TOPLINE:

Autoscoring home sleep apnoea testing (aHSAT) in primary care centres showed high specificity for diagnosing severe obstructive sleep apnoea (OSA) in patients at high risk, effectively supporting diagnosis without specialist intervention. Over 96% of severe cases were confirmed by specialists; however, mild-to-moderate cases often still required polysomnography (PSG).

METHODOLOGY:

• Researchers conducted a cross-sectional study at four primary care centres in Girona, Spain, comparing diagnostic approaches: primary care physicians (PCPs) performed aHSAT. whereas hospital sleep specialists used manual home sleep apnoea testing (mHSAT) and PSG as needed.
• They included 329 adults aged 30-70 years (mean age, 56.5 years; 63.8% men), selected between April 2016 and November 2020, with an intermediate or high risk for OSA (≥ 3 points on the STOP-Bang questionnaire).
• Participants installed the ApneaLink Air device — an ambulatory respiratory polygraph — at home, following nurse instructions to manually start and stop the device at bedtime and upon waking, ensuring at least 4 hours of valid data and reported sleep time. PCPs interpreted aHSAT records using the Airview diagnosis platform without involvement from hospital sleep units.
• Sleep specialists performed blinded mHSAT analysis, and participants with a respiratory event index (REI) < 30/h underwent PSG at the hospital.
• OSA was defined as REI ≥ 5/h, with severity thresholds of ≥ 5/h to < 15/h for mild OSA, ≥ 15/h to < 30/h for moderate OSA, and ≥ 30/h for severe OSA; statistical agreement was assessed using Cohen's kappa.

TAKEAWAY:

• Overall, 81.2% of patients were diagnosed with any OSA and 18.8% with no respiratory sleep disturbances in primary care centres, whereas 93.9% of patients were diagnosed with any OSA and 5.5% with no respiratory sleep disturbances by hospital specialists.
• The overall diagnostic agreement between primary care and hospital diagnoses was 41.6%, with the highest agreement for severe OSA at 96.2%, indicating that almost all severe cases identified in primary care were confirmed by hospital specialists.
• For severe OSA, diagnostic concordance was reported as a Kappa index of 0.46 (95% CI, 0.37-0.55), with a sensitivity of 0.42 (95% CI, 0.33-0.51) and a specificity of 0.99 (95% CI, 0.97-1.00).
• Among moderate OSA cases labelled in primary care (n = 73), 86.3% were confirmed as moderate or severe in the hospital, with poor diagnostic concordance (Kappa index, 0.06; 95% CI, -0.05 to 0.16).

IN PRACTICE:

"These results suggest that when aHSAT indicates severe OSA, hospital confirmation may be unnecessary, whereas negative or moderate findings may still require specialist assessment," the authors concluded.

SOURCE:

The study was led by Ramon Orriols and Eric Rojas of the Respiratory Department at Dr Josep Trueta University Hospital and Santa Caterina Hospital, both in Girona, Spain. It was published online on February 28, 2026, in npj Primary Care Respiratory Medicine.

LIMITATIONS:

Only individuals aged 30-70-years were included, limiting the generalizability of the findings. Differences in test results could have reflected differences in device algorithms and nightly variability. Errors in autoscoring invalidated some valid recordings upon manual review. PSG was not performed for all participants. 

DISCLOSURES:

No specific funding was received for this study. Authors declared having no financial or non-financial competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.