Dr Gay’s1 first and foremost argument in favor of allowing physicians without board certification in sleep medicine to prescribe CPAP on the basis of the home sleep testing (HST) is the potential cost savings. That would be a cogent argument if the cost-benefit ratio of HST with interpretation and clinical decision-making by a non-board-certified physician was sufficiently superior to laboratory polysomnography (PSG) interpreted by a sleep specialist. However, HST subjected to cost-benefit analysis may not represent the best value even in expert hands. Economic modeling demonstrated that laboratory PSG, rather than HST, provided the most cost-effective strategy for diagnosing moderate to severe OSA, largely due to frequent false-negative HST results.2 Moreover, the literature suggests that utilizing HST in a community setting requires significant expertise in data collection and scoring, with careful overreading by an adequately trained physician. For instance, the Sleep Heart Health Study used highly trained technologists for scoring and rigorous quality control to demonstrate intraclass correlations > 0.90.3 In contrast, Collop4 reported on variability in identifying respiratory events by technologists in nine different sleep laboratories scoring 11 identical PSG recordings. Apnea-hypopnea indices varied significantly, and wide disparities in interpretation and management would have resulted. For one particular recording, apnea-hypopnea indices from different scorers ranged from supporting the presence of severe OSA to no disease at all. Clearly, overreading by a well-trained interpreting physician is important, even assuming scoring of HSTs by highly trained technologists.