Video Instruction Just as Effective as In-person for OSA Test, Study Finds

A randomized, double-blind study found that there was no difference in the recording quality of a home sleep apnea test between patients given in-person instruction vs video instruction, which is an important step in telemedicine diagnosis of obstructive sleep apnea (OSA).

A study published in the Journal of Clinical Sleep Medicine found that patients receiving in-person instruction on using their home sleep apnea test (HSAT) had similar recording quality to patients receiving video instruction when comparing the quality of at-home sleep study recordings.

The study consisted of patients aged 18 to 70 years who were referred to Landspitali University Hospital in Iceland for an HSAT because of suspected obstructive sleep apnea (OSA). All participants were assigned to video or in-person instructions at random.

The group receiving in-person instruction were taught how to hook up the HSAT device by a sleep technologist. The group receiving video instructions was given a link to an online instructional video to watch at home. All participants were given a Nox T3 device that they hooked up by themselves each night. All participants were also offered the help of a sleep technologist through a phone call if needed.

All data was assessed by an expert sleep technologist who was blinded to the study group of participants. Total recording time of the sleep study was determined as the time when the participant fell asleep for the first time to when he or she work up for the last time. There were periods where the participant was awake while recording that were not counted toward the index time for respiratory event index. Artifacts were detected in the signals of 4 sensors (pulse oximeter, nasal cannula, thorax, and abdomen respiratory inductance plethysmography [RIP] belts).

There were 100 participants in this study with 97 valid recordings of sleep. Most patients were middle-aged (mean [SD] age, 50.5 [10.3] years in the in-person group; 48.4 [11.5] years in the video group), overweight to obese (mean [SD] BMI, 29.6 [5.9] in the in-person group; 30.8 [6.3] years in the video group) and male (77.6% in the in-person group, 64.7% in the video group).

The recordings of the 4 sensors (pulse oximeter, nasal cannula, thorax and abdomen RIP belts) were high quality for both groups on average. More than 90% of the recording durations were artifact free. Greater than half of the recordings in both groups were artifact-free for the RIP belts and nasal cannula (median quality: 100%) and nearly so for the pulse oximeter (median quality: > 99%).

Distribution of sensor qualities and outliers was similar in both groups, including the nasal cannula, whose recording quality was noticeably worse than the other 3 sensors on average.

There were some limitations to this study. The study participants were middle-aged, overweight to obese and two-thirds were male, which is not representative of the general population but representative of the average patient with OSA. The sample size of 100 participants is not large and the study is limited to a specific set of circumstances, which limits its generalizability. The study might not be powered to detect minor differences in groups.

The researchers concluded that video instruction in hooking up a HSAT is a viable option for patients looking to receive a diagnosis of OSA. The authors wrote that this could help patients who live in rural or remote areas receive treatment easily and could save health care personnel valuable time.


Horne AF, Olafsdottir KA, Arnardottir ES. In-person versus video hookup instructions: a comparison of home sleep apnea testing quality. J Clin Sleep Med. Published online May 5, 2022. doi:10.5664.jcsm.10084

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