Two Home Sleep Tests, Zero Data, and Still No Diagnosis

What an illustrative patient example shows about where home sleep testing can break down, and what the research says about how often it happens.

Key facts

• In published studies, 12% to 13.5% of home sleep tests were non-diagnostic or inconclusive.³˒⁴
• In one hospital study, 74.8% of patients with an inconclusive home test did not complete follow-up testing within six months. Of those who did, 57% had moderate-to-severe OSA.⁴
• One night of testing misclassified severity for about 20% of patients with mild-to-moderate sleep apnea in a study of 10,340 adults.⁶
• A sleep center that automatically repeated any study missing critical signals reported no failed home tests across 145 studies in one month.⁸

An illustrative patient example

This example is based on an anonymous patient account and is illustrative, not a literal record.

A patient’s physician suspected obstructive sleep apnea and ordered a home sleep test. It was supposed to be the quick, convenient way to get an answer.

She drove to her local sleep center to pick up the device, wore it overnight, and drove back to return it. A few days later, the clinic told her the test had recorded no usable data.

So she started over. She scheduled a new appointment, made another drive, picked up a second device, tested again and returned it. This time nobody mentioned a problem, and she assumed it had worked. When she arrived for her results appointment, she learned the second test had failed too.

After two failed home tests, the clinic scheduled an in-lab sleep study. That appointment was later canceled. In all, she made five trips to the clinic and spent two nights testing, and after weeks of waiting she still does not have a diagnosis.

Her experience is more common than most people expect. The research shows that failed home tests happen regularly, and that the steps after a failed test are where many patients stop.

How many people have undiagnosed sleep apnea

An estimated 83.7 million U.S. adults have obstructive sleep apnea, and about 80% of them have not been diagnosed.¹

An analysis commissioned by the American Academy of Sleep Medicine estimated that undiagnosed OSA costs the U.S. $149.6 billion per year, including $86.9 billion in lost productivity and $26.2 billion in motor vehicle accidents.²

Home sleep testing helps close that gap by making testing easier to reach, and for many patients it works well. When a home test fails, though, the patient has spent time and effort and still has no answer.

How often home sleep tests fail

A meaningful share of home sleep tests come back technically inadequate or inconclusive:

• At the Oklahoma City VA Medical Center, 52 of 454 home sleep tests (12%) were technically inadequate. The most common causes were pulse oximeter failure, insufficient recording time and airflow channel failure.³
• At a tertiary hospital sleep service in Singapore, 139 of 1,029 patients (13.5%) had an inconclusive home sleep test.⁴

For a clinic running a few hundred home tests a month, that works out to dozens of patients each month who need to test again.

What happens after a failed home sleep test

For many patients, a failed test is where the path to a diagnosis stops.

• In the VA study, 31 of the 52 patients with a failed test (60%) completed a second home test, and 65% of those repeat tests were usable. Of the 52 patients whose first test failed, about 20 got a usable result from the retest.³
• In the Singapore study, 74.8% of patients with an inconclusive home test did not complete follow-up testing within six months. Among the 35 patients who did, 20 (57%) had moderate-to-severe OSA.⁴
• Across six AASM-accredited U.S. sleep centers, 14.8% of patients with a negative home sleep test in 2019 had completed the recommended follow-up in-lab study by the end of 2021.⁵

The patients who drop out after a failed or inconclusive test include many with significant, untreated sleep apnea.

Why one night of testing may not be enough

Even when a single-night test records well, the result can be off. Sleep apnea severity changes from night to night, with factors like sleep position and how well someone sleeps with sensors on.

• A study of 10,340 adults tested over three consecutive nights found that about 20% of patients with mild-to-moderate sleep apnea would have been placed in the wrong severity category based on one night alone.⁶
• A study that followed 67,278 people for an average of about 170 nights each found that the chance of misdiagnosis from a single night ranged from about 20% to 50%.⁷

What helps patients finish testing

The same research points to what works. The Vanderbilt Sleep Disorders Center reported that all 145 home sleep tests completed in January 2024 were adequate. The authors credit a policy of automatically repeating a study whenever critical signals, such as pulse oximetry, were missing or badly compromised.⁸

In the Singapore study, patients who had been counseled about the need for repeat testing were about three times as likely to complete it (odds ratio 3.09).⁴

Where this patient’s process slowed down

The patient did everything she was asked to do. A few parts of the process made each failure harder to recover from:

• Every step needed a trip. Pickup and return happened in person, so each failed test meant more drives and more time off work.
• Failures showed up late. Nobody knew a study had failed until the device came back and someone reviewed it. The second time, she found out at her results appointment.
• One night carried the whole test. A single bad night meant starting the cycle over.
• Each retry added time. Every attempt added days or weeks, and the research shows that is when patients drop off.

