How aggressively do you screen the menopausal patient presenting with new or worsening insomnia for OSA, and what is your threshold for in-lab PSG after a negative HSAT in this population?

I would treat the insomnia and do actigraphy or obtain data from an Apple Watch, or even repeat HST before doing an in-lab. At least once in a while, there is someone scheduled in the sleep lab who cannot sleep and leaves in the middle of the night.

I'm pretty aggressive. Women are more likely to have arousals rather than desaturations with their respiratory events. Therefore, an in-lab study can more accurately identify many women who are missed by traditional home sleep apnea testing devices. However, we need to evaluate the patient holistica...