Sleep Apnea Testing: Home Ring vs Lab Study

What Is Obstructive Sleep Apnea (OSA)?

Obstructive Sleep Apnea (OSA) is a chronic condition where the airway collapses or becomes blocked during sleep, leading to repeated pauses in breathing. These episodes, known as apneas or hypopneas, disrupt sleep quality and oxygen balance. According to the American Academy of Sleep Medicine, an estimated 25 million adults in the U.S. have OSA, but many remain undiagnosed (Patil et al., 2021).

Symptoms can include loud snoring, daytime fatigue, morning headaches, mood disturbances, and difficulty concentrating. Left untreated, OSA increases the risk of cardiovascular disease, metabolic syndrome, type 2 diabetes, and premature mortality (Lévy et al., 2022).

Traditional In-Lab Polysomnography (PSG)

How It Works

Polysomnography is the “gold standard” diagnostic test for OSA. It is conducted in a sleep laboratory or hospital setting where the patient spends the night connected to sensors that measure brain activity (EEG), eye movement (EOG), muscle tone (EMG), heart rhythm (ECG), airflow, oxygen saturation, and chest/abdominal movement. A trained technician monitors the study throughout the night.

Advantages of In-Lab PSG

• Provides the most comprehensive data, capturing brain activity and other physiologic signals.
• Can diagnose a wide range of sleep disorders beyond OSA, such as narcolepsy, parasomnias, and periodic limb movement disorder.
• Enables CPAP titration during the same session to determine optimal treatment pressures.

Limitations of In-Lab PSG

• High cost, often ranging from $1,000–$3,000 per study (Lee-Chiong, 2023).
• Requires overnight stay in a clinical setting, which may feel uncomfortable and affect sleep quality.
• Scheduling delays due to limited availability of accredited sleep centers.

Home Sleep Apnea Testing (HSAT)

To make OSA testing more accessible, home sleep apnea tests (HSATs) have gained widespread adoption. Traditional HSAT devices involve a nasal cannula, chest belts, and oximetry sensors. While less comprehensive than PSG, HSATs are appropriate for patients with a high suspicion of OSA and few other comorbid conditions (Patil et al., 2021).

The Blackstone Ring Sleep Study

Overview of the Device

Our office often refers patients to Blackstone Medical Services, which offers a modern at-home sleep study using a lightweight ring device. The device is worn on the finger and tracks physiologic signals such as oxygen levels, pulse rate, respiratory effort, and actigraphy. Data are transmitted via a smartphone app and interpreted by board-certified sleep physicians.

FDA Clearance

The ring system used by Blackstone is based on the SleepImage technology, which has received FDA clearance as a diagnostic tool for sleep-disordered breathing. FDA clearance confirms that the device meets safety and efficacy standards and produces validated apnea–hypopnea index (AHI) scores comparable to polysomnography in specific populations (SleepImage, 2021).

Pros of the Ring Study

• Comfortable: No wires, chest belts, or nasal cannulas.
• Convenient: Conducted in the patient’s own bed, often over multiple nights, providing more representative data (Miller et al., 2022).
• Cost-effective: Less expensive than in-lab PSG, typically a fraction of the price.
• Accessible: Faster turnaround time and easier scheduling compared to lab testing.

Cons of the Ring Study

• Does not measure brain activity (EEG), meaning it cannot detect non-OSA sleep disorders.
• Data quality may be impacted by user error, device removal, or connectivity issues (Miller et al., 2022).
• Not suitable for patients with complex conditions such as neuromuscular disease, severe cardiopulmonary disease, or central sleep apnea.

Comparison: Ring Device vs Traditional PSG

Feature	Ring Device (Blackstone)	In-Lab Polysomnography
Comfort	High – simple ring worn at home	Lower – multiple wires and sensors in lab
Data Collected	Oximetry, pulse, actigraphy, respiration	Comprehensive EEG, ECG, airflow, limb movement, oximetry
Accuracy	Good for OSA diagnosis in straightforward cases	Gold standard for all sleep disorders
Cost	Lower	Higher
When Required	Suspected uncomplicated OSA	Complex cases, CPAP titration, inconclusive HSAT

When In-Lab Testing Is Still Required

While ring studies and other HSATs are excellent tools, there are scenarios where in-lab PSG remains necessary:

• Patients with complex or multiple suspected sleep disorders.
• Individuals requiring CPAP titration to determine optimal therapy settings.
• Cases where HSAT results are inconclusive or technically inadequate.
• Children under the age of 18, where guidelines recommend full PSG (Marcus et al., 2021).

Emerging Ring Technologies

The sleep diagnostics market is rapidly evolving. Other FDA-cleared smart rings, such as the Happy Ring and Belun Sleep System, have entered the field with promising accuracy and patient satisfaction. These innovations demonstrate a shift toward accessible, user-friendly sleep testing that aligns with telehealth trends (Jennings, 2025; Leung, 2023).

Transparency

We want to emphasize that our office is not sponsored by, reimbursed by, or financially affiliated with Blackstone Medical Services. We simply provide referrals to this service because it offers patients a comfortable, evidence-based, and FDA-cleared pathway to obtain sleep apnea testing.

Conclusion

Both in-lab polysomnography and home ring devices are valuable tools in diagnosing OSA. The right choice depends on the patient’s health profile, suspected severity of OSA, and practical considerations such as cost and access. For many patients, a ring-based home test provides a convenient and reliable solution, while others will benefit from the comprehensive data of an in-lab PSG. The most important step is simply to get tested—because untreated OSA is never harmless.

References

• Jennings, S. (2025, June). FDA clears Happy Ring for at-home diagnosis of sleep apnea and insomnia. PatientCare Online. https://www.patientcareonline.com/view/fda-clears-happy-ring-for-at-home-diagnosis-of-sleep-apnea-and-insomnia
• Lee-Chiong, T. (2023). Economics of sleep medicine and diagnostic testing. Chest Clinics of North America, 44(2), 341–356. https://doi.org/10.1016/j.ccc.2023.01.012
• Leung, L. (2023, March 9). Belun’s home sleep apnea testing device FDA-cleared. Respiratory Therapy Journal. https://respiratory-therapy.com/products-treatment/diagnostics-testing/diagnostics/beluns-home-sleep-apnea-testing-device-fda-cleared
• Lévy, P., Kohler, M., & McNicholas, W. (2022). Obstructive sleep apnoea syndrome. Nature Reviews Disease Primers, 8(1), 48. https://doi.org/10.1038/s41572-022-00382-w
• Marcus, C. L., Rosen, C. L., & Ward, S. D. (2021). Pediatric polysomnography: Clinical guidelines and indications. Journal of Clinical Sleep Medicine, 17(6), 1247–1255. https://doi.org/10.5664/jcsm.9204
• Miller, C. B., Espie, C. A., & Kyle, S. D. (2022). Digital and wearable technologies in sleep medicine: Clinical validation and applications. Sleep Medicine Reviews, 65, 101682. https://doi.org/10.1016/j.smrv.2022.101682
• Patil, S. P., Ayappa, I. A., Caples, S. M., Kimoff, R. J., Patel, S. R., & Harrod, C. G. (2021). Treatment of adult obstructive sleep apnea with positive airway pressure: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(10), 2113–2127. https://doi.org/10.5664/jcsm.8986
• SleepImage. (2021). SleepImage system receives FDA clearance for pediatric use. SleepImage Press Release. https://www.sleepimage.com/fda-clearance