Sleep Diagnostics and Monitoring Technology in Obstructive Sleep Apnea

This article helps neurologists understand modern approaches to diagnosing obstructive sleep apnea, including the clinical role and limitations of home sleep apnea testing, and learn how they can integrate wearable and noncontact technologies into patient care to improve diagnostic efficiency, monitor treatment, and reduce health disparities.

Advances in home sleep apnea testing have expanded beyond traditional type III monitors to include wearable devices such as wrist sensors and smart rings and noncontact "nearable" systems that use radar or acoustic signals. Since 2019, the US Food and Drug Administration (FDA) has cleared numerous software-as-a-medical-device platforms that leverage artificial intelligence and multisignal integration to estimate sleep parameters. These tools improve accessibility, particularly for patients who are unable or unwilling to undergo in-laboratory polysomnography. However, awareness of racial bias in pulse oximetry, regulatory gaps, variable accuracy, and privacy concerns highlight the need for further validation to ensure equitable and reliable clinical use.

Obstructive sleep apnea is common and underdiagnosed, particularly in patients with neurologic conditions. In-laboratory polysomnography remains the gold standard for the diagnosis of obstructive sleep apnea but is limited by cost and access, whereas home sleep apnea testing offers a validated alternative for appropriate patients. Wearable and nearable technologies expand diagnostic options, improving usability and scalability, although their accuracy and validation vary. Neurologists play a key role in identifying patients at high risk, selecting the appropriate test, and interpreting results with awareness of limitations such as pulse oximetry bias. Consumer devices can raise awareness but should not replace clinical evaluation, and modern continuous positive airway pressure (CPAP) platforms enhance remote monitoring and management.