key: cord-0774229-y9829jjw authors: Yoon, Dae Wui; Shin, Hyun-Woo title: Sleep Tests in the Non-Contact Era of the COVID-19 Pandemic: Home Sleep Tests Versus In-Laboratory Polysomnography date: 2020-11-01 journal: Clin Exp Otorhinolaryngol DOI: 10.21053/ceo.2020.01599 sha: 6b4c757e80f9d799b5f02611f6a2727e83136799 doc_id: 774229 cord_uid: y9829jjw nan lines recommend using PMs in patients with a high pretest probability of moderate to severe OSA without significant comorbid medical conditions. The use of a PM can also be considered if inlaboratory PSG is impossible due to immobility or serious illness. Comparative studies have reported good diagnostic performance of PMs for suspected OSA patients, as demonstrated by strong agreement between the apnea-hypopnea index acquired from PMs and in-laboratory PSG. However, home sleep tests seem to have a higher failure rate than in-laboratory PSG [5, 6] . Nonetheless, a recent randomized crossover study showed no significant differences in sensor quality and the number of non-interpretable tests between home sleep testing using type 2 PMs and in-laboratory monitoring using the same type 2 PMs [7] . As mentioned above, the clinical guidelines for the use of PMs limit the possible subjects to patients with a high pretest probability of moderate to severe OSA because of concerns that PM may have a higher false negative rate in the diagnosis of mild to mderate OSA. Indeed, the sensitivity and specificity of PMs for OSA vary depending on the severity of OSA and the type of monitor [8] . The recently developed type 3 PMs seem to have overcome the problem of low sensitivity, which is a disadvantage of existing PMs, even in mild OSA [9, 10] . Whether OSA patients prefer a home sleep test or in-laboratory PSG depends on the hook-up location. When patients were hooked-up in the hospital and asked to return home for the sleep recording, the preference rate for home sleep monitoring was lower than that for in-laboratory testing [6, 7] . When the hook-up was performed at patients' home, in contrast, the trend was reversed [11, 12] . These results indicate that transportation is a critical factor determining patients' preference for a test location, and if transportation is inconvenient, patients will be willing to accept spending the night under observation in unfamiliar circumstances. To address transportation-related concerns regarding home sleep tests, it is necessary to develop innovative PMs that can be easily worn and operated by patients at home. To minimize the failure rate, it is necessary to establish a self-monitoring system of sensor signals and to develop remotely controllable devices. Thanks to innovations in data transmission technology, this is no longer an impossible dream. According to an evaluation of a hypothetical cohort of 1,000 Medicaid patients with suspected OSA [13] , diagnostic testing using a type 3 PM and the therapeutic strategy of home sleep monitoring with an auto-titrating continuous positive airway pressure (CPAP) device could save more than $400,000 compared to in-laboratory PSG and in-laboratory PSG with a fixedtitration CPAP device. Considering the high cost of in-laboratory sleep tests, the deterioration of economic conditions due to the increase in unemployment resulting from COVID-19, and the increasing adoption of non-face-to-face-meetings in daily life, the transition to home sleep testing is an essential requirement in the current non-contact era. Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Standards of Practice Committee of the American Sleep Disorders Association Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American Academy of Sleep Medicine Clinical Practice Guideline Home diagnosis of sleep apnea: a systematic review of the literature: an evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome Evaluation of the feasibility and preference of Nox-A1 type 2 ambulatory device for unattended home sleep test: a randomized crossover study Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians Validation of the Nox-T3 portable monitor for diagnosis of obstructive sleep apnea in Chinese adults A pilot validation study for the NOX T3(TM) portable monitor for the detection of OSA Home set-up polysomnography in the assessment of suspected obstructive sleep apnea Sleep efficiency during sleep studies: results of a prospective study comparing home-based and in-hospital polysomnography The New England Comparative Effectiveness Public Advisory Council. Diagnosis and treatment of obstructive sleep apnea in adults Institute for Clinical & Economic Review No potential conflict of interest relevant to this article was reported.