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ACCESS-OSA: a randomized controlled trial for accurate, accessible, and cost-effective screening solutions for
Jack Manners1, Maddy Roch1, Lucia Pinilla1
1Flinders Health and Medical Research Institute: Sleep Health, Flinders University, Bedford Park, SA, Australia.
Sleep Advances : a Journal of the Sleep Research Society
|March 30, 2026
Summary
New multi-night home testing for obstructive sleep apnoea (OSA) may improve diagnostic accuracy and cost-effectiveness compared to traditional single-night polysomnography (PSG). This study evaluates these emerging technologies for routine care.
Area of Science:
- Sleep Medicine
- Diagnostic Technologies
- Health Economics
Background:
- Obstructive sleep apnoea (OSA) diagnosis relies on costly, single-night polysomnography (PSG) that may misclassify patients due to night-to-night variability.
- Emerging multi-night, in-home diagnostic devices offer potential for improved accuracy and accessibility, but require comparative evidence.
Purpose of the Study:
- To evaluate the diagnostic accuracy and cost-effectiveness of three multi-night in-home devices against single-night PSG for OSA diagnosis.
- To identify patient and signal characteristics that optimize diagnostic performance of home-based testing.
- To assess the clinical implementation feasibility of these novel diagnostic pathways.
Main Methods:
- A three-arm randomized diagnostic strategy trial involving 500 adults with suspected OSA.
- Participants will undergo both single-night PSG and multi-night assessment using an under-mattress sensor, oximetry ring, and forehead EEG device.
- Randomization to different interpretation pathways, with sequential diagnostic decisions and a blinded expert panel for consensus diagnosis.
Main Results:
- The primary outcome is the diagnostic accuracy of each multi-night pathway compared to the consensus diagnosis.
- Secondary outcomes include cost-effectiveness, patient acceptability, clinical confidence, and long-term health and quality of life.
- Analysis will determine if simplified, accessible multi-night testing enhances OSA diagnosis in routine care.
Conclusions:
- This study aims to provide definitive evidence on the utility of multi-night home testing for obstructive sleep apnoea.
- Findings will guide the adoption of more accurate, cost-effective, and patient-centered diagnostic strategies for OSA.
- The research will inform clinical practice and healthcare policy regarding sleep disorder diagnosis.
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