80-90% of obstructive sleep apnea cases in the U.S. remain undiagnosed, with home sleep tests producing false negatives 17-46% of the time

An estimated 80-90% of the approximately 30 million Americans with obstructive sleep apnea (OSA) have never been diagnosed, and the primary tool meant to close that gap -- Type III home sleep apnea tests (HSATs) -- produces false negative results in 17-46% of cases, sending patients home with a clean bill of health they do not actually have. Why it matters: undiagnosed OSA means patients continue experiencing fragmented sleep and intermittent hypoxia every night, so their blood pressure and cardiovascular strain escalate over months and years, so they face 2-3x higher risk of stroke, heart attack, and atrial fibrillation, so the U.S. healthcare system absorbs an estimated $150 billion annually in OSA-related costs from emergency visits, chronic disease management, and lost productivity, so millions of preventable cardiovascular deaths accumulate while a simple screening gap persists. The structural root cause is that home sleep tests measure only airflow, respiratory effort, and oxygen saturation without EEG or body position data, making them systematically unable to detect positional, REM-dependent, or mild-to-moderate apnea -- yet insurers and the AASM pathway funnel most patients to HSATs first because they cost $150-$500 versus $1,000-$3,000 for in-lab polysomnography, creating a cost-driven diagnostic bottleneck that prioritizes economics over sensitivity.