If you are an Aviation Medical Examiner, you may have had this scenario play out: a pilot comes in for a medical exam, you identify concerns about sleep apnea, and further evaluation is needed. If that evaluation calls for a sleep study, the next question is which type to recommend and where at-home Type II testing fits into your referral pathway.
Type II at-home testing offers comprehensive sleep recording outside the laboratory. This piece is a quick overview for AMEs of what the option looks like, how it fits your workflow, and what to consider when selecting a provider.
Why Type II Matters and Where Type III Fits
The FAA’s OSA assessment guidance specifies a Type I laboratory polysomnogram or a Type II seven-channel home sleep test when a study is necessary. The home study must provide comparable data and standards to laboratory diagnostic testing. Interpretation by a sleep medicine specialist must include a diagnosis and treatment recommendations, if any. [1]
The Onera Sleep Test System records EEG, EOG, EMG, respiratory measurements, oxygen saturation, ECG, and body position, supporting assessment of both sleep stages and breathing during sleep. [2]
The FAA also describes a limited Type III exception in communities where Type II testing is unavailable. Under that exception, a positive study does not require further diagnostic testing before following the treatment pathway. Equivocal findings may require a higher-level study unless a sleep medicine specialist documents why additional testing is unnecessary. [1]
Type II therefore offers a home-testing option with sleep-staging information as well as respiratory data. The appropriate study still depends on the clinical assessment and the FAA instructions for the individual case.
What the AME Workflow Looks Like with At-Home Type II
For AMEs considering referring patients to a Type II provider, the workflow is straightforward.
The patient contacts the provider directly or through your referral to arrange testing and any required clinical order. The kit is shipped to the patient, who follows the supplied instructions to apply the sensors and complete the recording at home. Onera describes its system as suitable for patient self-application and provides a platform for processing and reporting the recorded data. [3]
The patient returns the equipment using the supplied shipping instructions. The recording is scored and interpreted, and the completed report is provided for clinical review. ESD’s typical turnaround is three to five business days after receipt of the returned device, although recording problems or additional review may affect that timing.
From your side, home testing removes the need to coordinate an overnight laboratory visit. Confirm the provider’s referral requirements, how the report will reach your office, and what happens if the recording is incomplete.
Patients can review our guide to preparing for an at-home sleep study before their kit arrives.
Common Questions AMEs Ask
Is at-home Type II testing accepted for FAA assessment?
Yes. The FAA’s assessment guidance permits a Type II seven-channel home study meeting its stated requirements. That acceptance does not mean every home test is suitable or that the diagnostic report alone completes the certification process. [1]
How accurate is the data compared with an in-lab study?
Evidence should be assessed for the particular device and measurements involved. A 2025 multicenter study compared Onera STS with simultaneous laboratory polysomnography in 206 participants. It found high agreement for AHI and substantial agreement in sleep staging, supporting the system’s diagnostic utility. The comparison was performed in a laboratory, so it does not establish that every unattended home recording will be complete or identical to an in-lab study. [2]
What if the patient has a technical failure during the study?
Patient-applied testing can produce incomplete or unusable recordings. The interpreting team should determine whether enough reliable data were obtained to answer the clinical question. Before referring, ask the provider about setup support, technical review, repeat-testing arrangements, and any additional charges. Avoid assuming that a replacement study is always free.
Do I need to change how I document the referral?
Confirm the provider’s requirements rather than assuming every service uses the same process. Include the reason for evaluation, relevant clinical information, and any FAA request that defines the testing or documentation needed. Clarify who will arrange clinical follow-up and how the completed report will reach your office.
Why At-Home Type II Can Be Useful for Pilots
Pilots often have unpredictable schedules. Completing the recording at home can make testing easier to arrange around work and family commitments without requiring an overnight laboratory appointment.
There is also a practical benefit to familiar surroundings and equipment designed for home application. Onera’s patch-based system is intended to support this approach. Clear instructions and accessible support remain important parts of the patient experience. [3]
Home testing does not eliminate missed studies, technical problems, or the possibility of further FAA requests. Its value is providing an appropriate diagnostic option in a setting that may be more convenient for the patient.
For the practice, agreeing on report delivery and follow-up responsibilities before testing can help keep the process organized. The goal is a complete, interpretable study and the documentation needed for the next clinical and certification steps.
How ESD Fits In
At ESD, we provide Type II at-home sleep testing for pilots, with reports intended to support clinical evaluation and FAA medical documentation.
Dave and the ESD team can discuss practical questions about referrals, patient preparation, report delivery, and the testing process. Clinical interpretation and treatment decisions remain with the responsible medical providers, while the AME applies the relevant certification requirements.
If you would like to evaluate what the report contains, request a sample sleep study report. Reviewing a sample can help you identify the information available and discuss any requirements specific to your patients.
If you are an AME who would like to learn more about how at-home Type II testing could fit into your referral workflow, contact the ESD team.