How Accurate Are Home Sleep Tests for Sleep Apnea, Really?

If you suspect you have obstructive sleep apnea — a sleep disorder marked by repeated episodes of upper airway collapse, resulting in brief pauses in breathing and disrupted sleep — it's a good idea to seek out a  proper diagnosis. But if you’re not thrilled at the thought of going to an in-lab overnight sleep study, you’ll want to know if you can trust a sleep apnea home test for accuracy.

The answer is yes: An at-home sleep test is an accurate, convenient way to test for obstructive sleep apnea (OSA), but there are some things you need to know first.

Read on to learn more about home sleep test accuracy for OSA, what these tests measure (and what they can’t), who is a good candidate, what your results really say, and how Dreem Health’s Sunrise device works for at-home OSA testing.

How accurate are home sleep tests for detecting sleep apnea?

Some research suggests that home sleep tests can detect sleep apnea with 91% accuracy, according to a small study published in the Journal of the Chinese Medical Association. 

Sixty-seven patients received both an in-lab and at-home test for OSA, and no significant difference was found in the recorded apnea-hypopnea index (AHI)— a measure of the number of times you stop or have shallow breathing episodes per hour. Additional research in Sleep and Breathing concluded that home sleep testing holds up well against in-lab, gold-standard testing as an option for diagnosing OSA.

Still, research in Frontiers in Neurology suggests that at-home tests need to be interpreted cautiously. One retrospective study analyzed the cases of 115 patients who went to a sleep clinic with 

the results from an at-home sleep apnea test in-hand. After sleep medicine practitioner review, 40% of patients needed to get an in-lab polysomnogram test (sleep study). Of those, nearly half had their sleep apnea severity changed or were diagnosed with a non-OSA related sleep disorder. Ear, nose, and throat surgeon review changed the diagnosis in even more of these patients. 

It's also important to consider what variables home tests are measuring, and this can differ by device. For example, using respiratory event index (REI) — the number of apneas/hypopneas during total recording time —  may underestimate OSA severity or miss it altogether, which can result in underdiagnosis, per research in Sleep Advances. 

“For the right person, home sleep tests are quite good. They correctly spot about 8 out of 10 people who have moderate or severe sleep apnea, and for those cases they work about as well as a night in a sleep lab,” says Jamila Battle, MD, a triple board certified physician in sleep, family medicine, and addiction.  “They’re accurate, convenient, and far less expensive.” 

The bottom line: An at-home sleep test is accurate for many people, but it's important to work with a clinician to receive the best interpretation of results — and the best treatment plan, which may include CPAP therapy. Dreem Health can help you find the right sleep medicine specialist. 

What does a home sleep test measure — and what does it miss?

When it comes to how sleep apnea testing works, a home sleep test collects information on metrics such as breathing, blood oxygen level, and heart rate, according to the American Academy of Sleep Medicine (AASM). The exact metrics depend on the number and type of sensors the test or device tracks, per the AASM. 

Home tests typically do not cover all of the metrics of a standard polysomnography (PSG). A PSG is an in-lab sleep study that measures data from eight metrics, including respiratory airflow, blood oxygen saturation, body position, brain waves, breathing effort/rate, muscle electrical activity, eye movement, and heart rate. For that reason, a PSG provides more comprehensive information than a home sleep apnea test and can help identify other sleep disorders or causes of sleep-related symptoms.

What’s more, home tests generally do not have electroencephalogram (EEG) tracking, which records brain activity via electrodes placed on your scalp, and they don’t measure muscle tone, says Alex Dimitriu, MD, double board-certified in Psychiatry and Sleep Medicine and founder of Menlo Park Psychiatry & Sleep Medicine in Menlo Park, California. These measurements can help determine when you are actually asleep, identify sleep stages, and evaluate for other sleep conditions. “Home sleep tests are good for catching sleep apnea, but not much else,” he says.

Why some home tests can underestimate severity

A home sleep apnea test false negative is a real risk. “Many traditional home tests can’t  tell when you’re actually asleep, so they measure your breathing over the whole time you’re in bed, including time you’re laying awake,” explains Dr. Battle (this is the aforementioned REI metric). That’s a problem for the accuracy of your results because using time awake as part of the data collection “waters down” your score, making sleep apnea look milder. Many home sleep tests and tech wearables rely on REI or heart rate signal analysis . 

Other home tests are better able to track how much you’re actually sleeping for a more accurate result. Dreem Health’s Sunrise home sleep device uses data on mandibular jaw movements (MJM) to discern wakefulness from sleep, which has been clinically validated against in-lab sleep studies for its accuracy, says sleep medicine physician Kirstin Lloyd, MD, a clinician in the Dreem Health network.

The Sunrise Home Sleep Device does this through a sensor that sits on your chin and tracks how many times the jaw jerks open —  a clear, research-validated indicator of pauses in breathing during sleep. The other advantage of MJM data is that it's reliably associated with different wake and sleep states, including light non-REM, deep non-REM, and REM, adds Dr. Lloyd.

There are several variables that factor into result accuracy in home tests, such as length of recording time, sleep posture, and the severity of your OSA.

