Sleep and Breathing

, Volume 22, Issue 3, pp 593–611 | Cite as

Diagnostic accuracy of level IV portable sleep monitors versus polysomnography for obstructive sleep apnea: a systematic review and meta-analysis

  • Lusine AbrahamyanEmail author
  • Yeva Sahakyan
  • Suzanne Chung
  • Petros Pechlivanoglou
  • Joanna Bielecki
  • Steven M. Carcone
  • Valeria E. Rac
  • Michael Fitzpatrick
  • Murray Krahn



Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. In-laboratory, overnight type I polysomnography (PSG) is the current “gold standard” for diagnosing OSA. Home sleep apnea testing (HSAT) using portable monitors (PMs) is an alternative testing method offering better comfort and lower costs. We aimed to systematically review the evidence on diagnostic ability of type IV PMs compared to PSG in diagnosing OSA.


Participants: patients ≥16 years old with symptoms suggestive of OSA;intervention: type IV PMs (devices with < 2 respiratory channels); comparator: in-laboratory PSG; outcomes: diagnostic accuracy measures;studies: cross-sectional, prospective observational/experimental/quasi-experimental studies; information sources: MEDLINE and Cochrane Library from January 1, 2010 to May 10, 2016. All stages of review were conducted independently by two investigators.


We screened 6054 abstracts and 117 full-text articles to select 24 full-text articles for final review. These 24 studies enrolled a total of 2068 patients with suspected OSA and evaluated 10 different PMs with one to six channels. Only seven (29%) studies tested PMs in the home setting. The mean difference (bias) between PSG-measured and PM-measured apnea-hypopnea index (AHI) ranged from − 14.8 to 10.6 events/h. At AHI ≥ 5 events/h, the sensitivity of type IV PMs ranged from 67.5–100% and specificity ranged from 25 to 100%.


While current evidence is not very strong for the stand-alone use of level IV PMs in clinical practice, they can potentially widen access to diagnosis and treatment of OSA. Policy recommendations regarding HSAT use should also consider the health and broader social implications of false positive and false negative diagnoses.


Obstructive sleep apnea Home sleep apnea testing Polysomnography Systematic review 



The study team would like to thank Dr. Tetyana Kendzerska for providing her expert opinion in making decisions on selecting the final list of articles for this review.


Compliance with ethical standards

The manuscript does not contain clinical studies or patient data.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

11325_2017_1615_MOESM1_ESM.docx (25 kb)
ESM 1 (DOCX 25kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lusine Abrahamyan
    • 1
    • 2
    Email author
  • Yeva Sahakyan
    • 1
  • Suzanne Chung
    • 1
  • Petros Pechlivanoglou
    • 2
    • 3
  • Joanna Bielecki
    • 1
  • Steven M. Carcone
    • 1
  • Valeria E. Rac
    • 1
    • 2
  • Michael Fitzpatrick
    • 4
  • Murray Krahn
    • 1
    • 2
    • 5
  1. 1.Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
  2. 2.Institute of Health Policy, Management and Evaluation (IHPME)University of TorontoTorontoCanada
  3. 3.Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoCanada
  4. 4.Department of MedicineQueen’s UniversityKingstonCanada
  5. 5.General Internal Medicine, Toronto General HospitalUniversity Health NetworkTorontoCanada

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