scholarly journals Investigating Cost Implications of Incorporating Level III At-Home Testing into a Polysomnography Based Sleep Medicine Program Using Administrative Data

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Samuel Alan Stewart ◽  
Erika Penz ◽  
Mark Fenton ◽  
Robert Skomro
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disorders ◽  
Administrative Data ◽  
Home Monitoring ◽  
Cost Effective ◽  
Home Testing ◽  
Obstructive Sleep ◽  
Diagnostic Pathways ◽  
At Home

Objective. Obstructive sleep apnea is a common problem, requiring expensive in-lab polysomnography for proper diagnosis. Home monitoring can provide an alternative to in-lab testing for a subset of OSA patients. The objective of this project was to investigate the effect of incorporating home testing into an OSA program at a large, tertiary sleep disorders centre.Methods. The Sleep Disorders Centre in Saskatoon, Canada, has been incorporating at-home testing into their diagnostic pathways since 2006. Administrative data from 2007 to 2013 were extracted (10030 patients) and the flow of patients through the program was followed from diagnosis to treatment. Costs were estimated using 2014 pricing and were stratified by disease attributes and sensitivity analysis was applied.Results. The overall costs per patient were $627.40, with $419.20 for at-home testing and $746.20 for in-lab testing. The cost of home management would rise to $515 if all negative tests were required to be confirmed by an in-lab PSG.Discussion. Our review suggests that at-home testing can be cost-effective alternative to in-lab testing when applied to the correct population, specifically, those with a high pretest probability of obstructive sleep apnea and an absence of significant comorbidities.

Reliability of Holter Oximetry for Home Sleep Apnea Testing

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P83-P84 ◽  
Author(s):  
Jordan C Stern ◽  
Conor Heneghan ◽  
Redmond Shouldice
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Patients Âgés ◽  
Home Testing ◽  
Obstructive Sleep ◽  
Adults And Children ◽  
Home Sleep Apnea Testing ◽  
A Prospective Study ◽  
At Home

Objective To test the reliability of the Holter Oximeter for home testing of obstructive sleep apnea. Previous reports have shown a 96% correlation with simultaneous polysomnography and Holter Oximetry in the sleep laboratory. This study was designed to measure reliability of data obtained at home, as well as to obtain information from patients regarding comfort of the device. Methods A prospective study of 120 consecutive patients (ages 5 to 85) presenting to an otolaryngology practice during a 4-month period with complaints of snoring or sleep apnea symptoms. Device: The Holter Oximeter produces an apnea hypopnea index (AHI) based on an automated processing method of a continuous electrocardiogram and pulse oximeter. The reliability of the test was determined by the number of tests completed without interruption due to patient discomfort, electrode or device failure. Results There was 97% data recovery from the home testing device. Data failure was due to faulty memory cards in the device or surface electrode failure. All patients tolerated wearing the device at home, and there were no voluntary interruptions of the tests by patients. On a discomfort scale of 0 to 10 (0: no discomfort and 10: maximal discomfort), the average discomfort score was 2. Conclusions Holter Oximetry represents a new, easy to use, and reliable device for the home diagnosis of obstructive sleep apnea. It can also be used to measure outcomes for the surgical and non-surgical treatment of obstructive sleep apnea in adults and children.

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.

807 Diagnostic Pathways of Patients Authorized for Obstructive Sleep Apnea Testing and Treatment: A Retrospective Claims Analysis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A315-A315
Author(s):  
Binh Nguyen ◽  
Aliza Gordon ◽  
Stefanida Blake ◽  
Lakshmi Kalluri ◽  
Winnie Chi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Laboratory Testing ◽  
Diagnostic Testing ◽  
Prior Authorization ◽  
Home Test ◽  
Home Testing ◽  
Obstructive Sleep ◽  
Osa Treatment ◽  
Diagnostic Pathways ◽  
Lab Test

