Sleep-disordered breathing affects millions of adults and children, yet many people aren’t sure whether a home sleep apnea test (HSAT) or a full polysomnography (PSG) in a sleep lab is the right choice. Both tests can identify sleep apnea, sleep dysfunction, and related breathing problems—but they differ in scope, accuracy, cost, and clinical usefulness.

For patients beginning sleep apnea treatment, exploring snoring solutions, experiencing sleep apnea symptoms in women, or managing complex airway dysfunction, choosing the correct test is essential for diagnosis and long-term outcomes.

What Each Test Measures

Home Sleep Apnea Test (HSAT)

HSAT devices are small, portable monitors used at home.
Most devices measure:

• Breathing effort
  
• Airflow
  
• Oxygen saturation
  
• Heart rate
  
• Snoring
  
• Sleep position

What HSAT does not measure:

• Brain waves (EEG)
  
• Sleep stages
  
• Limb movements
  
• Subtle arousals
  
• Detailed cardiac data

This limitation is why HSAT is best for straightforward cases of suspected obstructive sleep apnea treatment rather than other forms of sleep dysfunction.

In-Lab Polysomnography (PSG)

Polysomnography is the gold standard. It measures:

• EEG (brain waves)
  
• EOG (eye movements)
  
• EMG (muscle tone)
  
• Airflow and respiratory effort
  
• Oxygen levels
  
• Heart rhythm
  
• Limb movements
  
• Arousals and microarousals
  
• Body position
  
• Sound and video monitoring

PSG detects OSA, UARS, periodic limb movement disorders, parasomnias, REM-related breathing problems, bruxism teeth grinding, and nighttime events associated with TMJ dysfunction, anxiety and chest pain, or chronic nasal congestion.

Who Is a Candidate for HSAT?

HSAT is typically recommended for adults with:

• High likelihood of moderate to severe obstructive sleep apnea
  
• Classic symptoms such as snoring, witnessed apneas, and daytime fatigue
  
• No major comorbidities
  
• No significant insomnia or complex sleep patterns

HSAT may be reasonable for individuals with:

• Symptoms of UARS (though with limitations, discussed below)
  
• Sleep apnea symptoms in women
  
• Mouth breathing treatment needs
  
• Bruxism therapy concerns
  
• Airway dysfunction evaluation

Not ideal for:

• Children
  
• Patients with neuromuscular conditions
  
• Significant cardiopulmonary disease
  
• Severe insomnia
  
• Suspected parasomnias or REM disorders
  
• Pharyngeal dysphagia treatment cases requiring broader evaluation
  
• Eustachian tube dysfunction symptoms linked with positional sleep disruption
  
• Individuals with complex TMJ therapy needs where jaw position may influence breathing

Patients with coexisting issues—such as temporomandibular joint dysfunction, chronic nasal congestion treatment needs, dysphagia therapy needs, or persistent chest pain when breathing—often benefit more from the detailed view provided by PSG.

When an In-Lab Study Is the Better Choice

Polysomnography dominates in accuracy when:

• HSAT results are negative but symptoms persist
  
• UARS therapy or UARS diagnosis is being considered
  
• ADHD symptoms or cognitive complaints may be linked to fragmented sleep
  
• There is concern for central sleep apnea
  
• The patient has chronic cough and chest congestion
  
• Chest pain after eating or GERD may be interacting with airway narrowing
  
• Bruxism, grinding or clenching teeth, or TMJ dysfunction treatment is part of the clinical picture
  
• A child needs evaluation
  
• CPAP titration is required
  
• Oral appliance titration requires precise monitoring

PSG also helps identify multiple contributors to sleep dysfunction, including airway obstruction, limb movements, anxiety-related arousals, or chronic congestion.

Costs and Logistics

HSAT

• Cost: Typically lower than polysomnography
  
• Setting: Patient’s home
  
• Setup: Pick up or receive device; instruction is simple
  
• Comfort: High—no wires beyond the essentials
  
• Turnaround: Results often within a few days
  
• Insurance: Usually requires an order and may require specific symptoms for approval
  See: /insurance

In-Lab Polysomnography

• Cost: Higher due to facility, technicians, and comprehensive monitoring
  
• Setting: Sleep center
  
• Setup: Sensors placed by trained staff
  
• Comfort: More wires, but necessary for accuracy
  
• Turnaround: 1–2 weeks depending on interpretation
  
• Insurance: Commonly covered for appropriate medical indications

Many patients begin with HSAT for convenience and cost, then follow with PSG if results are inconclusive, if symptoms persist, or if sleep apnea therapy planning requires deeper data.

Understanding Your Results

HSAT Results

HSAT reports typically include:

• Respiratory event index (REI)
  
• Oxygen desaturation patterns
  
• Snoring intensity
  
• Positional effects

HSAT cannot detect microarousals, sleep fragmentation, or airflow limitations characteristic of UARS treatment needs.

PSG Results

Polysomnography provides:

• Sleep stages and architecture
  
• Apnea-hypopnea index (AHI)
  
• Arousal index
  
• Limb movement metrics
  
• EEG-based markers of sleep quality
  
• Bruxism episodes
  
• Possible TMJ and eustachian tube dysfunction triggers
  
• Chest discomfort patterns that appear during sleep
  
• Comprehensive airflow and respiratory effort data

PSG data drives detailed and individualized treatment plans including CPAP, oral appliance therapy, myofunctional therapy, dysphagia treatment, TMJ dysfunction treatment, or combined airway care.

FAQ

Can an HSAT miss UARS?

Yes. HSAT does not capture the subtle respiratory effort–related arousals that define UARS. If symptoms of UARS persist—fatigue, unrefreshing sleep, morning headaches, ADHD symptoms, anxiety, chronic nasal congestion—PSG is indicated.

Do I need an order for HSAT?

In most cases, yes. HSAT requires a medical order to ensure proper testing indications and insurance coverage.
See: /services/sleep-apnea-therapy and /insurance

How fast are results?

Results for HSAT often return within 2–5 business days. In-lab PSG reports may take 1–2 weeks depending on physician review and scoring complexity.

Integrated Care at BreatheWorks

Because sleep-disordered breathing rarely occurs in isolation, many patients also benefit from:

• Myofunctional therapy
  
• Breathing treatment
  
• TMJ dysfunction treatment and temporomandibular joint dysfunction therapies
  
• Dysphagia therapy
  
• Speech and language pathology solutions
  
• Airway therapy for chronic nasal congestion, mouth breathing, and snoring solutions
  
• ADHD therapy support for sleep-related cognitive impacts

To learn more or begin your evaluation:

• Sleep Apnea Therapy – /services/sleep-apnea-therapy
• Insurance Information – /insurance