Sleep Testing - Types

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Introduction

First, All sleep tests are performed over a very finite amount of time, settings are usually determined by a small fraction of that time, 15-30 minutes is not uncommon. While this can provide good starting settings they rarely land on optimum settings. What type of sleep test is the best? -- Type 1 because it is attended and as such is more flexible.

Type I (in-lab attended)

Monitoring devices perform in-laboratory, technician-attended, overnight polysomnography (PSG) and are discussed separately. (CPT #95810 Baseline PSG Study, CPT #95805 MSLT Study and CPT #95811 Titration Study (CPAP))

Diagnostic

Baseline PSG Study, which is performed without a PAP device.

Titration Study

Performed with one or more PAP device modes to determine "Optimum" settings.

Type II (HST or in-lab unattended)

Monitoring devices can perform full PSG outside of the laboratory. The major difference from type 1 devices is that a technologist is not present. These devices are called comprehensive portable devices. (CPT #95807)

Home sleep test (HST) with Type II portable monitor, unattended (sleep studies that are performed without the oversight of a sleep technologist), with a minimum of 7 channels. Type II devices must include the following channels:

EEG: Sleep Stages. Know exactly how much Stage N1, Stage N2, Delta (Slow Wave Sleep) and REM sleep you’re getting. EOG: Eye movements recorded. These are important in recording sleep stages. ECG/heart rate: Know your heart rhythm and rate EMG: Chin, Know if you have a condition called Bruxism (teeth grinding) during sleep. Airflow: Know if you’re having some kind of sleep disordered breathing. Respiratory effort: Know if you’re having some kind of sleep disordered breathing. Oxygen saturation: Know your SPO2 levels throughout the night.

IMHO this is the best type of HST to get. Very few companies offer this type of sleep test.

Type III (HST)

Monitoring devices do not record the signals needed to determine sleep stages or sleep disruption. Typically channels include: Four physiologic variables are measured including: Two respiratory variables (eg, respiratory movement and airflow) Cardiac variable (eg, heart rate or an electrocardiogram) Arterial oxygen saturation Some devices may have other signals including a monitor to record snoring, detect light, or a means to determine the body position. (CPT #95806)

WatchPAT

Type 3
https://www.itamar-medical.com/patients/watchpat-home-sleep-testing/ WatchPAT Vendor
Utilizes the peripheral arterial signal (PAT®️). It measures up to 7 channels via three points of contact.

Channels

1. PAT
2. heart rate,
3. oximetry,
4. actigraphy,
5. body position,
6. snoring,
7. chest motion

It Reports

1. AHI
2. Central AHI
3. Apnea Episodes through the night
4. Snoring and Body Position
5. Oxygen & Heart Rate
6. Sleep Stages
7. Body Position Statistics and Graphic Display
8. Snoring Statistics
9. Sleep Stages Graphic Display
10. Respiratory Indices Chart
11. AHI Severity Scale

Full Report

Current Devices are (as of July 2021)

• WatchPAT 300, HST, return after use.
• WatchPAT One, Disposable HST, no need to return.

Discontinued Devices

• WatchPAT 100, production discontinued 2013, support through 2018
• WatchPat 200, sales discontinued, technical support through 28 February, 2025

ResMed’s ApneaLink Air

Type 3

provides performance and reliability in a compact, lightweight and easy-to-use home sleep testing device ever. A cost-efficient, type III home sleep testing device, the ApneaLink Air is capable of recording up to five channels of information: respiratory effort, pulse, oxygen saturation, nasal flow and snoring.

Channels

1. respiratory effort,
2. pulse,
3. oxygen saturation,
4. nasal flow and
5. snoring

It Reports

1. obstructive apnea
2. central apneas
3. CSR probability detection
4. body positioning calculation
5. pulse
6. oxygen saturation
7. Snoring

Discontinued

OBSOLETE: ApneaLink PC Software

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Type IV (HST - Partial)

These devices are called continuous single or dual bioparameter devices. Monitoring devices record one or two variables and can be used without a technician. Typically channels include:

• Arterial oxygen saturation
• Airflow

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