Abstract Introduction Obstructive Sleep Apnea (OSA) has been shown to reduce health-related quality of life and is associated with cardiovascular disease and other negative health outcomes. However, many patients with suspected OSA are never tested, thereby remaining undiagnosed and untreated. In this study, we explore the diagnostic pathways and eventual treatment of individuals with suspected OSA. Methods We conducted a retrospective, observational study, linking claims and prior authorization data of a large, geographically diverse health insurer’s commercial and Medicare Advantage members. Our sample included adults with suspected OSA and no prior OSA history, whose diagnostic testing had been approved through prior authorization (N=75,011). Using a 3-month time window following authorization, we searched for a claim to match the authorized service (home or laboratory sleep testing). We also looked for subsequent prior authorization for OSA treatment (Positive Airway Pressure (PAP) or oral appliance) and corresponding claims for those treatments within the 3-month authorization window. Results Among the study sample (N=75,011), 40,002 (53.3%) had home testing only, 17,319 (23.1%) had laboratory testing only, and 6,053 (8.1%) had a home test followed by a laboratory test. Only 476 (0.6%) had a home test after the date of a lab test. 11,161 individuals (14.9%) did not complete any sleep test. Of the 63,850 individuals with any sleep testing, 39,062 (61.2%) received prior authorization for initiating OSA treatment, and 36,158 (92.6%) of them had a corresponding claim for treatment. Conclusion One in eight adults with suspected OSA for whom diagnostic testing was authorized did not undergo testing; among those who tested, home testing was most common. While it is clinically appropriate to follow a negative home test with a lab test since a home test cannot rule out OSA (only confirm it), the study notes that a significant number of those with a home test require follow-up laboratory testing. Together, this represents an opportunity for reducing barriers to testing and improvement in home testing technology. Support (if any) This study was funded by Anthem, Inc.

Home testing for pediatric obstructive sleep apnea syndrome secondary to adenotonsillar hypertrophy

1995 ◽  
Vol 20 (4) ◽  
pp. 241-252 ◽  
Author(s):  
S. V. Jacob ◽  
A. Morielli ◽  
M. A. Mograss ◽  
F. M. Ducharme ◽  
M. D. Schloss ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Adenotonsillar Hypertrophy ◽  
Home Testing ◽  
Obstructive Sleep ◽  
Apnea Syndrome

scholarly journals The efficiency of obesity treatment in patients with insomnia and obstructive sleep apnea syndrome

2015 ◽  
Vol 13 (2) ◽  
pp. 25-32
Author(s):  
Natal'ya V. Strueva ◽  
Galina A. Mel'nichenko ◽  
Mikhail G. Poluektov ◽  
Larisa V. Savel'eva
Keyword(s):  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Body Weight ◽  
Sleep Apnea ◽  
Sleep Disorders ◽  
Sleep Apnea Syndrome ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Apnea Syndrome ◽  
Clinically Significant

The aim of this study was to investigate the relationship between the dynamics of body weight and sleep disorders in the treatment of obesity.Materials and methods. The study included 200 obese patients: 83 men and 117 women.Results. Complaints about problems sleeping (snoring, hypersomnia, insomnia, etc.) were present in 78% of obese patients. 89 patients were under the observation of an endocrinologist for 7 ± 1 months, they were divided into three matched by age, sex and BMI groups: patients with obstructive sleep apnea syndrome (OSAS) (n = 42), the second – with the syndrome of insomnia (n = 19), the third (control group) – patients without sleep disorders (n = 24). After treatment of obesity the weight loss in patients with insomnia syndrome was -2.5 [-4; 0]kg, in patients with OSAS -7 [-18; -2] kg, in patients without sleep disorders -6.5 [-12; -2.25] kg. Clinically significant weight reduction was reached in 25 (59.5%) patients with OSAS; 3 (16%) – with insomnia syndrome; 15 (62.5%) – without sleep disorders.Conclusion. Thus, the insomnia syndrome essentially influences the obesity treatment results – most of patients with this sleep disorder (81.2%) do not achieve clinically significant weight loss. The presence and severity of breathing disorders during sleep do not prevent weight loss. However, with the regular use of CPAP-therapy in patients with OSAS has a tendency of greater reduction of body weight. 

scholarly journals Case-Ascertainment Models to Identify Adults with Obstructive Sleep Apnea Using Health Administrative Data: Internal and External Validation

