Dr Freedman1 has accurately and effectively described the basis of the switch to use of home testing in the United States. I agree that for subjects with high pretest probabilities of OSA without other major issues, home testing is appropriate provided that subsequent management of therapy is by trained providers.
A test, however, does not by itself lead to “better outcomes.” What matters is management of the problem once the diagnosis is made. Moreover, what are the outcomes we seek to influence? Is it improved quality of life?2 Is it reduced crash risk?3 Is it improvement in BP?4,5 Is it reduced long-term health-care costs?6 Studies have shown that effective treatment of OSA can influence all of these outcomes.2-6