordered Breathing: Diagnosis and Treatment. 1^st ed. Ankara: Türkiye Klinikleri; 2025. p.59-66.

ABSTRACT

Polysomnography (PSG) remains the gold standard for diagnosing Obstructive Sleep Apnea Syndrome (OSAS), offering comprehensive neurophysiological and cardiorespiratory parameters including electroencephalogram, electrooculogram, electromyogram, electrocardiogram, airflow, respiratory effort, and oxygen saturation. PSG is performed in a sleep laboratory, under continuous supervision of a sleep technician all night long. Presence of a sleep technician enables to solve problems during recording including displacement of the elecroencephalogram or electrooculogram electrodes or correction of imperfect signals of other electrodes, changing the lying position of the patient, or waking up the patient in case of a very long apnea. Its evolution from early brain rhythm discoveries to modern sleep staging highlights its foundational role. While PSG provides detailed assessment, the high cost and complexity have driven the development of Home Sleep Apnea Tests or portable monitoring (PM). PM has emerged as an alternative for OSAS diagnosis, largely predicated on its perceived advantages of lower expense and simpler implementation compared to in-laboratory PSG. Home Sleep Apnea Tests offers a more convenient, comfortable, and affordable way to diagnose sleep apnea. However, absence of supervision of the PM by a sleep technician is a disadvantage. In conclusion, Polysomnography, undeniably remains the gold standard for the comprehensive diagnosis of OSAS, offering detailed insights into neurophysiological, cardiorespiratory, and other physiological parameters during sleep. Its ability to quantify sleep stages and accurately identify various sleep-related events makes it a crucial tool, particularly for complex cases or when other sleep disorders are suspected. Nevertheless, home-based tests offer enhanced convenience, comfort, and affordability, significantly improving access to sleep apnea diagnosis, especially for patients with a high pre-test probability of moderate to severe OSAS or those for whom in-laboratory PSG is not feasible. As diagnostic technologies advance, utilizing these varied evaluation methods, guided by established guidelines and expert clinicians, will continue to refine how we diagnose and manage sleep apnea, ultimately leading to better patient outcomes.

Keywords: Home sleep testing; Polysomnography; Portable monitoring; Sleep apnea syndrome; Sleep disorders