Sleep-disordered breathing diagnosis: a comprehensive audit of home sleep testing in real clinical settings.
Diagnostic pathway
Home Sleep Testing
Obstructive sleep apnea
Polygraphy
Polysomnography
Resource utilization
Journal
Sleep & breathing = Schlaf & Atmung
ISSN: 1522-1709
Titre abrégé: Sleep Breath
Pays: Germany
ID NLM: 9804161
Informations de publication
Date de publication:
29 Jul 2024
29 Jul 2024
Historique:
received:
10
04
2024
accepted:
24
07
2024
revised:
12
07
2024
medline:
29
7
2024
pubmed:
29
7
2024
entrez:
29
7
2024
Statut:
aheadofprint
Résumé
This study aimed to investigate the indications and outcomes of Home Sleep Testing (HST) for patients with suspected obstructive sleep apnea (OSA), aligning with guidelines set forth by the American Academy of Sleep Medicine and the European Sleep Research Society. Specifically, we aimed to audit whether validated type 3 polygraphy could effectively ensure patient care while optimizing resource utilization. A retrospective analysis was conducted on data from patients undergoing type 3 polygraphy for suspected OSA in a tertiary referral hospital between January 2022 and December 2022. Demographic, clinical, and management data were collected. The efficacy of HST in guiding management plans was evaluated, with outcomes categorized as effective or ineffective based on subsequent need for in-laboratory polysomnography. While 85% of patients received a reliable diagnosis, 44.4% of them still required subsequent polysomnography, primarily due to adherence to funding regulations, rather than clinical need for further testing. Factors impacting the efficacy of HST included patient age, severity of apnea, and referral by a certified sleep specialist physician. Our study highlighted the potential of type 3 polygraphy, as a valuable tool for diagnosing OSA in an outpatient setting. However, having the result interpreted by a certified sleep specialist doctor was not enough. To streamline the care pathway, the referral for polygraphy had also to be made by a trained specialist. Challenges related to funding regulations, patient demographics and physician training stress the need for optimized diagnostic pathways to improve patient care and resource utilization.
Identifiants
pubmed: 39073668
doi: 10.1007/s11325-024-03121-1
pii: 10.1007/s11325-024-03121-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
Références
Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R (2007) Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 3(7):737–747
doi: 10.5664/jcsm.27032
pubmed: 18198809
Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 13(3):479–504. https://doi.org/10.5664/jcsm.6506
doi: 10.5664/jcsm.6506
pubmed: 28162150
pmcid: 5337595
Rosen IM, Kirsch DB, Carden KA, Malhotra RK, Ramar K, Aurora RN, Kristo DA, Martin JL, Olson EJ, Rosen CL, Rowley JA, Shelgikar AV (2018) Clinical use of a Home Sleep Apnea Test: an updated American Academy of Sleep Medicine position Statement. J Clin Sleep Med 14(12):2075–2077. https://doi.org/10.5664/jcsm.7540
doi: 10.5664/jcsm.7540
pubmed: 30518456
pmcid: 6287732
Bassetti C, McNicholas W, Paunio T, Peigneux P (2021) Sleep Medicine Textbook, 2nd edition. European Sleep Research Society (ESRS), Regensburg, Germany
Fietze I, Laharnar N, Bargiotas P, Basoglu OK, Dogas Z, Drummond M, Fanfulla F, Gislason T, Gouveris H, Grote L, Hein H, Jennum P, Joppa P, van Kralingen K, Kvamme JA, Lombardi C, Ludka O, Mallin W, Marrone O, McNicholas WT, Mihaicuta S, Montserrat J, Pillar G, Pataka A, Randerath W, Riha RL, Roisman G, Saaresranta T, Schiza SE, Sliwinski P, Svaza J, Steiropoulos P, Tamisier R, Testelmans D, Trakada G, Verbraecken J, Zablockis R, Penzel T (2022) Management of obstructive sleep apnea in Europe - A 10-year follow-up. Sleep Med 97:64–72. https://doi.org/10.1016/j.sleep.2022.06.001
doi: 10.1016/j.sleep.2022.06.001
pubmed: 35724441
Caples SM, Anderson WM, Calero K, Howell M, Hashmi SD (2021) Use of polysomnography and home sleep apnea tests for the longitudinal management of obstructive sleep apnea in adults: an American Academy of Sleep Medicine clinical guidance statement. J Clin Sleep Med 17(6):1287–1293. https://doi.org/10.5664/jcsm.9240
doi: 10.5664/jcsm.9240
pubmed: 33704050
pmcid: 8314660
Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268(8):1233–1236. https://doi.org/10.1007/s00405-011-1633-8
doi: 10.1007/s00405-011-1633-8
pubmed: 21614467
Senny F, Destiné J, Poirrier R (2008) Midsagittal jaw movement analysis for the scoring of sleep apneas and hypopneas. IEEE Trans Biomed Eng 55(1):87–95. https://doi.org/10.1109/TBME.2007.899351
