Polysomnography, the gold standard for sleep assessment, can be a difficult experience for any child. For children with autism spectrum disorder, an in-laboratory sleep study often means unfamiliar surroundings, sensory overload, disrupted routines, and the presence of strangers applying electrodes and monitoring equipment throughout the night. These challenges raise a practical question: can these children undergo clinically useful sleep studies at home instead?
A new prospective observational study published in the Journal of Sleep Research suggests the answer is yes, with caveats. Led by Uchenna Ezedinma from the University of the Sunshine Coast in Australia, the study assessed the feasibility and adequacy of Level 2 home polysomnography in 20 children aged 6 to 12 years with ASD level 2 and reported sleep difficulties. The results are encouraging for families and clinicians seeking alternatives to in-laboratory testing.
What they found
The study enrolled 20 children (mean age 9.1 years, 16 males) between October 2023 and September 2024. Each child was scheduled for up to five home PSG studies as part of an interventional randomized controlled trial, for a total of 90 planned recordings. The researchers used Nox-A1 portable devices, which capture the full set of sleep parameters including EEG, EOG, EMG, ECG, respiratory effort, airflow, and oxygen saturation.
Of the 90 studies, 80 (89 percent) were successfully completed and considered feasible. Among those 80 feasible studies, 74 (93 percent) produced adequate signal quality for clinical interpretation. This means that overall, 82 percent of all attempted home studies resulted in usable sleep data.
The most common reason for inadequate studies was EEG signal artifact or absence, accounting for six of the eight failed recordings. Other issues included equipment malfunctions and children refusing to wear the equipment on a given night. Notably, none of the participants had a sleep disorder requiring medical attention identified during the study, suggesting the cohort represented children with general sleep difficulties rather than undiagnosed clinical sleep disorders.
Importantly, the primary caregivers reported that the setup process was easy and convenient. This subjective finding matters: parental buy-in and tolerance of the equipment application process is a key factor in determining whether home PSG can succeed in routine clinical practice.
The cost was estimated at AUD $258 per study. For context, in-laboratory PSG in Australia typically costs several times that amount. However, the study authors caution that this cost estimate reflects the research setting and may not translate directly to clinical practice.
Why it matters
Children with autism spectrum disorder experience sleep difficulties at disproportionately high rates compared with neurotypical children. Estimates suggest that 40 to 80 percent of children with ASD have clinically significant sleep problems, including difficulty falling asleep, frequent night wakings, and irregular sleep-wake patterns. Despite this high prevalence, these children are often underrepresented in sleep research, in part because standard assessment methods are difficult to implement.
Home PSG offers several potential advantages. It eliminates the need for travel to a sleep center, which can be distressing for children with ASD. It allows the child to sleep in their own bed, following their usual bedtime routine. It reduces sensory and social demands associated with a laboratory environment. And it may enable longer or repeated monitoring periods that would be impractical or prohibitively expensive in a laboratory setting.
The 82 percent overall success rate in this study is comparable to home PSG feasibility rates reported in general pediatric populations, suggesting that with appropriate preparation and support, children with ASD can tolerate home sleep studies at similar rates to other children.
The study also highlights a limitation of current approaches. The EEG signal quality issues that accounted for most of the inadequate studies may reflect movement artifact, difficulty maintaining electrode contact in children who touch or move their heads during sleep, or sensory sensitivities that lead children to remove electrodes. Improving electrode design and attachment methods specifically for this population could further increase success rates.
Limits
The sample size is small (20 children) and drawn from a single geographic region in Australia, limiting generalizability. All participants had ASD level 2 (requiring substantial support), so the findings may not apply to children with ASD level 3 (requiring very substantial support) or level 1 (requiring support). The study was conducted as part of an interventional RCT, meaning families were motivated participants who had already agreed to a research protocol; this may not reflect the real-world population of families seeking clinical sleep studies.
The Nox-A1 device, while validated for home use, may not perform identically to full laboratory PSG systems. The authors note that differences in electrode types, attachment methods, and recording settings could affect signal quality comparisons. Additionally, the study did not assess whether home PSG data yield equivalent diagnostic accuracy for specific sleep disorders such as obstructive sleep apnea or periodic limb movement disorder in this population.
The cost estimate of AUD $258 per study excludes equipment purchase costs, training, technical support, and data interpretation time, all of which would add substantially to the true cost in clinical practice.
Bottom line
Home Level 2 polysomnography is feasible and produces adequate signal quality in the majority of children with autism spectrum disorder level 2. The approach was well tolerated by families and caregivers. The main barrier to wider adoption is EEG signal quality, which could be addressed through device improvements and population-specific protocols. For clinicians managing sleep difficulties in children with ASD, home PSG represents a viable alternative to in-laboratory testing that deserves consideration.
Source: Ezedinma U, Burgess S, Greenhill J, Singh J, Jones E, Ladhams A, Campbell G, et al. Home polysomnography in children with autism spectrum disorder: A prospective observational study. Journal of Sleep Research. 2026; Early View e70265. doi:10.1111/jsr.70265.