Table of Contents
Table of Contents
The Authors reviewed published studies between January 2000 and July 2017 on the topic of outcomes with Sleep Apnea patients. They concluded that care provided by non-sleep trained providers was equivalent to care provided by providers certified in Sleep Medicine when measured by patient outcomes.
Kim et al. evaluated 373 patients referred to seven sleep centers in a random assignment design and concluded (a) outcomes were equal in PAP acceptance and PAP compliance and (b) healthcare costs were lower using home test and auto-titrating PAP versus In-Lab PSG and PAP titration.
The study compared functional outcomes and adherence to treatment by randomization of patients to a hospital PSG or a home test, followed by three nights of auto-titrating PAP at home. Both groups had significantly improved functional outcomes. The authors concluded that the functional outcome and adherence to treatment in the hospital group was not superior to the home group.
Skomro et al. compared two groups of patients. In the first group, the diagnosis was made by unsupervised home test. The patients were then titrated for a week with an auto-titrating PAP. In parallel, an In-Lab PSG was performed with blind results for the investigators. In the other arm of the analysis, the patients underwent hospital PSG with titration, before a pressure was chosen and a home test taken, again with blind results for the researchers. A wide range of four clinically accepted, commonly used outcome measurements were completed before and after the PAP treatment. The authors found no group differences in any of the outcome variables.
This multicenter study evaluated Home-based versus Lab-based testing and treatment of OSA. At three months, the time of PAP use was one hour more in the home-based group with 12.6% greater adherence compared hospital-based regimen. On assessment of patient outcomes, they concluded Home-based is not inferior to Lab-based management.
Mulgrew et al. compared matched subjects in either an At-Home diagnostic and PAP treatment process or an In-Lab PSG diagnostic and PAP treatment process. At three month follow-up they found greater adherence to treatment in the At-Home diagnostic and treatment process group versus In-Lab group.
In a critical review of studies comparing OSA patients managed via traditional In-Lab PSG versus an At-Home process, Atwood concluded that published clinical studies over the past five years consistently and uniformly demonstrate “essential equivalency between the At-Home diagnostic and treatment approach and the Lab-Based diagnostic and treatment approach for initial PAP adherence and initial functional outcomes.”
In a study conducted at the University of Chicago Sleep Center patients underwent a Snap Test and traditional PSG on the same night. Authors concluded that the Snap Test “is an excellent tool for the diagnosis of OSA.”
In a study conducted by the Sleep Center at Wilford Hall US Air Force Medical Center patients underwent a Snap Test and 12-lead PSG. Authors concluded that the “convincing correlation” between the Snap Test and PSG demonstrates that the Snap Test is “a suitable alternative to traditional PSG” and a home test is less expensive, decreases patient wait times, increases convenience, and is statistically proven to be accurate.
Redline’s review cited studies in which over 34% of patients reported the delay between their symptoms and OSA diagnosis exceeded 10 years and that patients on average had over 17 visits to a medical office between symptom onset and diagnosis.
Source: Frost & Sullivan Report (2016). What benefits do patients experience in treating their OSA.
Seventy-seven percent of patients with untreated OSA report overall life quality to be poor or very poor. Post treatment only five percent of patients report overall life to quality to be poor or very poor.
Likewise, only seven percent of patients with untreated OSA report overall life quality to be good or very good. Post treatment seventy-six percent of patients report overall life to quality to be good or very good.
“The diagnostic strategy includes a sleep-oriented history and physical examination, objective testing, and education of the patient. The presence or absence and severity of OSA must be determined before initiating treatment in or to identify those patients at risk of developing the complications of of sleep apnea, guide the selection of appropriate treatment, and to provide a baseline to establish the effectiveness of subsequent treatment.”
“All patients with OSA should have ongoing, long-term management for their chronic disorder. Those on chronic therapy (PAP, Oral Appliance, positional therapy) should have regular, ongoing follow-up to monitor adherence to therapy, side effects, development of medical complications related to OSA and continued resolution of symptoms.”
The authors provide a clinical practice guideline that was adopted by the American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) for the use of Oral Appliance Therapy. They conclude that the AASM and AADMS expected the guidelines to have a positive impact on patient outcomes and potentially health care costs.
The study compared initial PAP pressures that were determined from an in-lab PAP titration study with a pressure that was derived from a mathematical fomula. The authors concluded that the mathematical formula agreed closely with lab derived setting. Findings supported that it was reasonable to use the predicted value for initial PAP settings.
Based on the above findings, a significant proportion of healthcare insurance providers now require the patient to undergo a home sleep test when evaluating a patient for sleep apnea.