Is Single-Night Home Sleep Testing Failing Your Patients? Multi-Night Testing is the Solution

Multi-night home sleep testing with EnsoSleep PPG™ boosts diagnostic accuracy, reduces hardware costs, and results in better patient outcomes 

Stop us if you’ve heard this statistic before, but more than 54 million Americans are estimated to have mild, moderate, or severe obstructive sleep apnea (OSA), with more than 20 million suffering with an AHI > 15.¹ 

Yet, an estimated 80% remain undiagnosed.² Why?! 

This is a massive public health crisis with broad implications for patient health, provider workflows, and health system costs. One of the clearest pathways to closing the diagnosis gap is also one of the simplest: testing patients from the comfort of their own home with affordable, patient-friendly devices AND across multiple nights to remove the variability of single night testing.

Why Isn’t Single-Night Home Testing Enough?

OSA is not always a binary condition. Single-night HSATs misclassify up to 10% of patients when compared to a three-night study.³ This is because OSA burden is variable night to night: AHI can vary as much as 20% night-to-night, caused by factors like varying sleeping positions, sleep stage distribution, alcohol consumption, and medication use.⁴ 

Research published and presented at the SLEEP 2025 conference highlighted that relying on just a single night of testing can lead to missed diagnoses in more than 1 in 10 patients and that more than 1 in 4 patients experience a jump in OSA severity by at least one category on subsequent nights.⁵ This aligns with other research findings that demonstrated the importance of how the multi-night testing is approached, highlighting a 30% misclassification in night-to-night analysis when using peripheral arterial tonometry.⁶ 

When one night of home testing can result in such variability, is single-night home sleep testing really a viable solution? Have we been doing it all wrong because of the limitations of past home sleep testing technologies? 

For patients with mild or borderline moderate OSA, having only one night of testing might be the difference between receiving the timely, life-changing care that they need or simply being missed and lost in the shuffle.

Patients deserve the best. One night of testing simply is not cutting it. 

Why Do Legacy Disposable HSAT Devices Fall Short? 

When considering the importance of multi-night testing, you must also consider the form factors that are deployed for home testing. Many legacy devices require additional disposable parts with each test, limiting the testing window to a single night. 

Additionally, legacy-based, disposable-laden form factors are prone to false negatives, can’t assess fluctuating OSA severity across nights, and result in wasted resources. When a test is inconclusive, providers must either ship out a new device or patients must come back into the clinic to get one, significantly delaying care and increasing overall costs for both sides. And let’s face it, while it’s not at the top of the list of downsides, disposable parts in legacy devices also contribute to the growing waste problem in the world. 

On the other hand, there are many new PPG-based devices that are fully reusable and are far less expensive. For example, Viatom’s CheckMe O2 Max ($115) and Oxyfit ($64), and BodiMetrics’ circul Pro, ($174.50) are significantly more affordable. 

When paired with EnsoSleep PPG, these simple PPG-based rings and watches can provide a more sustainable, cost-effective, and clinically meaningful solution, both for diagnostic testing and for long-term remote physiological monitoring. In fact, studies have shown that multi-night data collection increased diagnostic confidence in longitudinal multi-night sleep monitoring and clinician agreement for CPAP therapy, particularly in borderline cases.⁷

But even with research-backed, financially savvy, and clinically viable solutions, we still hear providers who use traditional legacy devices say things like: We use a clinically viable, single-use HSAT device because it is convenient for us. We’re able to identify patients at a high enough rate that we’re comfortable with the status quo.

That may have been good enough in the past, but now it risks missing too many patients. 

Patients Deserve Better than the Status Quo

Multi-night testing has historically been underutilized due to cost, device limitations, and manual scoring burden. But EnsoData™ is helping change that with EnsoSleep PPG – an FDA-cleared SaMD that analyzes photoplethysmography (PPG) signals collected from wearable pulse oximeters to automatically score sleep apnea events and provide a clinically reliable output. 

Providers using EnsoSleep PPG can offer up to 7 nights of testing for just $15 per patient – maximizing diagnostic accuracy without increasing overhead. So, why is this novel and flexible PPG-based, multi-night testing solution beneficial?

• Affordable: Leveraging reusable pulse oximetry hardware (e.g., Viatom, BodiMetrics, Nonin) instead of expensive, one-time-use HSAT devices, like those offered by larger organizations, including Zoll’s WatchPAT devices.
• Scalable: With an AI-powered solution, there is no need to score sleep studies each night manually – EnsoSleep PPG automates the analysis.
• Simple reporting: Most HSAT solutions require individual reports for each study. Not with EnsoSleep PPG. For example, if a patient is tested across 3 nights, all of that data is located in a single report for easy physician and clinician review.
• Accessible: Unlike legacy-based HSATs, EnsoSleep PPG is flexible. As noted, it is compatible with a number of easily worn and comfortable devices, an ideal solution for patients who are discouraged by bulky equipment that can be challenging to put on and even more challenging to get a real night of sleep while wearing. 

Closing the Diagnosis Gap Starts with Smarter Testing

Ultimately, multi-night testing with EnsoSleep PPG supports better outcomes across the board. Patients get more accurate diagnoses, often with greater comfort and at-home convenience. Providers reduce manual scoring burdens, increase diagnostic throughput, and avoid repeat testing. Health systems streamline care pathways, increase ROI on devices, and help address the massive backlog of undiagnosed OSA cases.

It’s a triple win, and it’s unbelievably easy to implement. New EnsoSleep PPG customers can get started today and be fully implemented and live within a week of receiving their devices. 

With an estimated 1 BILLION people living with OSA globally, it’s time to bring your home sleep testing into the future with tools that can scale care, reduce variability, and improve outcomes, all without driving up costs. EnsoSleep PPG with multi-night testing is that solution: affordable, validated, and scalable for modern sleep medicine.

Transform your sleep testing program with EnsoSleep PPG multi-night home sleep testing, get more patients diagnosed, and stop leaving 10% or more of your patients in the dark. Connect with us today to get started. 

References:

1. Benjafield, A. V., et al. (2019). Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis. The Lancet Respiratory Medicine, 7(8), 687–698. https://doi.org/10.1016/S2213-2600(19)30198-5 
2. Kapur, V. K., et al. (2017). Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea. Journal of Clinical Sleep Medicine, 13(3), 479–504. https://doi.org/10.5664/jcsm.6506 
3. Stepnowsky, C. J., et al. (2004). Nightly variability of sleep-disordered breathing measured over 3 nights. Otolaryngology—Head and Neck Surgery, 131(6), 837–843. https://doi.org/10.1016/j.otohns.2004.07.011 
4. Lechat, B., et al. (2023). Night-to-night variability in OSA diagnosis: Impact on severity classification. Journal of Clinical Sleep Medicine, 19(3), 567–574. https://pubmed.ncbi.nlm.nih.gov/36991115/ 
5. Nygate, Y., MSc., et al. (2025). Evaluating the Impact of Multi-Night Home Sleep Apnea Testing for Obstructive Sleep Apnea Diagnosis. Sleep, Volume 48, Issue Supplement_1, Pages A297–A298, https://doi.org/10.1093/sleep/zsaf090.0683 
6. Tschopp, S., et al. (2021). Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry: a case for multiple night testing. Journal of Clinical Sleep Medicine, 17 (9), 1751–1758. https://www.atsjournals.org/doi/pdf/10.1164/rccm.202112-2677ED 
7. Roeder, M., et al. (2024). Longitudinal multi-night sleep monitoring improves CPAP decision accuracy in patients with suspected OSA. Journal of Sleep Research. https://doi.org/10.1111/jsr.13943