[UK] At-home sleep study

[InitialConditions]

Has anyone had a recent(ish) at-home sleep study, either on the NHS or arranged privately?

If on the NHS, I am wondering if this is something that usually requires a referral to a sleep clinic or hospital consultant, or whether this can be organised and completed in primary care?

If private, who did you use, and how was it?

 

[josepdelafuente]

I would also be interested in knowing the answers to the same questions!

 

[richie]

I cannot remember the details but home studies can be arranged by GP If a GP says "no" checkk with local clinical investigations unit for their view. However some measurements are only made on in patient overnight basis which , I think , is consultant only.

 

[NelliePledge]

When I asked about this in early years following diagnosis I was told sleep study referrals were only for sleep apnea

 

[Felis Catus]

I don't have any info about the NHS process.

A private doctor wanted me to do a sleep study via HCA Healthcare UK. There were private options where you could just book a sleep study online without a referral but my doctor wanted one via HCA.

When I contacted HCA Healthcare UK, I was told I would have to go to London for an appointment and to collect the equipment for the study. As I wasn't able to travel at all, they eventually found a respiratory consultant in London Bridge Hospital who spoke to me on the phone. They required a referral. They arranged the equipment/sleep study via another private provider. It was shipped to my address and collected by a courier after the use. The sleep study company sent the report to the respiratory consultant who called me again to discuss the results which were normal.

 

[nataliezzz]

The sleep study company sent the report to the respiratory consultant who called me again to discuss the results which were normal.

"Normal" on a sleep study essentially means nothing, it's just telling you that you didn't meet that particular clinic's criteria for obstructive sleep apnea (OSA), which can vary wildly based on equipment (nasal pressure transducers vs. thermocouple/thermistor to measure airflow) and hypopnea scoring guidelines:

*I've stopped placing much importance at all on % patients meeting criteria for OSA in various studies -- unless it is the same research group showing a difference in % meeting OSA criteria between different patient groups (blinded of course). I recently came across a large population-based study from Switzerland (n=2,121) that found using home PSG with nasal pressure transducers that 84% of men and 61% of women (ages 40-85) met criteria for OSA (AHI ≥5) when using the current recommended AASM scoring guidelines for hypopnea. See also Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea, 2015, Franklin et al for highly variable OSA prevalence rates between studies. Various factors likely contribute (beyond geographical population factors like obesity rates, craniofacial anatomy differences, etc.) including use of thermistors (less sensitive measure of airflow) vs. nasal pressure transducers (most clinics should probably be using pressure transducers by now) and use of different hypopnea criteria (to see an example of how different hypopnea criteria can dramatically affect OSA diagnosis rates, see this study).

Anyways, apneas and hypopneas are not actually the cause of fatigue in sleep-disordered breathing patients (I do think desaturation events and associated arousals drive objective daytime sleepiness -- how quickly one actually falls asleep given a nap opportunity -- but I won't get into the details of that because it's a bit complicated/probably not relevant to most people here):

The Inadequacy of the Apnea-Hypopnea Index (AHI): The AHI, which measures complete and partial cessations of breathing, correlates poorly with symptoms like fatigue and sleepiness (1, 2). This is underscored by the fact that over 50% of individuals with obstructive sleep apnea (OSA, AHI ≥5) are asymptomatic. If apneas, hypopneas, and the resulting arousals were the primary cause of symptoms, a much stronger correlation would be expected.

The Central Role of Inspiratory Flow Limitation (IFL): The theory proposes that the crucial pathological event is not apnea but IFL — the subtle, often inaudible "fluttering" of the upper airway during inhalation. This includes snoring but also non-audible fluttering. Large-scale epidemiological data supports this: snoring (a proxy for IFL) — not AHI — is the factor most strongly associated with subjective excessive daytime sleepiness* Two large sample size studies showed that increased IFL was independently associated with subjective excessive daytime sleepiness* and psychomotor vigilance task lapses, even after controlling for AHI, arousals, and other factors. However, IFL alone is not enough to cause symptoms; one study comparing UARS patients to rigorously screened healthy matched controls found that even controls with no medical conditions, fatigue, or pain can have high levels of IFL.

*A recent study identified that the Epworth Sleepiness Scale - which is used to assess daytime sleepiness - actually measures an uninterpretable mix of objective sleepiness and fatigue (which are uncorrelated symptoms in OSA patients).

Honestly, the UK does not seem like a great place to be if you are trying to get diagnosed/treated for sleep-disordered breathing that doesn't meet criteria for OSA. You can call around to sleep centers near you and ask what hypopnea scoring criteria they use though, and if they score respiratory effort-related arousals (RERAs), which would give you a better chance of being diagnosed/treated for sleep-disordered breathing, even though RERAs have never been shown to correlate with symptoms and likely play little to no role in causing symptoms. According to this list nowhere in the UK scores RERAs -- not sure if it's up to date though:


The only sleep specialist in the UK I am aware of that is "UARS aware" (i.e. aware of the fact that milder sleep-disordered breathing that does not meet criteria for OSA can cause a ton of problems) is Vik Veer, ENT:

Professor Vik Veer — Consultant ENT & Sleep Surgeon

The UK's leading sleep surgery practice. Expert care for snoring, sleep apnoea, ear, nose and throat conditions.

www.consultant-surgeon.co.uk

 

[Mij]

I went to the hospital 20 years ago for a sleep study and it was a complete waste of my energy. My insomnia problem was the inability to initiate sleep, the techs waited patiently behind the scenes for me to fall asleep, they came into my room and told me to "try harder" when I wasn't able to fall asleep by 3a.m.

I was kicked out at 5 a.m, and my doctor never received the report.