Objectives: To evaluate the feasibility and clinical performance of comprehensive home sleep testing for pediatric sleep assessment by comparing a wearable Type 2 sleep monitoring system with standard in-laboratory polysomnography. Given the limited availability of pediatric sleep laboratories and the scarcity of validated home-based alternatives capable of assessing sleep architecture, this study aimed to determine whether comprehensive home sleep testing can provide equivalent assessment of respiratory events and sleep architecture in children.

Methods: Children referred for overnight sleep evaluation underwent simultaneous recordings using Dormotech wearable Type 2 home sleep testing system and standard in-laboratory polysomnography (Nox A1). All recordings were independently scored according to the American Academy of Sleep Medicine guidelines. The primary outcome was the apnea–hypopnea index (AHI) and corresponding severity classification. Secondary outcomes included sleep architecture, sleep efficiency, total sleep time, respiratory indices, sleep latency, rapid eye movement (REM) latency, body position, device usability, and safety.

Results: Twenty-six children (mean age, 11.0 years; 50% girls) were enrolled, and 24 completed simultaneous overnight recordings. The AHI measured by the wearable system (5.3 ± 13.8 events/h) closely matched that obtained with in-laboratory polysomnography (5.6 ± 15.3 events/h; p = 0.95). Agreement in AHI severity classification was high (Cohen’s κ = 0.87), and Bland-Altman analysis demonstrated minimal bias (0.29 events/h; 95% limits of agreement, −3.5 to 4.1). No statistically significant differences were observed for any secondary sleep or respiratory parameters, including sleep architecture, total sleep time, sleep efficiency, oxygen desaturation index, sleep latency, REM latency, snoring, or body position. Participants also reported a favorable user experience, and no device-related adverse events were observed.

Conclusions: Comprehensive home sleep testing demonstrated strong agreement with in-laboratory polysomnography across both respiratory and sleep architecture measures in children. These findings support the feasibility of comprehensive home-based pediatric sleep assessment as a reliable and patient-friendly alternative for evaluating sleep-disordered breathing while preserving the physiological information required for full polysomnographic analysis.