From the Guidelines
Central sleep apnea (CSA) can be detected on home sleep studies, but with limitations, and the most recent evidence suggests that Type 3 home sleep apnea tests (HSAT) can be used for diagnosis in certain cases, as stated in the 2025 study 1. The detection of CSA on home sleep studies depends on the type of device used, with more advanced devices providing better results.
- Type 1: in-laboratory full attended polysomnography (PSG) is the gold standard for diagnosis
- Type 2: ambulatory full unattended PSG
- Type 3 (HSAT): limited channel devices, which can be used for diagnosis in patients with a high pre-test likelihood of moderate to severe obstructive sleep apnea (OSA)
- Type 4: 1 or 2 channels, usually using oximetry, which is not considered a diagnostic exam for OSA.
According to the 2025 study 1, Type 3 HSAT includes, at a minimum, the record of airflow, respiratory effort, and blood oxygenation, which can help detect apnea events. However, home studies typically use fewer sensors and may not distinguish as accurately between central and obstructive sleep apnea since they often lack EEG monitoring to measure brain activity and sleep stages. For patients with suspected central sleep apnea, especially those with heart failure, neurological disorders, or who use opioid medications, an in-lab polysomnography remains the gold standard for diagnosis, as recommended in the 2020 study 1. If a home sleep study shows evidence of sleep-disordered breathing but cannot clearly differentiate the type, follow-up with a comprehensive in-lab study is typically recommended to confirm the diagnosis and guide appropriate treatment, as suggested in the 2017 study 1.
The accuracy of CSA detection on home sleep studies is not as high as in-lab PSG, but it can still be a useful diagnostic tool in certain cases, as stated in the 2025 study 1. It is essential to consider the limitations of home sleep studies and to use them in conjunction with clinical evaluation and other diagnostic tools to ensure accurate diagnosis and effective treatment of CSA. In summary, while home sleep studies have limitations, they can be used to detect central sleep apnea, and the choice of device and diagnostic approach should be individualized based on patient characteristics and clinical presentation, as recommended in the most recent study 1.
From the Research
Detection of Central Sleep Apnea on Home Sleep Study
- Central sleep apnea (CSA) can be detected on a home sleep study, as shown in a study published in 2020 2.
- The study used WatchPAT, a device that uses a novel systolic upstroke analysis coupled with respiratory movement analysis, to detect CSA and obstructive sleep apnea (OSA) in adult patients.
- The results showed that WatchPAT can accurately detect overall apnea-hypopnea index (AHI) and effectively differentiate between CSA and OSA, with a sensitivity of 67% and specificity of 100% for diagnosing CSA 2.
Comparison with Polysomnography (PSG)
- The accuracy of home sleep studies in detecting CSA was compared to PSG, which is considered the gold standard for diagnosing sleep apnea 2.
- The study found that WatchPAT had a high correlation with PSG for detecting AHI and CSA, with a correlation coefficient of 0.90 for CSA 2.
- Another study published in 2018 reviewed classification methods to detect sleep apnea using respiratory and oximetry signals, and found that machine learning methods can be effective in detecting sleep apnea, including CSA 3.
Limitations of Home Sleep Studies
- While home sleep studies can be effective in detecting CSA, they may have limitations, such as the need for accurate placement of sensors and the potential for signal interference 4, 5.
- Additionally, home sleep studies may not be able to detect all types of sleep apnea, and may require additional testing or evaluation to confirm a diagnosis 6.