Home testing devices could increase the number of people diagnosed with sleep apnoea
Five home-testing devices to diagnose a silent sleep condition harming the health of an estimated 2.5 million adults have been recommended by NICE in draft guidance.
An independent NICE committee has recommended five devices to diagnose and assess the severity of obstructive sleep apnoea hypopnoea syndrome (OSAHS).
Around five per cent of the UK population are believed to live undiagnosed with the condition, which is associated with serious health problems including hypertension, diabetes, stroke and heart disease that can shorten life expectancy.
The new devices recommended by NICE in draft diagnostics guidance can be used at home while sleeping, do not require cannulas inserted into the nose, or formal instructions in hospital to use. They are considered less invasive, more comfortable to wear and easier to use.
Two devices are strapped to the wrist with sensors attached to the finger and chest which measure a number of inputs including heart rate, body movement and position, snoring and chest motion. Another has a wireless sensor attached to the throat to record sound generated from physiological body processes including respiratory and cardiac functions. A fourth device worn as a belt around the waist with a wired sensor on both the chin and forehead to measure jaw movements associated with OSAHS, while a fifth device uses a wireless sensor attached to the finger to detect symptoms using oxygen saturation, body movement and pulse rate.
Some devices require internet and smartphone compatibility, while others don’t, and the data is downloaded after the designated monitoring period. Three of the five recommended devices are reusable.
Currently people are diagnosed with home respiratory polygraphy (RP) as the initial test for OSAHS which involves sleeping with a band around the chest and abdomen to measure movement, a small flow sensor in the nostrils and a blood oxygen monitor (oximetry) on the finger.
If home RP is unavailable, oximetry alone can be used. But oximetry is not considered as sensitive a test for OSAHS diagnosis and may overestimate levels of oxygen in the blood for people with black or brown skin.
The committee noted there would be a large advantage to the home-testing devices if they improved detection of OSAHS for people with brown and black skin compared with currently used tests. However there is no subgroup data based on skin colour or ethnicity in current studies, so requested further research.
Test results using current equipment can be impacted by the person’s discomfort wearing it or if the device apparatus becomes detached in the night, which is less likely with the new devices which have wireless sensors.
Having obstructive sleep apnoea can cause serious health issues which could be managed if diagnosed and treated. Many people don’t even know they have this condition which is why it is important to be able to receive a diagnosis quickly and efficiently.
It is promising that some of the new devices could have the potential to further improve detection of sleep apnoea for people with black or brown skin, but further evidence is needed to show this.
Another added benefit to these new devices includes the fact they are less invasive, more comfortable to wear, and could cut waiting times because they are easier to use, thus speeding up diagnosis and freeing up clinician time.
Following diagnosis, continuous positive airway pressure (CPAP) is considered the most effective treatment. A small machine blows oxygen through tubing to a fitted mask to increase the pressure in the upper airway and preventing collapse. If used nightly, CPAP is very effective at reversing the symptoms of OSAHS.
A consultation on the recommendations has now begun and will run until Wednesday 5 June 2024.