Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: AASM Guideline

Diagnostic testing for OSA includes in-lab polysomnography (PSG) and home sleep apnea testing (HSAT). This guideline clarifies when each is appropriate.

Evidence-based guideline using GRADE methodology.

Key recommendations: (1) PSG or HSAT acceptable for uncomplicated suspected OSA; (2) PSG preferred if: complex medical/psychiatric comorbidities, suspected non-OSA sleep disorder, prior HSAT negative but high suspicion; (3) HSAT not recommended for: heart failure, COPD, hypoventilation, neuromuscular disease; (4) AHI ≥15 or AHI ≥5 with symptoms = OSA.

Know when to use PSG vs HSAT. HSAT is appropriate for uncomplicated OSA. PSG is required for complex patients, suspected central sleep apnea, or hypoventilation syndromes. AHI thresholds: mild 5–14, moderate 15–29, severe ≥30.

Guideline — evidence quality varies. HSAT technology continues to evolve.