scholarly journals Multiple-access versus telemedicine home-based sleep apnea testing for obstructive sleep apnea (OSA) diagnosis: a cost-minimization study

2021 ◽  
Author(s):  
Marcello Di Pumpo ◽  
Mario Cesare Nurchis ◽  
Antonio Moffa ◽  
Lucrezia Giorgi ◽  
Lorenzo Sabatino ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Multiple Access ◽  
Cost Minimization ◽  
Home Based ◽  
Obstructive Sleep ◽  
Apnea Testing

scholarly journals Initiation of therapy for obstructive sleep apnea syndrome: a randomized comparison of outcomes of telemetry-supported home-based vs. sleep lab-based therapy initiation

2021 ◽  
Author(s):  
Ingo Fietze ◽  
Sebastian Herberger ◽  
Gina Wewer ◽  
Holger Woehrle ◽  
Katharina Lederer ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Control Group ◽  
Sleep Laboratory ◽  
Home Therapy ◽  
Home Management ◽  
Therapy Initiation ◽  
Home Based ◽  
Obstructive Sleep ◽  
At Home

Abstract Purpose Diagnosis and treatment of obstructive sleep apnea are traditionally performed in sleep laboratories with polysomnography (PSG) and are associated with significant waiting times for patients and high cost. We investigated if initiation of auto-titrating CPAP (APAP) treatment at home in patients with obstructive sleep apnea (OSA) and subsequent telemonitoring by a homecare provider would be non-inferior to in-lab management with diagnostic PSG, subsequent in-lab APAP initiation, and standard follow-up regarding compliance and disease-specific quality of life. Methods This randomized, open-label, single-center study was conducted in Germany. Screening occurred between December 2013 and November 2015. Eligible patients with moderate-to-severe OSA documented by polygraphy (PG) were randomized to home management or standard care. All patients were managed by certified sleep physicians. The home management group received APAP therapy at home, followed by telemonitoring. The control group received a diagnostic PSG, followed by therapy initiation in the sleep laboratory. The primary endpoint was therapy compliance, measured as average APAP usage after 6 months. Results The intention-to-treat population (ITT) included 224 patients (110 home therapy, 114 controls); the per-protocol population (PP) included 182 patients with 6-month device usage data (89 home therapy, 93 controls). In the PP analysis, mean APAP usage at 6 months was not different in the home therapy and control groups (4.38 ± 2.04 vs. 4.32 ± 2.28, p = 0.845). The pre-specified non-inferiority margin (NIM) of 0.3 h/day was not achieved (p = 0.130); statistical significance was achieved in a post hoc analysis when NIM was set at 0.5 h/day (p < 0.05). Time to APAP initiation was significantly shorter in the home therapy group (7.6 ± 7.2 vs. 46.1 ± 23.8 days; p < 0.0001). Conclusion Use of a home-based telemonitoring strategy for initiation of APAP in selected patients with OSA managed by sleep physicians is feasible, appears to be non-inferior to standard sleep laboratory procedures, and facilitates faster access to therapy.

scholarly journals Home-based Screening for Obstructive Sleep Apnea in Children

2020 ◽  
Vol 5 (1) ◽  
pp. 38
Author(s):  
Dylan Bertoni ◽  
Amal Isaiah ◽  
◽  
◽  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Home Based ◽  
Obstructive Sleep

474 Phenotyping of patients with Moderate to Severe OSA on Polysomnography after Negative Home Sleep Apnea Testing

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A187-A187
Author(s):  
Sarah Sarfraz ◽  
Lindsay McCullough ◽  
Henry Arantes ◽  
Alejandra Lastra
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Flow Time ◽  
Apnea Hypopnea Index ◽  
Apnea Test ◽  
Recording Time ◽  
Time Flow ◽  
Obstructive Sleep ◽  
Severe Sleep Apnea ◽  
Apnea Testing