2021 ◽  
Vol Volume 13 ◽  
pp. 453-467
Author(s):  
Tetyana Kendzerska ◽  
Carl van Walraven ◽  
Daniel I McIsaac ◽  
Marcus Povitz ◽  
Sunita Mulpuru ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Administrative Data ◽  
External Validation ◽  
Health Administrative Data ◽  
Case Ascertainment ◽  
Obstructive Sleep

scholarly journals Cardiorespiratory Polygraphy for Detection of Obstructive Sleep Apnea in Patients With Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Michiel Delesie ◽  
Lieselotte Knaepen ◽  
Johan Verbraecken ◽  
Karolien Weytjens ◽  
Paul Dendale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Screening Tool ◽  
Area Under The Curve ◽  
Screening Tools ◽  
Apnea Hypopnea Index ◽  
Automated Algorithm ◽  
Obstructive Sleep ◽  
At Home

Background: Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients due to absence of good OSA screening pathways. Polysomnography (PSG) is the gold standard for diagnosing OSA but too resource-intensive as a screening tool. We explored whether cardiorespiratory polygraphy (PG) devices using an automated algorithm for Apnea-Hypopnea Index (AHI) determination can meet the requirements of a good screening tool in AF patients.Methods: This prospective study validated the performance of three PGs [ApneaLink Air (ALA), SOMNOtouch RESP (STR) and SpiderSAS (SpS)] in consecutive AF patients who were referred for PSG evaluation. Patients wore one of the three PGs simultaneously with PSG, and a different PG during each of three consecutive nights at home. Severity of OSA was classified according to the AHI during PSG (&lt;5 = no OSA, 5–14 = mild, 15–30 = moderate, &gt;30 = severe).Results: Of the 100 included AF patients, PSG diagnosed at least moderate in 69% and severe OSA in 33%. Successful PG execution at home was obtained in 79.1, 80.2 and 86.8% of patients with the ALA, STR and SpS, respectively. For the detection of clinically relevant OSA (AHI ≥ 15), an area under the curve of 0.802, 0.772 and 0.803 was calculated for the ALA, STR and SpS, respectively.Conclusions: This study indicates that home-worn PGs with an automated AHI algorithm can be used as OSA screening tools in AF patients. Based on an appropriate AHI cut-off value for each PG, the device can guide referral for definite PSG diagnosis.

scholarly journals Unwanted Overtures by Night, Remorse by Day

2019 ◽  
pp. 514-525
Author(s):  
Muna Irfan ◽  
Michel J. Howell
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sexual Behavior ◽  
Sleep Apnea ◽  
Sleep Disorders ◽  
Eye Movement ◽  
Management Strategies ◽  
Current Understanding ◽  
Obstructive Sleep ◽  
Epilepsy Treatment ◽  
The Subject

Sexual behavior in sleep has only recently been recognized as a variant of non–rapid-eye-movement (NREM) arousal parasomnias. This chapter discusses a case of sexsomnia precipitated by obstructive sleep apnea, the ensuing impact on the subject and his bed partner, and evaluation and management strategies. Sexsomnia is suspected to be highly underreported and carries significant physical, psychosocial, and forensic ramifications. Polysomnography with expanded electroencephalography can help identify concurrent sleep disorders and exclude other etiologies such as epilepsy. Treatment of comorbid sleep disorders such as obstructive sleep apnea and sleep deprivation is highly effective in controlling the abnormal sexual behavior. There is a pressing need for research and expansion of current understanding to develop a standardized approach to evaluation and management of sexsomnia.

scholarly journals Tormented Sunrises

2019 ◽  
pp. 418-434
Author(s):  
Maha Alattar
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
General Population ◽  
Sleep Disorders ◽  
Headache Disorders ◽  
Distinct Subset ◽  
Obstructive Sleep ◽  
High Prevalence ◽  
The Relationship

This chapter covers the relationship between sleep-related headaches and sleep disorders such as obstructive sleep apnea (OSA). Sleep apnea headache (SAH), a type of sleep-related headache that is classified in the International Classification of Headache Disorders, is a distinct subset of headache that is caused by OSA and occurs distinctly on awakening. Once recognized, treatment of OSA is associated with significant improvement in, and often resolution of, SAH. Given the high prevalence of headaches in the general population, sleep disorders must be considered in the evaluation of patients with headaches. A comprehensive sleep evaluation should be an integral part of the assessment of headache disorders. Sleep apnea headache and other types of headaches associated with sleep are reviewed in this chapter.

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