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Home, lab testing for obstructive sleep apnea produce similar outcomes

Data to inform management of obstructive sleep apnea can be obtained at home, according to findings published in Annals of Internal Medicine.

“Demand for diagnostic sleep services has grown substantially worldwide due to increasing prevalence of obstructive sleep apnea (OSA),” Ching Li Chai-Coetzer, MBBS, PhD, from the Sleep Health Service at Repatriation General Hospital in Australia, and colleagues wrote. They added, “Laboratory-based polysomnography (PSG), a level 1 (L1) study that is considered the gold standard for OSA evaluation, is labor-intensive, time-consuming and costly.”

Chai-Coetzer and colleagues performed a noninferiority study at seven academic centers to evaluate the clinical utility of PSG compared with limited-channel sleep studies (home sleep testing) in patients aged 25 years to 80 years with suspected OSA (n = 406). Participants were randomized into one of three groups based on the level of sleep study data to be disclosed to treating physicians: full PSG data (L1; n = 135), cardiorespiratory only data (level 3 [L3]; n = 136) or oximetry and heart rate only data (level 4 [L4]; n = 135).

Researchers assessed change in Functional Outcomes of Sleep Questionnaire score at 4 months and found that it was not inferior for L3 or L4 compared with L1. In addition, change in Epworth Sleepiness Scale was not inferior for L3 and was inconclusive for L4 compared with L1. The Sleep Apnea Symptoms Questionnaire score, continuous positive airway pressure use and physician diagnostic confidence was lower for L4 compared with L1.

Physicians received the corresponding data and study reports for each group to guide diagnosis and management of OSA. A similar percentage of patients in the PSG group and home sleep testing groups were diagnosed with moderate to severe OSA and were recommended similar treatment.

“[Although] this study provides reassurance about the clinical utility of manually scored L3 studies in the management of patients referred to a sleep clinic with suspected OSA, caution may be needed when using L4 testing,” Chai-Coetzer and colleagues concluded. “Further studies are needed to compare clinical outcomes and cost-effectiveness for the three levels of sleep study testing when conducted in the unattended home environment and perhaps after specific training in the use of L4 studies.”

In a related editorial, Lucas M. Donovan, MD, from the University of Washington, and Sanjay R. Patel, MD, MS, from University of Pittsburgh, wrote that the findings of Chai-Coetzer and colleagues provide welcome insights for health care providers looking to deliver cost-effective care options, such as home sleep testing. Due to its lack of infrastructure, home sleep testing allows for reduced wait times for testing and expansion to underserved groups, including rural populations, they added.

“It will be of paramount importance for professional medical societies to work with payers and other stakeholders to ensure an economically viable strategy of replacing in-laboratory polysomnography with [home sleep testing] in the routine evaluation of OSA in order to provide high-value care for patients with this common disease,” Donovan and Patel concluded. – by Alaina Tedesco

Disclosures: Chai-Coetzer and colleagues report primary funding from the National Health and Medical Research Council and Repat Foundation. Donovan reports no relevant financial disclosures. Patel reports grants from the ResMed Foundation and the American Sleep Medicine Foundation, as well as personal fees from Medtronic.