doi: 10.1109/TBME.2007.899351
pubmed: 18232350
Vermeire P, Fanielle J, Gilon Y, Pepinster C, Quaedvlieg V, Rogister F, Poirrier AL (2020) Impact of a shift in treatment funding on a multidisciplinary sleep clinic: a cohort study. Acta Neurol Belg 120(5):1151–1156. https://doi.org/10.1007/s13760-020-01419-x
doi: 10.1007/s13760-020-01419-x
pubmed: 32647972
Cleemput I, Neyt M, Van de Sande S, Thiry N (2015) Belgian guidelines for economic evaluations and budget impact analyses: second edition. Health Technology Assessment (HTA). Belgian Health Care Knowledge Centre (KCE). KCE Report 183 C. Brussels
Carroll AE (2017) The high costs of unnecessary care. JAMA 318(18):1748–1749. https://doi.org/10.1001/jama.2017.16193
doi: 10.1001/jama.2017.16193
pubmed: 29136432
Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, Nagpal S, Saini V, Srivastava D, Chalmers K, Korenstein D (2017) Evidence for overuse of medical services around the world. Lancet 390(10090):156–168. https://doi.org/10.1016/S0140-6736(16)32585-5
doi: 10.1016/S0140-6736(16)32585-5
pubmed: 28077234
pmcid: 5708862
Barratt A, McGain F (2021) Overdiagnosis is increasing the carbon footprint of healthcare. BMJ 375:n2407. https://doi.org/10.1136/bmj.n2407
doi: 10.1136/bmj.n2407
pubmed: 34607810
Geessinck FAJ, Pleijhuis RG, Mentink RJ, van der Palen J, Koffijberg H (2018) Cost-effectiveness analysis of the DiagnOSAS Screening Tool compared with Polysomnography diagnosis in Dutch Primary Care. J Clin Sleep Med 14(6):1005–1015. https://doi.org/10.5664/jcsm.7170
doi: 10.5664/jcsm.7170
pubmed: 29852908
pmcid: 5991951
Masa JF, Corral J, Pereira R, Duran-Cantolla J, Cabello M, Hernández-Blasco L, Monasterio C, Alonso-Fernandez A, Chiner E, Vázquez-Polo FJ, Montserrat JM (2013) Effectiveness of sequential automatic-manual home respiratory polygraphy scoring. Eur Respir J 41(4):879–887. https://doi.org/10.1183/09031936.00186811
doi: 10.1183/09031936.00186811
pubmed: 22878873
Pietzsch JB, Garner A, Cipriano LE, Linehan JH (2011) An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea. Sleep 34(6):695–709. https://doi.org/10.5665/SLEEP.1030
doi: 10.5665/SLEEP.1030
pubmed: 21629357
pmcid: 3098944
Ayas NT, Pack A, Marra C (2011) The demise of portable monitoring to diagnose OSA? Not so fast! Sleep 34(6):691–692. https://doi.org/10.5665/SLEEP.1026
doi: 10.5665/SLEEP.1026
pubmed: 21629355
pmcid: 3099490
Zancanella E, do Prado LF, de Carvalho LB, Machado Júnior AJ, Crespo AN, do Prado GF (2022) Home sleep apnea testing: an accuracy study. Sleep Breath 26(1):117–123. https://doi.org/10.1007/s11325-021-02372-6
doi: 10.1007/s11325-021-02372-6
pubmed: 33837916
Maury G, Cambron L, Jamart J, Marchand E, Senny F, Poirrier R (2013) Added value of a mandible movement automated analysis in the screening of obstructive sleep apnea. J Sleep Res 22(1):96–103. https://doi.org/10.1111/j.1365-2869.2012.01035.x
doi: 10.1111/j.1365-2869.2012.01035.x
pubmed: 22835145
Chakar B, Senny F, Cambron L, Poirrier AL, Bruwier A, Baharloo F, Poirrier R (2022) Validation of mandibular movements’ analysis to measure sleep in adults with sleep complaints by comparison with actigraphy and polysomnography. Sleep Sci 15(3):318–325. https://doi.org/10.5935/1984-0063.20220057
doi: 10.5935/1984-0063.20220057
pubmed: 36158712
pmcid: 9496485
Wickwire EM, Albrecht JS, Towe MM, Abariga SA, Diaz-Abad M, Shipper AG, Cooper LM, Assefa SZ, Tom SE, Scharf SM (2019) The impact of treatments for OSA on Monetized Health Economic outcomes: a systematic review. Chest 155(5):947–961. https://doi.org/10.1016/j.chest.2019.01.009
doi: 10.1016/j.chest.2019.01.009
pubmed: 30664857
Yang X, Wen Y, Xie S, Chen J, Liu Y, Zhou J (2023) Research trends and hotspots regarding treatment of obstructive sleep apnea. Front Neurol 14:1268639. https://doi.org/10.3389/fneur.2023.1268639
doi: 10.3389/fneur.2023.1268639
pubmed: 37920837
pmcid: 10618364
Fietze I, Herberger S, Wewer G, Woehrle H, Lederer K, Lips A, Willes L, Penzel T (2022) Initiation of therapy for obstructive sleep apnea syndrome: a randomized comparison of outcomes of telemetry-supported home-based vs. sleep lab-based therapy initiation. Sleep Breath 26(1):269–277. https://doi.org/10.1007/s11325-021-02371-7
doi: 10.1007/s11325-021-02371-7
pubmed: 33993394
Møkleby M, Øverland B (2021) Long-term use of CPAP in patients with obstructive sleep apnea: a prospective longitudinal cohort study. Sleep Biol Rhythms 20(2):239–246. https://doi.org/10.1007/s41105-021-00361-6
doi: 10.1007/s41105-021-00361-6
pubmed: 38469264
pmcid: 10899904