COVER SERIES
Closing the OSA Diagnostic &
MANAGEMENT GAP
How at-home sleep testing addresses the lab bottleneck
By Amir Reuveny
In sleep medicine, almost everything is growing. Awareness is up, driven by wearables that encourage people to take a closer look at their sleep quality. Treatment options are multiplying, with oral appliances, hypoglossal nerve stimulation and pharmacological options entering the market.
What happens in between awareness and treatment—getting a diagnosis—remains a bottleneck, with an estimated 80% of obstructive sleep apnea (OSA) cases in the United States going undetected. This is mostly a structural problem. The in-lab polysomnography (PSG) sleep study remains the diagnostic standard for sleep apnea, but sleep medicine is among the most understaffed specialties in healthcare, and wait times for sleep studies can stretch from weeks to months.
For home medical equipment (HME) providers, it’s a familiar frustration: a large population that needs continuous positive airway pressure (CPAP), and a diagnostic funnel too narrow to reach most of it. Additionally, treatment innovation means long-term monitoring and titration can support more personalized care, but the testing bottleneck limits implementation.
Closing the Gap Starts With Naming It
What makes underdiagnosis on this scale so consequential is what happens when sleep apnea goes unaddressed. Sleep apnea can be related to several serious diseases. Untreated OSA is independently associated with hypertension, heart disease, stroke, Type 2 diabetes, cognitive impairment and mental health conditions. Because its daytime symptoms—exhaustion, moodiness, difficulty concentrating—are easily attributed to ordinary stress or aging, patients and clinicians alike routinely miss sleep apnea, even as it poses major health risks.
The clinical and commercial gaps describe the same problem, viewed from two different angles. CPAP is the first-line therapy for sleep apnea, and it’s effective for patients who are diagnosed, prescribed and supported throughout treatment. But a patient who is never tested can never reach that step, and once a patient begins their treatment, setup is too often the final step without ongoing management.
The Lab Bottleneck
Rising awareness and expanding treatment options push more people toward a diagnosis. The trouble lies in the system those patients encounter when they set out to get answers.
Consider the supply side. The in-lab testing model depends on a strained specialist workforce, with an estimated patient-to-sleep-physician ratio of 43,000:1. Physical labs are also limited by beds, staffing and time. None of these constraints will ease easily or quickly. Training specialists and standing up labs take years. Meanwhile, demand is rising now.
The goal should not be to push patients through a pathway that wasn’t built to scale, but to examine alternatives to the in-lab pathway.
Medicare has expanded coverage for remote physiologic & remote therapeutic monitoring & the 2026 fee schedule adds codes for additional monitoring periods. These changes can support the between-visit management that longitudinal care depends on.
At-Home Testing as the Bridge
The most immediate change that at-home testing can make is in reach. A diagnostic or ongoing management pathway only helps patients who can complete it, and the in-lab model doesn’t always work for people who live far from a sleep center or who can’t take time away from work or family. Bringing the study to the patient removes those obstacles and extends testing to populations that facility-based models can’t always reach.
Reach means little without rigor, of course, but the two don’t counteract the way they once did. Home sleep testing with multi-sensor technology and strong PSG correlation has become a common form of diagnostic sleep study in the U.S., and for appropriate patients, it provides the information needed to diagnose sleep apnea and begin treatment. It also returns results quickly, closing the gap between when symptoms are noticed and when a diagnosis is received—and before a long wait erodes a patient’s resolve.
Of course, none of this displaces the sleep lab. Complex and ambiguous cases still belong in a supervised setting, and clinical judgment still decides who is tested and how. But for many patients with suspected sleep apnea, expanding access to home testing with strong PSG correlation is the most realistic way to convert the undiagnosed into the diagnosed and treated. This may be where the testing journey begins.
The HME Provider’s Role in Longitudinal Care
Due to regulations, HME providers cannot promote diagnostic testing to Medicare patients. However, the at-home sleep testing paradigm creates an opportunity to support long-term patient monitoring post-diagnosis. Sleep apnea care is becoming more continuous, with new treatment approaches creating demand for at-home monitoring that continues well after the initial prescription.
HME providers already stay close to patients through the life of their therapy, and reimbursement is starting to reflect that role. Medicare has expanded coverage for remote physiologic and remote therapeutic monitoring and the 2026 fee schedule adds codes for additional monitoring periods. These changes can support the between-visit management that longitudinal care depends on.
Sleep is closely tied to conditions HME providers and their referral partners already manage, including hypertension and obesity. Ongoing sleep data can inform care well beyond the apnea diagnosis. The same compliance lines apply, particularly around who provides the qualifying test. Within them, the role can extend from delivering a device to supporting care over time.
The Opportunity Ahead
As more people are diagnosed and treated, more will need support and longitudinal care monitoring to ensure optimization and personalization of treatment for each patient. At-home testing and monitoring won’t close the gap on its own, but it widens the path to the patients who need it most. HME providers play a key role in bridging this gap toward better, more holistic patient care.
Amir Reuveny is cofounder and CEO of Wesper, a company advancing accessible at-home sleep apnea testing. He holds a Ph.D. in electrical engineering and information systems from the University of Tokyo and was previously a postdoctoral fellow at Cornell Tech. Visit wesper.co.
Satjawat, Robert Kneschke - adobestock.com