“A home test is better at confirming sleep apnea than ruling it out,” says Dr. Battle. She points out that one in four “normal” home test results are wrong (a false negative). In that case, you should pay attention to your symptoms. If the person who sleeps beside you tells you that you snore loudly or you have pauses in your breathing at night, or if you experience excessive daytime sleepiness or morning headaches, you should speak to your clinician. “Don’t assume you’re in the clear,” Dr. Battle says.

So if your home test is negative but you and/or your clinician still suspect an issue, you may need to make arrangements for an in-lab sleep study, adds Dr. Dimitriu. “A follow-up lab study is the best way to rule out OSA or catch fragmented sleep patterns."

Who's a good candidate for a home sleep test — and who should go straight to a lab study?

Not sure if you or your sleeping partner should test at home versus in a lab?  This is the criteria Dr. Battle says can help you decide if a home sleep test is a good choice for you:

• You are otherwise healthy 

• You have clear signs of sleep apnea:

• Loud, nightly snoring, gasping, or choking during sleep (experienced by you or verified by a sleeping partner)

• Waking up unrefreshed despite adequate sleep (defined as 7 to 9 hours of sleep per night)

• Difficulty staying asleep

• Daytime sleepiness 

• You might not snore but have less obvious signs of sleep apnea:

• Insomnia

• Fatigue

• Morning headaches

• Frequent nighttime urination

• Mood symptoms like anxiety or depression

Both obvious and less obvious signs of sleep apnea warrant testing, says Dr. Battle. It’s people who don’t fit the “classic” pattern of OSA (read: loud snoring or gasping) that are most at risk for going undiagnosed.

Who should go straight to an in-lab study?

If you have a medically complex history, you’re probably better off with in-lab testing, says Dr. Dimitriu. That includes people with a history of stroke, heart disease, or who may have disorders like narcolepsy, REM behavior disorder (acting out dreams), or periodic limb movements at night, he says. 

In addition to the above, Dr. Battle recommends people with lung disease (like COPD), muscle or nerve conditions that might affect breathing, or regular use of opioid pain medications. “A home test can miss or misread their sleep,” she explains. 

What happens if your home sleep test comes back negative?

If a home sleep test comes back negative, you may need to repeat the test if you still have symptoms of sleep apnea. A single negative test does not rule out OSA.

At-home testing can have limitations because your sleep is not the same each night, and there is a high variability of OSA from night to night, with 78% of patients experiencing changes in OSA severity on differing nights, according to a randomized controlled trial in the Journal of Sleep Research. “Sleep apnea can vary quite a bit from night to night, so a single night at home doesn’t always capture it,” says Dr. Battle. Testing more than one night will improve accuracy, and many home tests, such as the Sunrise Sleep Test, are designed to record two or more nights. 

If one single night test comes back negative, it’s reasonable to repeat it again, recommends Dr. Battle. If a good-quality sleep home test over several nights comes back negative and you’re still having symptoms, go to a sleep lab (rather than continuing to try to test at home). “The lab study is more sensitive, so it can catch sleep apnea the home test missed and pick up other sleep problems that might explain your symptoms,” she explains. 

How Dreem Health's home sleep test adds another layer of validation

One FDA-cleared home sleep test, Dreem Health’s Sunrise Sleep Test, measures five signals, including nose and mouth airflow, mandibular jaw movement, heart rate, blood oxygen saturation, and head movement for a clearer picture of your sleep apnea and how it’s affecting you. 

In-lab sleep data shows the FDA-cleared Sunrise Sleep Test has a 95% accuracy rate of finding mild sleep apnea and a 93% chance of identifying moderate to severe sleep apnea. With a no-referral, insurance-covered access model, there are fewer access barriers to getting a sleep test and finally diagnosing OSA. 

The bottom line

Home sleep apnea test reliability is high — with about 80 to 90% accuracy, though research on individual devices shows that some may have 90%-plus accuracy. Accuracy will vary depending on device and the sensors it uses. More data points collected can improve accuracy, and eventual OSA diagnosis. 

With home sleep testing, there is no in-lab stay required for most people and no long referral queue to access a sleep clinic lab. That can remove barriers for a lot of people and improve OSA diagnosis, a condition that goes commonly undiagnosed. If you’re ready to get started, Book a consultation with Dreem Health. 

Frequently asked questions (FAQs)

Can a home sleep test miss sleep apnea?

Yes, a home test is not a perfect test. While home testing identifies moderate to severe sleep apnea in about eight out of 10 patients, there are some patients whose results will be a false negative or inconclusive.

What should I do if my home sleep test comes back negative but I still have symptoms?

You should retest, since there are several factors that can affect sleep apnea symptoms from night to night. If you’ve retested two or three nights and your results are still negative but symptoms remain, talk to a sleep medicine provider. You’ll likely need to make arrangements for an in-lab sleep study.

How long does it take to get results from a home sleep test?

Your healthcare professional can get results within minutes, depending on the home sleep test device you’re using. That said, results should always be reviewed and interpreted by a sleep clinician who will guide you on next steps. They will usually connect with you to discuss your results within a few days.