How Wesper helps patients get to an answer

Wesper manages the sleep testing workflow end to end, so each step is built around getting the patient to a result:

• Direct-to-patient shipping. Devices ship to the patient’s home with return shipping included, so there are no pickup or drop-off trips.
• Cloud uploads. Study data uploads to the Wesper portal, so the care team can review it without waiting for the device to come back.
• Session feedback. Patients and clinics can see whether a session recorded.
• Multi-night testing comes standard. One difficult night doesn’t decide the study, and clinicians see a fuller picture of how the patient sleeps.
• Early notice when a retest is needed. If a patient needs to try again, the care team finds out in time to act.
• Automated patient communication and 24/7 support. Reminders, prep, check-ins and follow-up help patients complete each step.

Wesper has a 99% patient success rate (internal data, on file) and 96% AHI correlation to PSG, across two levels of testing, Wesper Lab and Wesper Lite, on one workflow.

Frequently asked questions

How often do home sleep tests fail?

In published studies, 12% to 13.5% of home sleep tests were non-diagnostic or inconclusive. The most common technical causes were pulse oximeter signal loss, too little recording time and airflow sensor failure.

What happens if my home sleep test doesn’t record enough data?

Your care team will usually order a repeat home test or an in-lab sleep study. Research shows many patients never complete that follow-up, so it helps to schedule the retest as soon as you hear about the problem.

Is one night of home sleep testing enough?

For many patients one night gives a clear answer. Sleep apnea severity varies from night to night, though, and one large study found a single night placed about 1 in 5 patients with mild-to-moderate sleep apnea in the wrong severity category. Testing over multiple nights gives clinicians more data.

Why do patients not finish repeat sleep testing?

Studies point to no-shows, refusals and the time a retest takes. Patients who were counseled about the need for repeat testing were about three times as likely to complete it.

How does Wesper reduce failed home sleep tests?

Wesper ships devices directly to patients, uploads study data to the cloud, shows whether a session recorded, tests over multiple nights as standard and lets the care team know quickly when a retest is needed. Wesper reports a 99% patient success rate (internal data, on file).

What’s next

Home sleep testing should be the easy part of getting diagnosed. If your clinic wants fewer repeat studies and more patients reaching a diagnosis, see how Wesper works, review our validation data, or book a demo. For more on night-to-night variability, read Unveiling the surprising variability in home testing for sleep apnea.

Sources

1. Sönmez I, Vo Dupuy A, Yu KS, Cronin J, Yee J, Azarbarzin A. Unmasking obstructive sleep apnea: Estimated prevalence and impact in the United States. Respiratory Medicine. 2025. sciencedirect.com
2. American Academy of Sleep Medicine / Frost & Sullivan. Hidden Health Crisis Costing America Billions. 2016. aasm.org
3. Mahmood T, Bauer C, Jones K, Doshi V. Repeat Home Sleep Apnea Testing (HST) for Technically Inadequate Initial HST. SLEEP. 2018;41(Suppl 1):A182, Abstract 0484. academic.oup.com
4. Sim MJH, Poh Y, Wong HS, Mok Y. Failure to complete diagnostic testing in patients with suspected obstructive sleep apnoea and inconclusive home sleep apnoea test. Sleep and Breathing. 2025. link.springer.com
5. Nygate Y, et al. Polysomnography following an indeterminate HSAT: Low Compliance with AASM Guidelines. SLEEP. 2022;45(Suppl 1):A166, Abstract 0370. academic.oup.com
6. Punjabi NM, Patil S, Crainiceanu C, Aurora RN. Variability and Misclassification of Sleep Apnea Severity Based on Multi-Night Testing. CHEST. 2020. pure.johnshopkins.edu
7. Lechat B, et al. Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care Medicine. 2022. researchnow.flinders.edu.au
8. Motes A, Upender R. Home sleep apnea testing failure rate and its causes at Vanderbilt Sleep Disorders Center. The Southwest Journal of Medicine. 2025. pulmonarychronicles.com

The patient example in this article is based on an anonymous account and is illustrative, not a literal record of one patient’s care.