Abstract Introduction Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnea (OSA). Given cost, insurance restrictions and in some cases limited access to sleep center testing, the use of home based sleep apnea testing is becoming increasingly more common. A proportion of patients with technically adequate HSAT who are negative end up having significant disease on PSG. The characteristics of patients who are found to have moderate to severe sleep apnea on polysomnogram (PSG) after a negative home sleep apnea test (HSAT) are not known. We aim to phenotype these patients. Methods We conducted a retrospective chart review from March 2018 to February 2020. A total of 953 adult patients (18 years old and older) underwent HSAT, 248 tests resulted negative (apnea-hypopnea index &lt;5/h). Out of the negative HSAT, 17 patients had moderate to severe obstructive sleep apnea on PSG. Those were included for analysis. Data on patient characteristics such as age, body mass index (BMI), gender, STOP-BANG, ESS and comorbidities was gathered. Respiratory disturbance index, recording time, flow time, oximetry time on HSAT was recorded. PSG recording time, baseline AHI, supine AHI and non-supine AHI were also noted. Technically inadequate HSAT were excluded from analysis. Results The percentage of patients with negative HSAT who were found to have moderate to severe sleep apnea on PSG and were included for analysis was 6.85% (n17). Mean age was 41 years. Mean BMI was 33 kg/m2. Common comorbidities were hypertension (29%), asthma (17.6 %), depression (17.6%), anxiety (11.7%) and reflux (5.9%). Average ESS was 11.7 and STOP-BANG was 3.8. The mean recording time was 477 minutes, flow time 391 minutes and oximetry time was 426 minutes on HSAT. Average PSG recording time was 433 minutes. Average AHI was 24 with supine being 33.2/h and non-supine 17.9/h. Conclusion A proportion of patients with negative HSAT have moderate to severe OSA on follow-up polysomnogram. These patients were young, with lower-class obesity, more positional OSA, and no associated complex comorbidities. Re-evaluation of current diagnostic algorithms and further research is needed to phenotype this at-risk group, as first-line PSG may be more cost-effective and efficient. Support (if any):

scholarly journals Home-based Diagnosis of Obstructive Sleep Apnea in an Urban Population

2014 ◽  
Vol 10 (08) ◽  
pp. 879-885 ◽  
Author(s):  
Natasha Garg ◽  
Andrew J. Rolle ◽  
Todd A. Lee ◽  
Bharati Prasad
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Urban Population ◽  
Home Based ◽  
Obstructive Sleep

Outcomes of Home-Based Diagnosis and Treatment of Obstructive Sleep Apnea

CHEST Journal ◽  
2010 ◽  
Vol 138 (2) ◽  
pp. 257-263 ◽  
Author(s):  
Robert P. Skomro ◽  
John Gjevre ◽  
John Reid ◽  
Brian McNab ◽  
Sunita Ghosh ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Diagnosis And Treatment ◽  
Home Based ◽  
Obstructive Sleep

Sex differences in patients with obstructive sleep apnea and suspected hypoventilation on home sleep apnea testing

2019 ◽  
Vol 64 ◽  
pp. S297-S298
Author(s):  
M. Braganza ◽  
W. Tsai ◽  
M. Lee ◽  
K. Fraser ◽  
P. Hanly ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sex Differences ◽  
Sleep Apnea ◽  
Obstructive Sleep ◽  
Home Sleep Apnea Testing ◽  
Apnea Testing

A COST-MINIMIZATION STUDY OF TELEMEDICINE

2001 ◽  
Vol 17 (4) ◽  
pp. 604-611 ◽  
Author(s):  
Nathalie Pelletier-Fleury ◽  
Frédéric Gagnadoux ◽  
Carole Philippe ◽  
Dominique Rakotonanahary ◽  
Jean-Louis Lanoé ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cost Saving ◽  
Crossover Trial ◽  
Cost Minimization ◽  
Sleep Apnea Syndrome ◽  
Transport Costs ◽  
Obstructive Sleep ◽  
Apnea Syndrome ◽  
Sleep Laboratories

Objectives: In a context where sleep laboratories are overwhelmed by a growing demand to diagnose obstructive sleep apnea syndrome (OSAS), efficient substitutive solutions to in-laboratory polysomnography should be found. To compare the effectiveness and costs of home unattended polysomnography (Hpsg) and telemonitored polysomnography (TMpsg), a cost minimization study was performed.Methods: In a crossover trial, 99 patients underwent on two consecutive nights TMpsg and Hpsg according to a randomized order. A legibility recording criterion was retained to measure effectiveness. A microcosting study of TMpsg and Hpsg was performed. The risks to adopt home strategy or telemonitored strategy, according to different scenario chosen to reach the diagnosis in case of failure of Hpsg or TMpsg, were analyzed.Results: The recording was considered to be ineffective in 11.2% of TMpsg (95% CI, 4.9–17.4) and in 23.4% (95% CI, 19.12–27.68) of Hpsg. The effectiveness differential was 12.2% (95% CI, 1.8–22.6) (p = .02). Assuming that in case of failure PSGs would be re-realized in the same condition to reach the diagnosis, then TMpsg could be selected if Hc/TMc (cost of Hpsg/cost of TMpsg) > 0.97; Hpsg could be selected if Hc/TMc < 0.76. If 0.76 ≤ Hc/TMc ≤ 0.97, the choice of TMpsg would be ambiguous. TMc was estimated to be $244, while Hc was $153 (Hc/TMc = 0.63).Conclusion: Unless some specific geographical situations generate significant transport costs, the implementation of a strategy based on unattended polysomnography at home is cost-saving compared to a telemonitoring strategy.

Sign in / Sign up

Export Citation Format

Share Document