Home Sleep Testing for GLP-1 Coverage Shows Modest Diagnostic Yield in New Study

Home sleep testing ordered to support glucagon-like peptide-1–related medication coverage accounted for 15.3% of all home sleep tests performed during a 1-month period at a tertiary medical center and represented 44% of all primary care referrals, according to late-breaking findings presented at SLEEP 2026 in Baltimore, Maryland.

In the retrospective review of 111 home sleep tests (HSTs) performed in January 2026, 17 were ordered for GLP-related coverage rather than standard clinical referral. Among those 17 GLP-related referrals, 23.5% of studies were negative, 41.2% showed mild obstructive sleep apnea (OSA), 11.8% showed moderate OSA, 11.8% showed severe OSA, and 11.8% were suboptimal.

The findings come as the approval of tirzepatide has introduced a new pharmacologic option for some patients with OSA and obesity, while also creating new insurance-related pathways that may require documentation of sleep apnea. Investigators noted that these coverage requirements have increased referrals for sleep studies, but the diagnostic yield and clinical characteristics of this patient population have been unclear.

Truong-An Andrew Ho and colleagues from the Department of Thoracic Medicine and Surgery at Temple University Hospital reviewed all HSTs completed in January 2026. Charts were evaluated to determine whether testing was ordered for GLP coverage or standard clinical indications. Investigators collected demographic data, referring provider, comorbidities, symptom documentation, and HST metrics.

GLP-related referrals came most often from weight management clinicians (47.1%), followed by internal medicine (41.0%), family medicine (5.9%), and sleep medicine (5.9%). Among patients referred for GLP-related testing, common comorbidities included hypertension (52.9%), hyperlipidemia (47.1%), asthma (47.1%), gastroesophageal reflux disease (41.1%), prediabetes (35.0%), and chronic kidney disease (5.9%).

Pretest symptom documentation was limited. STOP-Bang score was absent in 65.0% of GLP-related cases, snoring documentation was absent in 58.8%, witnessed apneas in 82.4%, excessive daytime sleepiness in 58.8%, Epworth Sleepiness Scale in 94.1%, morning headaches in 94.1%, and poor sleep in 88.2%.

Compared with non-GLP referrals, patients referred for GLP coverage trended younger, with a mean age of 41.1 vs 48.4 years, and had higher mean body mass index, at 40.4 vs 35.6 kg/m², although these differences were not statistically significant.

Among GLP-related referrals, mean apnea-hypopnea index was 17 events/hour and mean oxygen desaturation index was 23.8 events/hour. Nocturnal hypoxemia was present in 23.5% of GLP-related cases. By comparison, non-GLP referrals had a mean apnea-hypopnea index of 20.4 events/hour, mean oxygen desaturation index of 23.5 events/hour, and nocturnal hypoxemia in 12.6%.

For primary care clinicians, the findings highlight a practical challenge: insurance-driven sleep testing may be increasingly common, but low rates of symptom documentation and validated screening use could reduce diagnostic yield. Improved pretest screening with tools such as STOP-Bang and Epworth Sleepiness Scale, along with clear documentation of OSA symptoms and cardiometabolic comorbidities, may help identify patients most likely to benefit from testing.

The authors concluded that approximately one-third of GLP-related HSTs were negative or suboptimal, and positive studies were most often mild. They suggested that improved screening may better identify appropriate candidates for testing and improve diagnostic yield as referrals related to medication coverage continue to evolve.

Reference

1. Ho TA, Sompalli S, Shariff T, et al. Home sleep testing for GLP coverage—utilization and diagnostic yield. Late-breaking abstract LBA 1515. Presented at: SLEEP 2026; June 2026.