Portable Devices for Diagnosis of Sleep-Disordered Breathing

Key Messages

What Is the Issue?

• Sleep-disordered breathing (SDB) includes a range of conditions that make it difficult to breathe while sleeping and can lead to heart failure, neurodegenerative diseases, cognitive impairment, and poor quality of life. Many people in Canada have obstructive sleep apnea (OSA), a type of SDB, but they often remain undiagnosed.
• The gold standard for diagnosing SDB is polysomnography (PSG), which is referred to as a level 1 test. PSG is conducted in a sleep laboratory and attended by a sleep technician. Because access to this test can vary, is often limited geographically, and can have long wait times, portable devices for diagnosing SDB have emerged for use at home and may help speed up diagnosis and access to treatment.
• Provincial decision-makers requested this report to assess the evidence available on using portable devices for diagnosing SDB. The findings will inform whether results from these devices can be used with confidence as an alternative to PSG.

What Did We Do?

• We conducted a rapid review to identify and summarize evidence that compared the diagnostic accuracy and clinical utility of these devices as well as evidence-based guidelines published in the past 5 years. Two clinical experts reviewed the report, and 1 expert identified devices to supplement the literature available. We conducted a horizon scan to identify any new devices emerging in the field.

What Did We Find?

• A total of 92 portable sleep devices were identified. Ten systematic reviews were identified that examined the diagnostic accuracy or clinical utility of more than 60 portable diagnostic sleep tests compared to those of PSG. Five guidelines with recommendations for adults or people who are pregnant were identified, of which 1 guideline reported on 6 specific portable diagnostic sleep devices. An expert identified an additional 26 devices to consider. A Canadian guideline on the diagnosis of OSA in children was published in 2026 while this report was being written, and relevant information from that guideline has been included in this report.
• Sleep diagnostic devices have traditionally been categorized using levels. Unlike PSG studies, tests using devices categorized as level 2, 3, or 4 are unattended by a technician. Level 3 devices usually have at least 3 channels that measure airflow, respiratory effort, and oximetry. Airflow-based measurement is considered necessary to inform diagnosis. Level 4 devices usually have 1 channel measuring blood oxygen saturation and are not generally used for diagnostic purposes. Some emerging or novel devices fall outside these levels.
• Of the 92 devices identified in this report, 25 were identified as having active licensing from Health Canada and are currently being manufactured. Current evidence was identified for 6 of these devices.
• For adults suspected of having OSA, level 3 devices and some wearables (e.g., WatchPAT devices) were generally reported in systematic review evidence as having adequate sensitivity, while level 4 devices tended to have varying sensitivity and specificity. There was less evidence for other devices (e.g., noncontact systems, smartphone-based tools); generally, the evidence reported adequate sensitivity, but specificity varied by factors such as OSA severity and device type.
• For adults, guidelines recommend level 3 sleep tests for adults with a high pretest probability for moderate to severe OSA and who do not have complicated comorbidities such as chronic obstructive pulmonary disease; heart failure; neuromuscular conditions; and physical, sensory, and cognitive impairment. The AcuPebble SA100, Sunrise, WatchPAT 300, and WatchPAT ONE are 4 specific devices recommended for assessing people aged older than 16 years; the WatchPAT 300 device is licensed for sale in Canada.
• There are several evidence gaps regarding the use of portable devices for the diagnosis of SDB in specific populations. Yet, for people who are pregnant, guidelines state that home sleep apnea testing, but not overnight pulse oximetry, can be considered, and for children aged between 6 and 17 years without significant comorbidities, a Canadian guideline published in 2026 recommends PSG to diagnose OSA. It also recommends that overnight oximetry (level 4 testing) should not be used.

What Does This Mean?

• Some portable sleep devices can be considered for the diagnosis of adults suspected of having moderate to severe OSA who do not have comorbidities.
• Portable sleep devices are generally not recommended for those who have complicated comorbidities. It is also unclear whether these devices work for people of all genders and/or sexes or for people with darker skin tones given that pulse oximetry cannot accurately measure oxygen saturation in melanated skin.
• Careful consideration should be given to the following points regarding the use of portable sleep devices to diagnose SDB: the patient’s potential SDB severity and the presence of comorbidities; the number of channels the device measures; whether the device uses airflow or indirect measurements potentially generated by artificial intelligence; the accessibility and cost of the device; the security of the patient sleep data collected; whether devices and software are regularly updated or out of use; and the training or education required to support patients administering tests at home and to interpret sleep test results.